Healthcare Reform - A counteragrument

The editiorial in the Wall Street Journal , http://online.wsj.com/article/SB124692973435303415.html#mod=djemWMP, argues that the Obama healthcare reform proposal will ration care like that which is done in the UK. I agree with the fact that any government managed healthcare program includes concepts of rationing service. This is, however, true of Medicare and Medicaid in the US and almost all healthcare programs in other countries around the world. We lived in the UK and used National Health. It was far from perfect, but it was freely available to all (including Americans living and working in the UK).

I disagree with the implied conclusion of this editorial that the US should not adopt Healthcare Reform because there would necessarily be rationing of service. I believe that the US would be a better society if all residents had a public option for healthcare. If an individual wanted to stay with her/his private health insurance, they could do that and receive the level of service (rationed or not) associated with that insurance policy. If a person wanted to have most every drug and procedure covered, and had the money, they could purchase that higher level of insurance. By the way, that is exactly what happens in the UK and other countries with some form of universal healthcare. So, the Obama proposed plan, like most other social programs (Social Security, Medicare, and others) gives everyone a humane level of service, even though that may be rationed. And the higher level of service needs to be paid by those who want and can afford that level of care.

Healthcare Problems, Policies, and Priorities

The Obama administration has an unprecedented set of problems: financial crisis, two wars, healthcare reform, energy policy, Iran, nuclear proliferation, education reform, and others. Having read, thought and taught strategy, I believe in making choices and prioritizing the use of resources. Although far from over, I think that the financial crisis is past the worst of the peril. Globally, the complex collection of problems in the Middle East and Central Asia are the highest priority. On the domestic front, I believe that healthcare reform is the most important. So today, I am going to comment on healthcare.

There are many thoughtful points of view on healthcare reform. The Obama administration's arguments in favor of an overhaul of the healthcare system include: increased coverage of the uninsured (was universal coverage, but this has been diluted due to costs), increased quality, reduced costs, and the public option. Proponents of healthcare reform include Paul Krugman (http://krugman.blogs.nytimes.com/) and Robert Reich (http://robertreich.blogspot.com/). Opponents of the administration's approach to healthcare reform include Greg Mankiw (http://gregmankiw.blogspot.com/) and Newt Gingrich (http://newt.org/). Persons with moderate views in favor of reform, but concerned about costs, include David Brooks (http://topics.nytimes.com/top/opinion/editorialsandoped/oped/columnists/davidbrooks/index.html) and Ross Douthat (http://topics.nytimes.com/top/opinion/editorialsandoped/oped/columnists/rossdouthat/index.html).

As I see it, the logic for healthcare reform follows this line of thinking; 1) the US pays more per person than any other developed country for healthcare but has health outcomes that are worse than most developed countries and 2) the US has about 40 million uninsured inhabitants which is a significant cause of the poor health outcomes and is not consistent with a highly civilized society. I believe that these arguments are compelling for increasing coverage, increasing quality, and decreasing costs of healthcare. In order to increase coverage and to keep private medical insurance costs in check, I think that the public option is absolutely necessary. Therefore, the final question is the cost and affordability to individuals and the nation. There is a good article on the Economix blog (http://economix.blogs.nytimes.com/2009/06/26/is-health-care-reform-worth-16-trillion/?hp) which puts the $ 1 trillion or $ 1.6 trillion over 10 years in context. Although a large amount of money, it is about 1% of GDP over the decade. I would argue that this total is reasonable to improve the health and fairness of the American society.

I believe that healthcare is a high priority problem that deserves a high priority reform. The reform should be accomplished with efficiency and effectiveness in order to maximize the benefits and minimize the costs. I am an IT professional and teacher and believe that healthcare IT is an important part of the solution. I will change my curricula this year to emphasize the importance and impact of IT to healthcare quality, coverage, efficiency, effectiveness, and cost.

Middle East, Information Technology, and Change

The column by Thomas Friedman, "Winds of Change?" -http://www.nytimes.com/2009/06/14/opinion/14friedman.html, tells an encouraging story about the change occurring in the Middle East. One of the four forces he discusses is technology. The Internet and applications like Twitter, Facebook, and Blogs have enabled the horizontal flow of information that is necessary (but not sufficient) for awareness, freedon, and democracy. As AT&T's optical communications business unit president in the 1990's, I testified to a US congressional committee on export controls of high technology equipment. The line of testimony that I used was that communications technology opened up societies and made governments more accountable to their citizens. And, therefore, the risk of military use of communications technology against the US was less that the risk of an aware and connected populace within an oppressive regime. So, I am pleased to hear Friedman say information technology is playing a role in opening up the Middle East.

Diligence and Intelligence

Nick Kristoff's column "Rising above I.Q." http://www.nytimes.com/2009/06/07/opinion/07kristof.html?_r=1&em captures my experience in industry and academia. Persons with similar I.Q.'s achieve significantly different levels of performance based on diligence and love of learning. As Kristoff states in the column, the policy implications are clear, "education, education, education".

Mental Health and War

Bob Herbert's column, http://www.nytimes.com/2009/05/19/opinion/19herbert.html, tells the well known, but under-reported, story of the mental health victims of war. Although the physical wounds and deaths are horrific, the often quiet mental suffering during and after war surely dwarfs this bodily pain. And the impact of the warriors' mental health problems affects their family, friends, and society in profound negative ways. And the mental health suffering of the civilians overwhelms even that of the military.

Having recently watched the twenty-six hour documentary of "The World at War" (British documentary of WW II), the necessity for war in certain cases and the horrors of war are both vividly portrayed. However, if as the United States Declaration of Independence stated, the "inalienable rights" of man include "life, liberty, and the pursuit of happiness", war restricts the inalienable right of happiness.

Best CEO's are boring

David Brooks column - http://www.nytimes.com/2009/05/19/opinion/19brooks.html - suggests that, "In other words, warm, flexible, team-oriented and empathetic people are less likely to thrive as C.E.O.’s. Organized, dogged, anal-retentive and slightly boring people are more likely to thrive." Oh-well, that is what I observed over 40 years.

The Power of Art

I am a manager and engineer by training and experience. I don't claim to know know much about art, but I deeply enjoy visiting art museums and exhibits. I just finished watching Simon Schama's eight hour video series, "The Power of Art". Schama has produced fascinating movies about the lives, times and art of Caravaggio, Bernini, Rembrandt, David, Turner, Van Goch, Picasso, and Rothko. Each video is filled with biography, history, psychology, and magnificent artistic creations. I was enthralled by the influence of contemporary events on the artist and the resounding impact of the art on history. You can order the DVD for $50 at
http://www.shoppbs.org/product/index.jsp?productId=2742279&cp=&sr=1&f=PAD%2FFormat%2FDVD&kw=the+power+of+art&origkw=The+Power+of+Art&parentPage=search or watch segments on YouTube at http://www.shoppbs.org/product/index.jsp?productId=2742279&cp=&sr=1&f=PAD%2FFormat%2FDVD&kw=the+power+of+art&origkw=The+Power+of+Art&parentPage=search. Enjoy.