Well, as expected, they thought my view of Washington was
jaded. Then after a brief while, their career in DC cut short for the predicted
reasons, we met and they told me that my advice had been the only true and spot
on advice they received. Everyone else said they should “make a difference”.
Yet how could one do that if they were continually stabbed in the back. And,
yes they told me that there was, indeed, a cadre of professional “back stabbers”.
If only they had listened.
I had seen this in the 70s during my stay in the City of No
Good. It has just gotten worse and the one thing our Founders did that was just
brilliant was to place the Capitol in a swamp, a metaphor for future
generations. They kindly took it from New York, and sat it on the banks of the
Potomac, just below the Falls.
Thus when I read the complaints of a recent academic having
gone to DC I saw again the same story, and perhaps this individual had no one
to tell them what would happen. What would you expect, especially if your goal
is to change something that half the country out the gate despises? Just
because you think it is good does not mean anything.
As this more recent academic who journey into the belly of
the beast states[1]:
Few lobbyists in Washington are more powerful than
organized medicine and organized hospitals. Were they to demand a new health
care system, they would prevail. But their agendas, mostly, are not yet about
change; they are about surviving the current storm.
Survival is and has always been the mantra of those in DC.
So what is the surprise, if one had ever sought advice then this would hardly
have had been news.
The author continues:
Local, state, and national governments all affect health
care. For instance, the safety net for the poor tends to be based in
communities and states, whereas Medicare is, of course, national. Because of
this chimeric structure, almost any proposal for federal action as ambitious as
the ACA exposes ambivalence about federalism making the politics of reform
contentious. For example, there is chaotic variation among states in how
Medicaid expansion and exchanges will coordinate enrollment processes under the
ACA.
People do not really trust the Federal Government much.
Never did and never will. The old adage, “I am from the Federal Government and
I am here to help you.” has always been a joke. It gets a laugh every time it
is told. One must understand that and not have some ambiguity of expectations.
The Constitution, the law of the land, is structured to allow blocking on one
branch by another. Yes, “elections have consequences”, and since we do not yet
have a monarchy the House can block the Executive. That is the way it works.
A final comment is made:
The ACA has begun the most significant tectonic shift in
the nation’s health care since Medicare and Medicaid arrived in 1965.
Professionals have an opportunity to guide this country out of the battleground
and into the creativity needed. The toxins of politics have only one effective
antidote: the memory of the shared purpose of care, which is to heal. The needs
of the patient come first. That is the guidepost to success for a nation whose
vision is clouded at the moment by the fog of conflict.
The ACA has clearly begun to collapse under its own weight,
which frankly is only beginning to be shown. The ACA does everything but put
the needs of the patient first. In fact one need just look at the past few
weeks. The needs of the patient, as the patient sees them, have been put dead
last. The “needs” as the Central Governmental Executive sees them is another
thing. Academics are always amazed when they face reality, either in business
or Government. Reality is ruthless, and it is often in that ruthless combat that
solutions are forged. Good solutions are compromises, bad solutions are
mandates.
Another Academic who has managed their way through
Washington says we need another goal, another Space Program. He states[2]:
The US health care system needs a new BHAG: By 2020, per
capita health care costs will increase no more than gross domestic product (GDP)
+0%. That is, by the end of the decade, health care costs per person will not
grow faster than the economy as a whole.
By BHAG he apparently means “big hairy audacious goal” which
must be Academic speak for something just beyond any reasonable goal. He
compares this to the Moon Program. In a previous set of pieces I had argued
that the Moon Program actually set the US back a decade or two. For as we sent
the best engineers into NASA type jobs the Japanese sent their new engineers into
building electronics and a better economy so that by the 1980s they were ahead
and we were behind. One should be thankful for the financial incompetence in
Washington in the 1970s since it forced the creative minds out of Government
work and into the commercial sphere. That led to our boom in the 1990s.
The driving of these Government programs will most likely
repeat the failures of the 1970 and 1980s, but on a much grander scale. We no longer
just worry about Japan, we have China. As we tighten the noose around a tightly
controlled Central Government, China is lessening theirs. That is the risk we
see in the future, not just the fact that the ACA is a disaster as a web site.
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