Trump is Right: Healthcare is Complex, but it does not have to be

from “If You’re Not Making History, You Are History” by Bob MacDonald

 

No doubt about it, the healthcare system in America is a mess. Obamacare is not working as intended and the proposed Republican replacement is being castigated, even by Republicans, as potentially even worse. Democrats complain the American Health Care Act (ACA) takes too much away from people who need coverage the most. Republicans who oppose the ACA call it “Obamacare-lite” and complain it does not go far enough to repeal Obamacare; and that it creates an entirely new entitlement program.  

The reality is that resolving the healthcare challenge is simple, but it is made complex because Republicans and Democrats have diametrically divergent views on what the end result should be. In simple terms, the Republicans believe the answer lies in assuring that all Americans have “access” to healthcare coverage, while the Democrats believe the answer lies in assuring that all Americans actually have healthcare coverage. There is a big difference between having access to healthcare coverage that an individual needs but cannot afford and providing the needed coverage, regardless of the ability to pay.

This difference exists because the political leaders have failed to address and resolve the most fundamental healthcare question: Is basic healthcare a right or a privilege?

The Republicans believe that healthcare is a privilege, and thus, so long as there is universal access to healthcare coverage (no matter what form or price), the problem is solved. (It should be noted that prior to becoming president, Trump consistently argued that healthcare coverage is a right.) On the other hand, Democrats take the position that every American citizen, regardless of financial status, has a right to receive basic healthcare.

It is this philosophical difference that motivates the Republicans (believing healthcare is a privilege) to propose in the ACA that Medicaid (the state/federal plan that covers low income citizens) funding be slashed. (This is one of the chief reasons why the Congressional Budget Office estimated that as many as 24 million Americans will lose their coverage under the Republican plan.) Conversely, (believing that healthcare is a right) the Democrats used Obamacare to expand Medicaid that covered 15 million people who previously could not afford coverage of any type.

There can be no effective bipartisan agreement on the best form of a healthcare system, unless or until there is a debate and resolution of the question as to whether healthcare is a basic right of every American citizen or a privilege based on means to pay. If, as a society, we decide that healthcare is indeed a privilege, then the Republican ACA plan will work just fine. If, we as a society decide (as virtually every other industrialized nation has) that basic healthcare, like a basic education, is a natural right of every American citizen, then we can work together in a bipartisan way to find the best way to achieve that goal.

Repeal and Replace Obamacare

Ironically, if it is decided that healthcare is a basic right, it would call for the repeal and replacement of Obamacare, because it has failed to achieve the objective of covering all Americans. But such a replacement would be based on the rights of all, rather than the privilege of a few to have healthcare.

If this approach to repealing and replacing Obamacare is taken, the solution is right in front of us. It is a healthcare system already in operation. It has proven to be effective and efficient; it has high consumer satisfaction and acceptance. Maybe even more important, it is a plan that President Trump has endorsed and pledged to protect.

Taking the complexity out of the healthcare solution.

The simplest and most effective way to solve the healthcare crisis is to merge the Medicare and Medicaid systems into one program that, on a phased in basis, will provide basic health care services to every American citizen, regardless of age, social status or income.

There would be no need to create another bureaucracy. Both of these programs have processes and procedures in place and in point of fact are paying for the health services provided by clinics, hospitals and doctors for millions of Americans age 65 and over, along with millions more of low income citizens. Patients covered by Medicare are free to select any of the 95 percent of the doctors, clinics and hospitals that accept Medicare payments. This is not the government deciding or providing the healthcare, but simply being the “single payer” of the benefits provided.

Of course merging and expanding Medicare and Medicaid into a universal healthcare system can’t be done with a flip of a switch, but an organized phase-in of this system over time for those not currently covered under Medicare or Medicaid could smooth the way. This would allow for Obamacare, along with all other forms of healthcare such as individual and employer group plans, to be repealed and phased out at the same pace the new system is expanded.

Certainly there will be concerns about the cost of such a change, but a number of serious studies have concluded that diverting all expenditures on the current system (federal, state, individual and employer) toward this new system and combining this with premiums, deductibles and co-pays based on income, would create more efficiency and actually be less costly than the current system. President Trump has even made this point in interviews.

Using this approach to fixing the healthcare system could be a win-win for everyone. Trump and the Republicans could fulfill their campaign pledge to repeal and replace Obamacare; Trump could remain consistent in his call for universal healthcare and his pledge to protect Medicare and, most important, all Americans could finally join the millions of citizens of every other industrialized nation in the world for whom basic healthcare is a right of citizenship, not just a privilege for the wealthy.

Trump’s Actions Show that Change is Messy

 

The election of 2016 was billed as a “change election.” It is clear now that a large portion of the electorate had reached such a level of frustration and feeling of disconnect with the status quo that they were willing to vote for change – any change. Even though they came from different sides of the political spectrum, Donald Trump and Bernie Sanders were the only presidential candidates to recognize and tap into this powerful undercurrent of the desire for change.

Unfortunately for Sanders, his message of change was blunted by the Democratic National Committee that had effectively rigged the party nomination in favor of an establishment status quo candidate. On the other hand, Trump benefited from the fact that, while the Republican National Committee favored establishment candidates, a gaggle of 15 other candidates diffused the establishment support. This allowed disaffected Republican voters to coalesce around Trump’s message of change. Even though Trump never received a majority of Republican primary votes, the concentration of voters driven by the desire for change pushed him to the nomination.

The same phenomenon (plus a little help from Russia) also impacted the general election. Even though Trump and his message of change failed to garner a majority of the popular vote, he was able to cobble together enough disaffected voters to flip a number of traditionally establishment Democratic states in order to win the majority of Electoral College votes (the votes that really count) and win the presidency. Much to the chagrin of the bulwarks of the government establishment status quo – the mainstream Democratic and Republican parties and the national media.

Learning the Lessons of Change Management

As president, Trump is now challenged to live up to his promise to be a change agent. He is quickly learning the lesson that any person in a position of leadership who seeks to bring about change must understand: Change is not something that is simply announced, it has to be created.

Change has two natural enemies: Those who resist change and those are frustrated by the status quo, but fear what change will bring. Those who are comfortable with the way things are and view change as a threat to be resisted. For them, change is the answer to a question they never asked. Ironically, those who most vociferously call for real change can become fearful of change when the answer to what change means is not clearly answered. As a result, change, no matter how beneficial it may ultimately be, is always difficult to implement and accept. And change becomes downright messy and chaotic when what is to replace the status quo is muddled or nonexistent.

Real change is about being positive, not negative …

For a leader to be a successful change agent, it is critical for them to shift the focus off the desire for change itself and focus on the benefits that will be derived from change. In other words, for followers to accept change, the debate should not center on what they are losing, but on what they can gain from the change. If that does not happen, change will be stillborn.

A good example of this change dynamic at work is the current debate over Obamacare. From its inception, the majority of Americans have had a negative opinion of the program. The Republicans seized on the unpopularity of Obamacare to promise that if given the power to act, they would “repeal and replace” it. Likewise, during the campaign Trump railed against Obamacare and promised that his first act as president (right after tearing up the Iran nuclear agreement) would be to repeal and replace Obamacare.

But now with the Republicans in full control of the government, the effort to deliver on the promise of repealing and replacing Obamacare has become, at best, messy and chaotic. Even the Republicans are fighting among themselves as to how to implement this change. There is no clear, coordinated plan being offered by Trump or the Republicans; despite the fact that they have had years to develop one.

As a result of this befuddling Republican approach to change, even those who disapprove of Obamacare have begun to have second thoughts. For the first time in years, public opinion polls have shifted and more people approve of Obamacare, than oppose it.  

Why is it that even those who were demanding change (and voted for it) are now uneasy with change? The problem is – and this is a great lesson for any leader to learn – that by simply announcing the intent to repeal Obamacare and not coupling it with a clear plan for going forward, Trump and the Republican leaders have allowed people to focus on what they will be losing (as bad as it may be) rather than on what they will gain by a new approach to healthcare. 

What Trump and the Republican leaders are missing in their effort to implement the promised change (not only for Obamacare, but other issues as well) is the understanding that while people may be frustrated with the status quo and claim to want change, they are even more fearful of an uncertain future. As a result, there is nothing but confusion, frustration and fear of what the change will bring.

Again, the key to effective change management is for the leader to focus on where they are going, rather than where they have been. No matter how much people may protest against the status quo, unless they clearly understand the benefits of the proposed change, they will resist the change.

For example, Trump and the Republican leaders could have said something like, “We are going to repeal Obama care and replace it with an expanded Medicare system that would be available and cover all Americans.” By offering an alternative to the status quo, rather than simply attacking it, leaders can marshal support needed to make change positive.

Living with change …

There is a good lesson here for anyone who seeks to implement change in an organization. No matter how passionate people may be about seeking change and especially for those who do not recognize the need for change, the best approach for gaining acceptance of change is to debate the future, not the past. It is the duty of the leader to paint that future and explain the benefits to those who will live it. Only that way will real change come about.

Trump Tries to Triumph in the Tumult of a Vuja De World

from “If You’re Not Making History, You Are History” by Bob MacDonald

 

Soon, Trump will formally inherit the titles of the office of the president such as “leader of the free world,” “the most powerful man in the world,” and “commander in chief.” But there is one title he will bring to the office with him. It is a title no occupant of the White House has been entitled to for over a century; and that is the moniker of “disrupter in chief.” Not since Teddy Roosevelt was elevated to the office of president by the assassination of William McKinley in 1901 has an individual assumed the presidency more determined to disrupt the status quo as is Trump.

It is apparent that no longer will there be a feeling of “Déjà vu” as Trump settles into the routine of being president. Instead, Trump will bring to reality the concept of “Vuja de” coined by the late comedian and insightful urban philosopher George Carlin.

We are all familiar with the term Déjà vu which literally means “already seen” or the general vernacular of “been there, done that.” On the other hand, as Carlin explained it, Vuja de is the uneasy feeling people have when the status quo is being disrupted and they are in a place they have never been before; not knowing how the rules will change. That uncertainly is the uneasy feeling now being experienced by the political establishment, the mainstream media and a majority of American voters as the era of Trump begins.

Trump is not the first disrupter. Just the first disrupter to lead government

Disrupters in business – those who change the way the game is played – are, when successful, legendary and revered as visionaries. Some of these historical business disrupters would include Henry Ford, Bill Gates at Microsoft, Steve Jobs at Apple, Phil Knight at Nike, Fred Smith of FedEx and Richard Branson of Virgin Group. All of these individuals thrived in the world of Vuja de by being comfortable doing what others had not already seen to do.   

While naturally resistant and comfortable with the status quo, the business world has been susceptible to a Vuja de approach because of the power vested in the leader. But government has never been exposed to a true Vuja de type leader, because by its very structure – the constitution – our government is based on the concept of defused power that is intended to assure the consistent continuity of the status quo. Power is passed from one president to another, while the Republican and Democratic Parties rotate supremacy within the confines of government, the slow flow of the status quo remains. The players may change, but the way the game is played does not change; the rules remain constant. At least they have up to this point.

The intriguing aspect of a Trump presidency is that he will be the first person to bring a Vuja de business leadership style to the highest level of the government. It is an axiom that successful business leaders seek to do what has not been done to create the future, while the establishment that populates the government seek the repetition of what has been done to preserve the past. For many (in both business and government) the feeling of Vuja de is intimidating, while for others it is exhilarating. It will be beyond interesting to see how this conflict between Déjà vu and Vuja de will play out in government over the next four years.

It could well be that this conflict of diametrically opposed approaches to governing will create even more polarization and dysfunction in government. On the other hand, it may open our eyes to the idea that government, just as in business, can function more effectively if it is not shackled to the practice of doing the same thing, the same way it has always been done, because that’s the way it has always been.

A peek at a Vuja de world

We are already privy to a glimpse at how this clash of attitudes may play out in a Trump presidency. Trump has been roundly criticized in the media for being publicly skeptical of the “intelligence community” reporting that the Russian government sanctioned – indeed sponsored – cyber hacking efforts to influence the outcome of the presidential election. It is true that there are other factors at work here, but Vuja de leaders naturally challenge the conclusions of those in the status quo; especially when their conclusions are offered with no dissent. Even if the conclusions of the intelligence community are accurate, that does not mean the process of reaching them can’t be challenged. Trump has not denied the conclusions of the intelligence community, but he has challenged them to prove their point. I have no doubt that the intelligence leaders who presented their case to Trump last week had done much more work and were better prepared to present their case, than if they had not been challenged by Trump.

And history proves the point. In early 1961, John Kennedy, a new president in the continuum of the status quo, accepted, without challenge, the unanimous conclusion of the intelligence community that Castro was a weak leader and the people would rise up against him if America supported an invasion of Cuba. If Kennedy had been more of a Vuja de leader who was willing to challenge the establishment, the Bay of Pigs fiasco may never have happened.     

There may be valid reasons to oppose or even fear a Trump presidency, but unfortunately many of those in the establishment of government and the media are dreading a Trump presidency simply because his style of leadership is so foreign to their traditional thinking. Trump’s style will force them to step out of their comfort zone and this engenders a queasy feeling of uncertainty and loss of power that comes with the surmised safety of the status quo.

The Vuja de style of leadership may fail miserably when applied to managing a government, but on the other hand, it just may be a new way to effectively manage government and make it work. One thing we know for sure is that Trump will not be a Déjà vu president.