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Posts Tagged ‘tom daschle’

Policy making and politics is a rough undertaking.  Reading Sen. Tom Daschle’s recent book on health car reform, Critical, underscores this.

Note: I read the book partially this Saturday evening (dusk to primetime) after visiting Medival Times (full stomach and exhausted children!). I finished it this morning over 3 cups of joe, Meet the Press (with Daschle on!), and the first half of Kentucky/Florida. It’s good to keep a catalog of contexts in which one first encounters information – the immediate context and values (sites, sounds, smells, people, air, time, exhaustion…) combined with historical contexts and values (other books I’ve read, my own health, my own policy opinions, who I vote for…).

Here are some quick statements, stream of thought, impressions, questions.  I’ll have more analysis and detailed responses to his proposal and how we propose policy in general, but I figured I’d dump some quick thoughts down after finishing the book before those thoughts get mangled.  My goal here is not to moralize, politicize or promote a viewpoint of my own.  More than anything I am trying to catalogue my response to this book, this issue, this “media event” as fully as I can.

  • A politician has to always be out of office before they can promote a policy that is robust, in line with public opinion, and more complicated than a 30 second spot.
  • How many people actually understand the Federal Reserve System?
  • Does not understanding it impact our lives?  That is, if we don’t understand something how can we hold people accountable?
  • A Federal Health Board sounds promising, but will it suffer from the same misunderstanding by the public and failure at the most critical times? (The Fed blew the great depression, screwed inflation and isn’t helping now… or is it?)
  • Did you know we only have 800,000 doctors in America?
  • Did you know the Federal Reserve as almost $1 billion in “coin”.  Imagine those pennies! ( I learned this after researching a point in the book)
  • Bill Clinton delivered a health reform bill of over 1300 pages.  It’s no wonder nothing gets done.  Then again, that was a fraction of the Ken Starr report and we seem to have NO PROBLEM getting through that as a country.
  • If policy makers, lawyers and presidents have trouble going through bills, laws and complicated systems, what hope is there for the general public?  for the 800,000 doctors?  The world is not getting less complicated, can we keep up? By keeping up, can we process everything that’s going on? No.  How, then, will we select by consequences?  Will the consequences of complication lead to simplification?
  • Political books read as though they were written discontinuously.  The chapters don’t  flow naturally, data and arguments are repeated over and over and sometimes the references to “now” and other time is out of sync.
  • This book could be 80 pages and be just as effective
  • The cover of the book is sort of annoying.  The big red “critical” as so cliche
  • Barrack Obama’s quote is lame.  Having his name as the lead quote won’t sell as many books if he loses this primary.
  • Well researched.  Lots of facts and figures that are well documented/footnoted
  • Easy to read.  However, the prose is such that you can skip a paragraph here and there and it doesn’t change anything.  Implies there are wasted words.
  • If the Clintons had all this awesome motivation then for health care reform, their values must have changed because they don’t spend a lot of media time talking about what they did in Health Care then.  Or the media doesn’t value their discussion on that so they don’t air it?
  • If Daschle is right that Congress would happily be rid of the burden of health care regulation and policy making, what do they want to have a direct say in?
  • Why don’t I go to the doctor more often?  (Consequences! Values! Conditioning!)  I don’t like the doctor.  It takes time, lots of paper work, it’s uncomfortable.  I hate confronting my own responsibilities for health.  Re-explaining my coverage, my situation, my history takes a long time.
  • I need to go to the dentist.  No insurance.  Doesn’t seem worth it to carry.  Unless I have a problem.  We joke about wooden teeth a lot.  We should go to the dentist.  That might be worse than the doctor though.  We don’t floss enough, they always ask about that and we all node knowingly like 8 year olds.  Does anyone floss enough?
  • Why don’t I use my own health product I made more?  (www.angelpowered.com)
  • Mental health – why does that have a worse stigma than any illness.  Heck, seems like mental health is less controllable than a lot of physical conditions.
  • Agent Orange.  yikes.  haven’t thought about that stuff for awhile
  • We really are in the infancy of policy making for health care.  Modern medicine has only been modern in any sense for maybe 100 years, most of it is advances since WWII.  What other giant social instution is that new?
  • Previously “failed” attempts at health care reform didn’t work out because the consequences didn’t generate a change in behavior.  Health care and personal health decisions still aren’t dire enough.  perhaps?  Or the consequences of our complicated and less good health care system don’t apply equally to all.  In fact, the policy makers are at least one degree removed, unlike with war and the economy – those things impact all in very similar ways.
  • why not justtry to get everyone to send the government $100 to raise money to establish the federal health board or some other national instution.  Really, imagine if 2 million people just put cash or checks in the mail to the White House signed to Federal Health Board.  Would they turn $200,000,000 down?  Why do we all waste money on political campaigns and odd charity donations that don’t directly go to institutions we want directly doing things?  Hmm, think about the behavior of sending checks signed to a institution we want formed.  hahahaha.  really.
  • What is bipartisan really?  what does that mean?  If something starts bipartisan but then is assigned partisan meaning afterward or ends up with a party’s slant, was it bipartisan?  who cares? what a meaningless question, Russ.
  • Behavior, Behavior, Behavior.  This entire book is about selection by consequences.  Employers wanted talent, so the picked up the tab mid century.  Cost goes up, talent not worth that much, employers want government to jump in.  Consumers want coverage and sometimes have trouble coming to grips with own selections in life.  Country goes to war, we stop listening.  Need votes, bring up health care.  Want approval ratings, deal with foreign events.  Economy tanks, we care about health care.  ….  gotta follow those consequences always….
  • Free market.  someone show me a perfect free market.  I’m an econ dude, but there’s no such thing as a free market, not in any meaningful situation involving people
  • who will read this book?
  • Do the people with most to gain in reform read these books?  how do they get their information?
  • Tim Russert asked the simplistic question about this book to Daschle on MTP, did Russert read the book or did a researcher?  The question was about mandated health insurance and Daschle’s agreement with Hillary Clinton on that.  Gotta love mainstream political shows and their couching of viewpoints wholy within campaign strategies.  Oh well, maybe I should watch less?  Why do I value these shows at all?  Sunday morning calm?  Do I sound smarter at parties?  Does it inform me? Do I like the host? Have I always done it?
  • Kentucky and Florida – should I spent less time watching sports? Think anyone at the arena cares about health care today?  If people could choose to go to Final Four or have better health care what would they do?  What would their answer say about what they value? How they behave?
  • Behavior. Behavior.  mine, Daschle’s, publishers, readers, book buyers.

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Take a look at Sen. Tom Daschle’s latest note on his approach to improving health-care.

His summary of his ideas focuses mostly on exposing more data to people (transparency). This is the only workable strategy because it doesn’t assume any particular one cause for the cost of health-care nor any specific solution to one identified cause. In a sense it is not a strategy but an improved framing device (aka context) to let each type of consumer of the system (all companies, organizations, politicians, individuals) come up with better solutions for their particular, and ever changing, situations.

Take a look at the comments now.

Mono or Nearly Mono Causes of Health-Care Costs Cited:

  • existence of insurance
  • existence of free markets
  • bad health choices by consumers
  • cigarettes
  • alcohol
  • human greed
  • politics
  • government
  • medicare
  • medicaid
  • old people
  • young people
  • poor people
  • insured people
  • rich people
  • drugs
  • iraq
  • growing lifespan
  • ….

And the solutions proposed are one fix solves all.

Here we arrive at the true “crisis” of the situation.  Consumers of the system suffer from monocausilitis.  This approach is not unique to health-care.  We all suffer from this in some way in our jobs, families, religion, business.  One Cause, one solution, utopia.

“If only we did X…”

“It all started because…”

This is the basis of “markets” (and, no, not just financial markets).  Each node in a market can suffer from monocausilitis and the market proceeds with selection by consequences in a non-monocausilitis way.  Complexity emerges from simple rules at the nodes.  If nodes’ approaches are reinforced by consequences, those nodes’ approaches persist.  Others extinguish. Consequences can be measured by all sorts of different exchange units (dollars, shiny objects, sunlight, water, food, sex – more generally “energy”).

With that in mind, consider the current, and very complicated, health care context.  It is the “way” it is based on consequences.  And it will only change based on strategies tested by consequences.

If we desire more rapid improvement, more strategies need to be tried in shorter time periods.  And not all strategies can be condensed in time.  Complicated, eh?

The rules are simple – selection by consequences.  The outcomes and context is complicated. (just consider your personal state of your health and your health-care.)

Transparency – expanding our knowledge of the consequences – improves our ability to try more strategies faster.

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