Tag Archives: Obamacare

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.

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Trump Should Focus on Replacing Obamacare

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A cornerstone of Trump’s campaign for president was the promise he would repeal and replace Obamacare. And rightly so, because Obamacare is an unmitigated failure. The promise of Obamacare was to provide “patient protection and affordable healthcare” for some 40 million uninsured Americans. The plan has failed on both points.

The saga of Obamacare is a great example of wanting to do the right thing, but going about it the wrong way. Obamacare as we know it came about because President Obama capitulated to the merchants of the devil – the health insurance industry – in order to strike a deal on healthcare reform. The great myth surrounding Obamacare is that it is some type of government provided healthcare coverage like Medicare, but it isn’t. Under Obamacare the government has nothing to do with the type of coverage offered, the quality of the services provided or the cost consumers pay for healthcare; that is all left up to the whims of private health insurance companies.

Obamacare is nothing more than a (clunky, complicated) website that is intended to match-up those who need healthcare coverage with private, for-profit insurance companies looking to sell their policies. The only requirement for insurance companies to market their policies on the “exchange” is that pre-existing conditions are covered and children can be included under the policy until age 25. Beyond that, insurance companies are free to determine the structure of the policies, the provider networks the insured must use, deductibles and the co-pays – the amount the insured must pay out of pocket; and those can run as high as 40 percent of medical charges. Most important, the insurance companies are free to charge any premium they desire and increase those premiums at will. In short, Obamacare has become nothing more than a profitable boondoggle for insurance companies. As usual, the ones left holding the short end of the stick are individuals who most need and can least afford healthcare coverage.

In addition, employers who are mandated to provide employees with healthcare coverage are free to use all sorts of machinations to avoid this responsibility. (For example, hiring employees as part-timers and making sure they work less than 40 hours a week.) This forces the employees to use the Obamacare website and be pillaged by the insurance companies.

Be careful what you wish for …

With a Republican soon to be in the White House, the Republicans in Congress who believe healthcare is a privilege based on the ability to pay, rather than a right of citizenship, are stupid-drunk giddy over the prospect of killing Obamacare, but they need to be careful what they wish for. There may be one problem that could turn their dream into a nightmare. While that Republican soon to be in the White House has savaged Obamacare, he has consistently supported the rights of every American to have healthcare coverage. Over the years Trump has repeatedly praised the concept of universal healthcare.

On 60 Minutes Trump said, “Everybody’s got to be covered. This is an un-Republican thing for me to say because a lot of times they say ‘No, no, the lower 25 percent that can’t afford private.’” He continued, “I am going to take care of everybody. I don’t care if it costs me votes or not.”

On the Larry King Show Trump bluntly proclaimed, “If you can’t take care of your sick in the country, forget it, it’s all over … I believe in universal healthcare.”

In his book The America We Deserve Trump wrote, “We must have universal healthcare … I’m a conservative on most issues but a liberal on this one. We should not hear so many stories of families ruined by healthcare expenses …”

So the Republicans in Congress may be in for a bit of a surprise blowback from their Republican president when it gets down to the nitty-gritty of repealing Obamacare, without offering a reasonable alternative for millions of Americans who lack access to healthcare or don’t have the ability to pay the exorbitant premiums charged by private insurance companies.

What is the alternative that Trump could propose?

If Trump is sincere in his belief that all Americans should have affordable access to basic healthcare services, he could achieve that goal by simply expanding the scope of two healthcare plans already in existence – Medicare and Medicaid. Medicare provides effective and efficient medical care for millions of Americans age 65 and over. Medicaid – a combination of state programs funded by the federal government – provides medical care to millions of low income individuals.

The point is that these two programs have processes and procedures in place and in point of fact are paying for the healthcare provided by hospitals, care givers and doctors for millions of Americans. Patients are free to select any of the 95 percent of hospitals and doctors who accept Medicare payments to provide their care. This is not the government deciding or providing the healthcare, but simply being the “single payer” of the benefits provided by private hospitals and doctors.

So the question is: Why not repeal Obamacare and replace it with the two national healthcare programs already in existence and functioning effectively? There is no need to create an entirely new bureaucracy. The simplest and most direct way to offer basic healthcare to all Americans at affordable costs is to expand and enroll everyone – at all ages – into Medicare or Medicaid.

Of course, this can’t be done with a flip of a switch, but an organized national phase-in of Medicare over time could make it happen. For example, in the first year those 60 to 65 would be eligible for Medicare, then the next phase would include those 50 to 55, and so on until everyone is covered. This would allow for Obamacare to be repealed and phased out at the same pace Medicare is expanded.

This approach could be a win-win for everyone. Trump and the Republicans could fulfill their campaign pledge to repeal Obamacare; Trump could remain consistent in his call for universal healthcare 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.

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So What Exactly is Wrong With “Single-Payer” Healthcare?

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About a month ago, I posted a blog (click here to read) making the case that Obamacare has failed to achieve its primary objective of providing affordable healthcare for all Americans. While 17 million more Americans now have health coverage under Obamacare, it is far from affordable and there are still almost 30 million Americans who lack any form of healthcare. My suggestion was to repeal Obamacare and replace it by expanding Medicare and Medicaid, so that all Americans would be guaranteed access to basic healthcare.

The reaction to the blog was swift and sometime acerbic. Comments split pretty much along party lines, but by far most of those who opposed my proposal did so by criticizing it as a “single-payer” system. I was not surprised by that, but that argument is an old dog that just won’t hunt any longer.

You see, “single-payer” is a dog-whistle phrase the insurance industry – and their lobbyist friends – created and have used for decades to protect their turf in the healthcare business. The “single-payer” concept has become a code-word derisively repeated ad nauseam by the insurance industry and its supporters, arguing that “single-payer” is a dark conspiracy of the part of the government to usurp the freedom and right of Americans to select a personal healthcare provider and manage their own healthcare.   

The strategy employed by the insurance industry in this deceitful, greed-driven approach has been to shift the focus away from the need and right of individuals to access affordable healthcare and instead, make it a debate about individual freedom. That’s a nice trick if you can pull it off, but the insurance companies along their well-funded friends have done it.

For decades, the idea of a single-payer healthcare system has been metaphorically the “third-rail” of politics that was so charged with controversy that politicians were afraid to touch it. We see how terrified politicians are to take on the NRA and responsible gun control; well it has been the same with politicians taking on the insurance industry with a single-payer system of healthcare. The chief reason President Obama was willing to accept the insurance industry centered cumbersome system of “insurance exchanges” that are at the core of Obamacare was because he feared taking on the myths of “single-payer” head on. The result is that the insurance companies get their way and their profits and the rest of us are stuck with a muddled, inefficient and high-cost healthcare system. And millions more Americans still lack access to basic healthcare.

So What Really is a Single-Payer System?

A single-payer healthcare system is simple. Under such a plan the government would collect the taxes and premiums needed to fund universal healthcare. The government would then contract with and reimburse private doctors and hospitals for the healthcare services they provide.

What would such a plan look like and how would it work?   

Well, many may not realize it, but Medicare is an example of this dreaded single-payer system. Medicare has proven to work well and covers millions of Americans – including me — without a loss of freedom or choice. Anyone covered under Medicare has the right to choose any doctor or healthcare provider they desire; so long as that doctor or hospital accepts Medicare. The most recent survey determined that over 90 percent of all doctors and virtually every hospital accepted Medicare payments.

It should be noted that Medicare gives those covered the freedom to not only select their personal provider, but virtually any type of medically necessary service. For example, Medicare covers the reasonable costs of doctor, hospital, preventative care, long-term care, mental health, reproductive health, dental, vision, prescription drug and medical supply costs. Contrary to what critics of the single-payer system claim, Medicare actually expands the freedom of individuals to manage their healthcare, because it lowers the financial barriers to selecting the doctor or hospital they choose.  

Those fearful of a single-payer system might suggest that such an all-encompassing government program would be inefficient and costly. Based on the history of other government programs, that might seem logical, but the reality is that the administrative costs for Medicare are at about 2 percent of total services. At the same time, the overall embedded administrative costs in the private healthcare system amount to over 30 percent of the services provided.

The insurance industry and its supporters argue that expanding the single-payer concept of Medicare and Medicaid to all Americans would bankrupt the system, but the truth is it would secure the financial viability of both programs. The system could be funded with premiums paid (based upon ability) by those covered and employer health taxes (employers would actually save money by not being required to provide coverage), but the most significant funding would come from savings obtained by replacing the current system of patchwork coverage. America now has the most inefficient and highest cost system of any industrialized nation; while failing to provide coverage for all citizens. Redirecting the expenditures from this failed private system would provide more than adequate funding for the single-payer Medicare and Medicaid systems. Furthermore, with everyone covered under the same plan, the government would have the clout to monitor and control the costs of services and medication.

The bottom line is that it is all well and good to discuss and debate whether all Americans should have a right to basic healthcare and if expanding Medicare and Medicaid is the way to provide it. However, to base opposition to these questions solely on the “evils” of a single-payer system is to fall prey to the self-serving, greedy and disingenuous arguments of the health insurance industry.  

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