Those of you who know me or have read my books know that one of my pet peeves is the way weak executives and bureaucrats always try to make themselves look better by taking very simple problems and making them very complicated. These people – who are by nature insecure – believe that if they can convince others that an issue is almost too complex to resolve, then if they resolve it they are heroes and if they fail to solve it, it is not their fault. I must admit that taking a simple issue and making it complicated is a wonderful strategy for weak, bureaucratic workers.
It has always been my belief that real leaders distinctly different. They take very complicated issues and make them very simple. Thinking in simple terms about complicated issues is the way problems are solved.
The current health care debate is a classic example of weak leaders and bureaucrats attempting to make themselves look good by taking a simple proposition – providing health care for all Americans – and making it complicated. If the issue is not resolved, it is not their fault because it was just too complicated. If a resolution can be found, then it will be because they are such great leaders.
Of course, I have to admit that as with all political matters, the three evil sisters — power, money and sex — are also clouding the health care challenge. Power and money taint the debate because the participants relentlessly argue over who will control the system and who will make the most money. The sex element is a little more obscure, but here is a hint – what if a national health plan would not pay for breast augmentation? That would disappoint a lot of politicians!
On a more serious vein, lets try a little exercise and see if we can express this “complicated” issue of health care in simpler terms. Lets start with the fundamental question:
Should it be the right of all Americans to receive basic health care coverage?
If we as a society answer that question in the negative, then the debate is over. Very simple. Lets move on. However, if we Americans believe that all citizens should have the right to basic health care, then the only question is how it should be done.
Despite all the commotion, heated debates and outright misrepresentation of the issues, there is a simple solution.
We already have a national health care system. It covers 43 million Americans who, even if they have the resources, could not otherwise obtain health coverage. The medical services are provided by private health companies and hospitals. The costs are paid for by employer and employee payroll taxes and premiums paid (on the basis of ability) by those covered under the plan. A recent survey found that 86 percent of those covered by this plan are satisfied with the service received. This plan is called Medicare.
Medicare provides health care coverage to millions of senior citizens who would not otherwise have coverage. The system and structure are in place and functioning smoothly. The simple solution is to simply enroll every American in this plan.
Of course there would be arguments against this type of proposal, but on balance it is the easiest, simplest and quickest way to provide some form of health care for all Americans.
Some will argue that Medicare runs a deficit that will only get worse if all Americans are covered. Others would argue that if all the funds now being poured in a patch-work of state health care plans were instead allocated to a national Medicare system that costs would be significantly reduced. In addition, those covered would pay into the plan based upon their ability to do so and this would significantly reduce the deficit. Employers who now pay into private group coverage could pay that same amount to have their employees covered. Those who don’t provide such coverage would be taxed to do so.
Power and Money Breed Resistance
Insurance companies will resist this approach because they fear it will reduce their profits or worse, take them out of the health care business. However, insurance companies make no effort to make coverage available to all Americans and in fact ration healthcare based solely of the ability to pay high premiums. And, even then they refuse to cover many who can pay. With all Americans covered under Medicare the insurance industry (just as they responded to Social Security after fighting it) will find creative new ways to make money from the plan. Insurance companies now offer “Medicare Supplement” policies to fill the gaps and co-pays of Medicare. If all Americans were covered under Medicare would suddenly have a huge market to tap. In addition, insurance companies could develop and market policies to those who can afford and desire services not covered by Medicare.
Health care companies and hospitals argue that Medicare would arbitrarily set the reimbursement for services that are below the cost to offer them. As a result, they would lose money or be “forced” to cut back or not offer services to the patients. However, I have not yet heard about a health care facility that has refused to care for Medicare patients.
Think about it this way: Utilities are private companies that have the prices they charge for services that are not only regulated, but determined by a government board. And yet utilities still raise significant private capital for investment and are profitable. There is no reason the same philosophy could not work for a national Medicare plan.
Another argument against using Medicare as a true national health care plan is the dreaded specter of fraud. Yes, there has been fraud in Medicare, literally billions of dollars wasted. What is not mentioned is that the great bulk of this fraud has been perpetrated – not by the government or the insured – but by private providers of the service. Tell me there is not fraud in almost any system – public or private – that involves money! Yes there has been fraud in the Medicare system, but that is not the fault of the system. It is the fault of those who abuse the system.
The ace in the hole for those who resist the simple idea of expanding a system such as Medicare to all Americans is to argue that people will have little choice and they will receive inferior care. Even if that were true (and I don’t think it is) let me ask this question: Would most people be willing to accept inferior care over no care at all? As mentioned above, those with the resources will always be able to obtain what they believe to be superior care.
And the Moral of the Story …
Anyone can make an issue complicated. Especially if they want to confuse the issue. That is the easy part. The hard part is to take a complicated issue and make it simple. If that can be done, the issue meets quick resolution.
Perhaps this is an approach we should try in our daily activities more often. And to resolve the health care issue, it’s essential. Remember to keep it simple.