One year ends, another begins. The wheel of history turns and a new opportunity presents itself. I have never been a big fan of New Year’s resolutions, for I prefer specific plans over wishful expectations. But planning for a whole year can be a formidable task–so much so that many consider it futile and do not even bother. Others get discouraged after a few months and drift away from whatever plan they adopted.
But planning is important for those who want to live an intentional life and business career. The best advice I ever received regarding planning maintained that when you have a big job to perform, break it up into small increments, prioritize them, and then attack them in order, one at a time. Too often, facing the job in its totality becomes overwhelming and leads to confusion and failure.
When prioritizing objectives, some cannot be accomplished early on. Set a time when they can be tackled and don’t worry about them until the appropriate time arrives–budgetary requirements being an example. If you don’t have the funds necessary for a project, then obviously it has to be delayed until they are available.
As I thought about this simple process I wondered why the powers that be in Washington do not follow this kind of procedure. The current debate on health care reform seems to me to be a prime example of where these principles could be useful.
Health care in our country consumes one-sixth of our economy so there is no question that it constitutes a really big job. One should start with the proposition that there is more that is right about the present system than is wrong. No one denies that there is room for improvement and that 10% or 20% of the population is not being properly served. Would it not make more sense to identify the problem areas and break them out into separate pieces, prioritize them and solve them individually? My guess is such an approach would very likely gain the kind of bipartisan support an issue of this magnitude deserves.
As I have listened to the debate about health care, both in the public arena and by lawmakers, the major problems that could be separated out and dealt with individually are as follows.
Number one is the ever-rising cost that is squeezing the wallets of individuals and raising employers’ cost of doing business. It seems appropriate to just acknowledge that if you have what many believe is the best health care system in the world it will naturally cost more. We should not be trying to achieve cost levels of other countries who deliver less.
Having said that, there are major cost factors that could easily be addressed on an individual basis rather through than an omnibus approach. Chief among these are the direct and indirect costs created by litigation, some of which is frivolous and lawyer-induced. Eliminating or even reducing this burden would not affect the quality of health care and would lower the cost for everyone. Other cost factors can be identified and dealt with in similar fashion.
Number two involves making coverage available to people who are not insurable. Medicaid is already in place for the poor but is not helpful for others. Again this problem can be solved if it is looked at individually. State pools reinsured and perhaps subsidized by federal funds make more sense than changing the system for everyone else.
Portability of coverage could easily qualify for priority number three. This is not an easy problem to solve but it is not impossible. People change jobs and today many lose jobs for long periods of time. COBRA is helpful for those in between jobs but without the employer contribution it is expensive. For long-term unemployment perhaps reasonable spend-down provisions could bring such people into Medicaid or state pools. The problem can be solved if we want to.
Of course, none of the above will be considered if the ultimate objective of those in control is to expand the federal government to run an exclusive insurance program. All the promises that the private plans now delivering quality care will be untouched is just smoke and mirrors if that is the real objective. It is ironic that if that is the objective that we can’t learn from the lessons of other countries that are already there. Many are trying now to unwind their plans because of the enormous financial burden and the long delays being endured for many medical procedures. As George Santayana wisely said, “Those who do not learn from history are doomed to repeat it.”
As of this writing the plans that are being debated ignore the most obvious cost-saving measure–my number one priority–tort reform. Proposals to solve my priorities two and three effectively shift the costs on to private plans, thereby raising their costs significantly. Not a good move when raising the costs of doing business will impede the creation of new jobs.
New Year’s resolutions are a wish list–planning is a way to make wishes come true. The real question today is exactly what is it that is being planned? Are we trying to fulfill the wishes of those who believe the government can best run our health care or are we trying to solve real problems without upsetting that which we already have? You make the call.
Happy New Year!