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When we eventually recover from the novel coronavirus pandemic, there may be hell to pay for China’s government – and it could be the start of another Cold War, this time with a different dictatorship across the Pacific Ocean. It’s also a golden opportunity to bridge our widening and increasingly ugly political divide and unite against a common enemy. But first a surreal anecdote from 40-plus years ago to explain my thinking: I vividly remember a college professor of mine freshman year at Boston University who taught us about the People’s Republic of China. There was a gleam in his squinty eyes when he spoke of Chairman Mao Zedong, despite the fact that his leadership was largely responsible for the deaths of at least 20 million Chinese between famine and the Cultural Revolution. Some estimates place the gruesome death toll as high as 45 million. It made the country’s Great Leap Forward seem like a race back to the Dark Ages with some historians arguing that Mao had more blood on his hands than Hitler and Stalin. He couldn’t help but hide his twisted admiration for Mao, which wasn’t surprising considering he was the most ultra-liberal professor I ever had short of Howard Zinn, author of the “A People’s History of the United States,” a living legend who was known on campus as the chief Communist in residence. The irony was his balding appearance and reddish goatee very much resembled another iron-fisted Communist leader, Vladimir Lenin, mastermind of the Bolshevik Revolution that powered the former Soviet Union. His students would snicker about that comparison behind his back, as well as mimic his unusual voice and mannerisms. At the time it seemed odd that an educator would gloss over atrocities and gush about a cult of personality before such impressionable young minds, however well intentioned Mao’s mission might have been in uncovering the inequities of class warfare. Years later I cringe that such an important piece of history could be presented in such now-comically lopsided and highly irresponsible fashion. The fact is that Mainland China is a paradox full of hypocrisy – a Communist nation that allowed “Creeping Capitalism” under Deng Xiaoping to flourish. Under Mao’s successor, the world’s largest workforce mastered the art of mass producing products at the lowest possible cost without a hint of innovation. Such cheap labor became synonymous with poor quality. The Chinese government also have for years allowed the stealing of intellectual property. One consistency since the latter half of the 20th century is that China, a cloistered society once described as the Great Sleeping Giant long been poised for world dominance, has been brutally suppressant toward its own citizens. Doing business with China during the pandemic can literally and figuratively be hazardous to our health. Many of the roughly 90 companies selling antibody tests that determine whether people built immunity to the coronavirus are based in China, many of which failed. The Chinese government also has stood accused of price gouging not only on diagnostic tests for Covid-19, but also basic medical equipment for a crisis it caused. Another worry has been the government’s complicity in the spread of disinformation about this topic. If these stark developments don’t outrage people to their core, then we’re in big trouble. The fact is that China botched containment of a regional virus that triggered a pandemic and worldwide recession, the likes of which we haven’t seen on our shores since the Great Depression. There are now 33 million Americans out of work with an unemployment rate of more than 20%. Getting angrier? I sure am. My livelihood and daily routine were disrupted in ways I could never have imagined. Comedian Bill Maher recently admonished the politically correct police for crying racism over early descriptions of the Wuhan virus and generic references thereafter to the China virus. He pointed out how it’s customary for infectious disease experts to name ailments after regions where they originated, using Lyme Disease as one such example (a small coastal town in my home state of Connecticut). Let’s not get hysterical over how we might feel about labels. Facts are facts. What I’d like to see moving forward is blanket condemnation of China from around the globe, as well as intensive pressure on that brutally secretive government to be transparent and reasonable. We can apply that same litmus test to the World Health Organization, which critics have lambasted for hiding or downplaying early threats to placate China, which is the largest source of financial assistance to the WHO. At any rate, let’s start with the threat of sanctions forcing China to end the sale of exotic animals such as bats at so-called wet markets, the widely accepted cause of Covid-19. If those efforts fail, which I suspect they may, we can only hope that there’s another attempt at democracy that mirrors the Tiananmen Square uprising of 1989 – one that finally succeeds. But we also must vastly reduce our dependence on China and outsource work to other countries or find a way to cost-effectively return much of that labor to our country. In the U.S., the time has come for Democrats and Republicans to stop accusing each other of mishandling this crisis and join forces. Trump needs to stop demonizing anyone who disagrees with him, including the media. GOP leaders must do the same. But in all fairness, the media and president’s political opponents also need to stop demonizing him. We have an election in November. Let the people decide at that time who should and shouldn’t be in power. Let’s end the Divided States of America, restore the United States of America and cast blame where it belongs: China’s government. Finger pointing during a serious crisis both nationwide and worldwide is a failure in leadership. We’re all in this together, just like after the Revolutionary War, the Civil War, the Industrial Revolution, the Great War, the Great Depression, World War II, 9/11, the Great Recession and now Covid-19. The future is ours to determine. If we repeat mistakes of the past, then we place ourselves in mortal peril. But if we rise to the occasion and embrace common ground, then we will emerge a stronger country.
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COVID-19. Social distancing. Sheltering in place. WFH, aka work from home. This is the language of 2020. None of us saw it coming, except for maybe Lawrence Wright whose forthcoming novel, “The End of October,” was supposed to be a work of imagination and not prophecy.
The fact is, we’re all forced to ride out this raucous story arc that appears to have far more in common with science fiction or fantasy than reality. It’s surreal. A serious suspension of disbelief. Maddening. Downright frightening. Pure exhaustion. For working parents, the 9-5 juggle has never been harder with the kiddos at home on an extended spring break that could stretch into summer – and those are the ones who can actually accomplish tasks in fuzzy slippers. Anyone in blue-collar and service industries aren’t so fortunate. They’re being furloughed or laid off. Small-business owners are barely staying afloat, terrified by broken supply chains and the prospect of a Chapter 7 filing. A strained health care system is exposed as never before. Stock exchanges are panicking. Nest eggs are cracking. The world economy has nearly ground to a halt as lawmakers and public health officials weigh the impact of their choices on health and business, prudence and prosperity, life and death. Is this for real? Afraid so. Is it a new normal with more pandemics on the way? It’s anyone’s guess. Are we reacting in such hysterical fashion that the cure is worse than the problem at hand? Some say yes. Are we not adequately adopting a herd mentality, blinded by our obsession with individual desire at the expense of group consciousness? Some also say yes. What’s clear is a looming epic battle between business and science that, like it or not, has become politicized. Our response to the coronavirus will test us in ways we never thought were possible. At a time when other countries may consider us the Divided States of America, the need to reunite has never been greater than any time since 9/11 and the Great Recession. Politicians may be in charge, but infectious disease control experts are the ones who know best and should be running the show. And while partisan politics are once again holding up critically important directives, middle-ground solutions are a must before time runs out for mom-and-pop operations and corporate behemoths alike. Bipartisan support has lifted us through other crises. Now is no different. Democrats may fret that Republicans are more concerned about protecting Wall Street than Main Street, but at least several businesses across multiple industries are stepping up. Here are some examples: Bank of America is offering homeowners emergency relief on mortgages while major lenders are allowing deferred payments. Retailers such as Abercrombie & Fitch and Nike will continue paying their store workers and taking online orders while they close stores for two weeks. Target will extend access to a backup family care benefit to all its employees. And in the face of massive furloughs and layoffs, Amazon will add 100,000 U.S. employees an unprecedented explosion in demand for online deliveries. I can only hope in the days, weeks and months ahead that as a nation we’ll strike a better balance between the need for personal sacrifice and pragmatism for the greater good. The need for visionary leadership without divisiveness is nearing an apex. Let’s not miss a precious opportunity to regain control over our lives, preserve the American Dream and show the world that we’re still capable of greatness. When I learned that basketball legend Kobe Bryant died in a helicopter crash with his daughter Gianna and seven others very close to where I once lived, my initial reaction like millions of other sports fans was disbelief. It was a combination of numbness and heart-racing claustrophobia. I cheered for the Los Angeles Lakes during my 20 years in Southern California and even saw the team play at Staples Center.
Kobe was a transformative figure on a number of levels. Not only did he pave the way for other phenoms like LeBron James to transition from high school to professional sports, his legendary work ethic became the gold standard for excellence in the National Basketball Association. This is where he made his mark and it’s clearly his chief legacy. Borrowing from a self-proclaimed nickname that boldly compared his basketball skills to that of a black mamba snake and stuck through decades, Kobe’s approach to the game he loved morphed into a mamba mentality that spilled into other professional athletic endeavors. It’s heartening to hear all the tributes during Super Bowl week from football players who internalized his competitive spirit. And it’s equally heart-breaking to process the news of his tragic death at just 41 when his Second Act had barely begun. Even worse: his daughter perishing at 13 and how she was being groomed to take the mamba mantel into the world of women sports. We all saw Kobe grow up before our eyes soon after he entered the NBA at 17. He wowed us with his ability and relentless dedication to winning and improving. He also broke our hearts with poor choices that led to a rape allegation that was settled out of court. But he owned that mistake in one of the most cringeworthy press conferences ever held, struggling through intense cotton mouth to apologize to his beautiful wife, Vanessa, who was by his side, the Lakers organization and basketball fans everywhere. He also was roundly criticized for being a ball-hog and too solitary, not socializing with teammates. But that sense of isolation and hard exterior melted away over time as he became an elder statesman and exited the game he loved. Kobe eventually won back any lost respect from legions of disappointed friends and admirers, repaired his marriage, became a doting father to four girls, went on to win five NBA titles and embraced the next generation of players who would chase his records. Then he earned an Oscar for a short film about his love of basketball, became a mentor to younger athletes and was clearly poised for a lot more greatness off the court. We can all relate to Kobe because we’ve all made mistakes, though not many of us can bounce back the way he did. But what I love most about his life was a maniacal pursuit of excellence, which as someone who has written about the workplace for 32 years really resonates. If only more of us would adopt that thinking – from the lowest-level employee and middle-management to the C-Suite and boards of trustees – there’d be a lot more high-fives and less whining or excuses. Imagine working alongside others who share that dedication and philosophy and reaping the benefits of a winning culture. With winning comes respect, mutual admiration, appreciation, gratitude and satisfaction – all essential values in the working world and life in general. When we think about Kobe Bryant in the future, it would be nice to re-dedicate ourselves to excellence – adopting his mamba mentality in our jobs or careers and never letting go of that pursuit for something better. There has been a lot of talk about something called load management in the National Basketball Association since earlier in the year when then-Toronto Raptor Kawhi Leonard paced himself during the regular season along the way to a championship title.
The idea is to rest star athletes who grind it out during the regular season so that they have enough fuel in the tank come the all-important playoffs. Imagine for a moment how this concept might translate into other workplaces (more on that a bit later). “There’s no formula or algorithm” for load management, according to San Antonia Spurs coach Gregg Popovich under whom Leonard played for seven seasons. “You just have to have a feel.” Pop, as he’s nicknamed, is credited with helping develop the load-management concept, which goes hand in glove with the analytics movement sweeping the injury-prone professional sports world. Fresh legs paid off not only for his team, the first ever to be crowned champs beyond U.S. borders, but also for the star player who was about to become a free agent again and eventually landed with the Clippers in Los Angeles where he commanded a huge salary. Given how the NBA season is seen as a marathon at 82 games (though it pales in comparison to Major League Baseball at 162), it’s worth noting that Leonard missed 22 games. That’s a pretty significant number for a number of reasons, and Leonard isn’t the only marquee athlete not on injured reserve who is occasionally warming the bench. Think of the poor fans who shell out hard-earned dollars to see their favorite player in person, and not just the home-town crowd. NBA stars draw attention wherever they go. In Portland, Oregon, where I moved earlier in the year, ticket prices for Blazers games are commensurate with team talent (i.e., it’ll cost more to see the star-laden L.A. Lakers than, say, a largely no-name roster like the Washington Wizards). Also think of how TV ratings must take a hit whenever Leonard or other stars aren’t suiting up. Will viewers still enthusiastically tune in? Load management is the antithesis of a puritanical work ethic whose athletic roots can be traced to baseball greats Lou Gehrig and Cal Ripken, Jr. whose respective iron-horse reputations for consecutive-game streaks won the hearts and minds of rapid fans. I was fortunate enough to see Jr. play with gusto numerous times at Camden Yards in Baltimore in the years leading up to when he broke Gehrig’s record. It was a thrilling sight, and the record he chased is widely considered one of the greatest feats in all of professional sports. As a long-time fan, I wonder what the implications are for achieving a personal-best performance during every opportunity to compete. As a father of three, I fret about the message this sends to young athletes. Are we so beholden to analytics that we’ve lost our collective heart to compete along the way? Having written about the American workplace for decades, I can’t possibly wrap my head around the idea of employees, supervisors or executives sitting out beyond their paid time off. An occasional mental health day may be necessary, but isn’t the goal to suit up and show up for your job with pride and do the best possible job each and every day as long as you’re healthy and gainfully employed? Generous health insurance and a retirement savings plan have long served as pillars of protection, but they’re now considered baseline offerings along the ever-changing employee benefits landscape. Forward-thinking employers realize that traditional ancillary plans such as dental, vision, disability and life insurance no longer serve as window dressing to draw top talent.
So they’re polling the workforce and getting creative, acknowledging mounting interest in more tangible, personalized and flexible benefits that strike a better work-life balance and improve financial wellness. There’s even an emerging category under the lifestyle moniker that grew out of the concierge-services movement that took shape decades ago. Two of my recent magazine articles examined these developments in greater details. Corporate America recently acknowledged these developments when nearly 200 chief executives belonging to the Business Roundtable pledged to provide more meaningful benefits, fair compensation, training and education. And in a rare moment of candor, captains of industry admitted that focusing only on shareholder value is a short-sighted strategy when they should be investing more in human capital. It comes when employment has never been stronger over the past century than it is today. In the meantime, venture capital pours into startups and stalwarts that aim to make the workplace more responsive to the needs of working Americans as part of a holistic approach. One driving force is a demographic shift involving more women entering the workforce and senior-level roles while the population ages. An unintended consequence is that working parents in the so-called Club Sandwich Generation are tied down to both children and elderly parents and need a helping hand as never before. Savvy employee benefit brokers and advisers who know core and ancillary group insurance products and services have become commoditized are freshening up their portfolios. Unusual and innovative offerings appeal to multiple generations with changing expectations about their employment contract. One of my sources suggested that while the word lifestyle implies nice-to-have benefits, these offerings have actually become necessary in today’s competitive workplace. The category was built around the notion of employee wellbeing – an all-encompassing effort featuring physical, mental, emotional, social and financial components to pack a more powerful punch. Another expert described the benefits as a tangible way of delivering work-life balance and employee satisfaction. Key trends include student loan refinancing and financial wellness programs that help people of all ages manage or avoid debt. There’s even a lifestyle spending account modeled after the health savings account, as well as growing interest in plans or apps that promote healthy living. It’s easy to see why: employee health benefit costs represent the largest P&L expense after payroll, while two-thirds of the nation is overweight. Employers realize that healthier and happier employees are good for business on a number of levels. And the quest to reduce health care costs, absenteeism and presenteeism alongside improving productivity and morale for their most valuable asset (i.e., people) ultimately gives them a competitive edge. When Abigail Disney recently revealed her outrage at learning undercover the extent to which Disneyland workers were struggling to make ends meet, she highlighted a serious national embarrassment across Corporate America.
The Disney heiress and daughter of Roy E. Disney, who has been described as both a filmmaker and activist, urged CEO Bob Iger to fix an enormous wage gap between his annual pay and the company’s average worker. Iger was paid $66 million last year, whereas the median salary of a Disney employee was $46,127. How can people who work at the so-called Happiest Place on Earth possibly match the smiles of paying customers, she wondered, when scores of disgruntled employees shared such extreme financial struggles? Rather ironic, I thought, considering how the theme park’s admission keeps rising at obscene levels. So much for sharing in the wealth. Although praising Iger for being “a great CEO by any measure, perhaps even the greatest CEO in the country right now,” she lamented that “by any objective measure, a pay ratio over a thousand is insane.” In May, she stressed to a House committee the importance of delivering returns to shareholders “without trampling on the dignity and rights of their employees.” Recent federal data shows that an S&P 500 company CEO earned 287 times more on average than his or her median employee last year. It was a staggering $14.5 million in 2018 ($500,000 more than the previous year) compared to $39,888 for rank-and-file workers (whose raise was barely more than $1,000 from 2017). Interestingly enough, all public companies were required this year to disclose for the first time their pay ratios in filings with the U.S. Securities and Exchange Commission. In the past, they only needed to report compensation for top executives. I feel strongly about this topic, which I first blogged about in 2009 when lamenting not only the cringe-worthy pay ratio problem in this country, but also golden parachutes for executives who missed earnings targets and spoiled shareholder value. “How much pay is enough to live on comfortably without arrogance and disregard for one’s underlings?” I wrote 10 years ago. “Is it $3 million? Is it $50 million? Is it $1.5 billion?” Noting a growing concentration of wealth that deeply separated average working Americans from their corner office occupant, I also referenced how chief executives were “said to have earned anywhere from 179 to 369 times the pay of an average worker.” My conclusion a decade later is the same as I initially suggested: Let’s not begrudge captains of industry for earning their keep but at least rethink capitalist zeal “to ease the system’s extremes, correct any perceived imbalances and aspire to true pay-for-performance packages. There’s just no escaping this moral imperative and the time to act is now.” Corporate boards clearly need to address the pay-ratio issue and decide on amounts that not only seem reasonable, but also reward all employees for a job well done. There are many avenues available, including profit-sharing plans and stock options as well as bigger matching contributions to retirement savings plans. I have noticed a cultural shift in the workplace where younger employees increasingly value respect from supervisors and corporate responsibility. The customers of these companies also share those ideals, so it makes perfectly good business sense to ensure that prudent pay ratios are in place. About 30 years ago I started researching and writing a story about repetitive motion injuries. Ironically, I incurred one of them by the time I met my deadline!
For the next five years, I would endure a highly random and uncomfortable tingling sensation in my left hand – that is, until a combination of physical and occupational therapy that included dipping my hand in hot paraffin wax and redesigning my office workstation bore results. Thankfully, the pain would never return, but I learned a hard lesson about the importance of ergonomics, which is defined as “the study of people's efficiency in their working environment.” Just three years ago I became painfully re-acquainted with this topic – and it literally and figuratively became a pain in my neck. Decades of viewing a desktop (and then laptop) computer monitor on too steep of a downward slope landed me in a chiropractor’s office where an X-ray of my then-chronically stiff neck revealed that the three lower vertebra were nearly bone on bone. Misguided workplace ergonomic practices finally caught up with me. So I bought a wireless keyboard and adjustable shelf for my laptop to elevate the monitor. I also re-learned the importance of frequently stepping away from my workstation to relieve my hands, eyes and neck and not skipping the suggested 12-minute spinal daily spinal conditioning program that was prescribed. But it took about 18 months for daily neck discomfort to finally go away. The next chapter in this ergonomics journey was written just three short months ago when I decided to finally purchase a split-level, adjustable standing desk that as the name suggests allows people to work on a computer in a sitting or standing position. There’s a place to put a wireless keyboard below a larger area for the computer to prevent neck pain associated with poorly designed workstations. About a month or so later I decided to buy an adjustable stool that can significantly reduce low-back pain from prolonged sitting. Between these two recent acquisitions, I took my ergonomic knowledge to the next level in hopes of avoiding further work-related injuries. I’m gradually easing into the new arrangement, starting each work day on my feet getting caught up on email, which can take about half an hour, then sitting through most of the day with a few additional standing breaks. I have high hopes for the remainder of my ergonomic journey and career. One of them is to no longer encounter any additional body pain that will eventually be turned into another blog on this topic! After more than three decades of writing about employer-based health care delivery, I have a pretty keen sense of where the bread crumbs of innovation are leading. Of all the exciting trends and practices that have taken hold, one really stands out. It’s a simple solution to an overly complex marketplace mired in perversity, waste and inertia.
At a time of rising costs with no end in sight and embarrassing inefficiencies, we’ve been beholden for far too long to health insurance carriers, pharmaceutical manufacturers and pharmacy benefit managers that answer to their shareholders at the expense of patients. What’s lacking is transparency. When shopping for coverage is a completely transparent process, health plan participants make far better decisions and can drive down the cost of medical services by helping force greater competition across the healthcare supply chain. Seven years ago I started to dig into the weeds of self-insurance and within the past year I’ve had the pleasure of connecting with an industry thought leader who’s creating a new category of innovative solutions he calls transparent health benefits. Lester Morales, CEO of Next Impact LLC, says THB can help employers cut their health care costs 20% to 40% cost savings while vastly improving the quality of care being accessed. It’s a multi-pronged approach with several key components that include direct contracting with facilities, direct primary care (DPC), a 2.0 version of reference-based pricing that eliminates obstacles associated with that approach, more meaningful Rx strategies devoid of opaque contracts and eye-popping revenue-sharing arrangements, bundled and cash payments. His goal is to help benefit brokerages and advisories take control of the biggest P&L expense after payroll, as well as turn employees and their dependents into better healthcare consumers. I know we’re on the right track after seeing an interview Adam Russo, co-founder and CEO of The Phia Group, LLC who currently serves as chairman of the Self-Insurance Institute of America, did with Ana Christina for the May edition of SIIA News + Views. He validated our work by citing three key innovations that are expected to have a game-changing impact on employer-provided health plans. The first is pure transparency of cost and quality information on specific medical procedures, as well as patient reviews of doctors that are easily accessible on multiple technology platforms. Russo, who I have interviewed several times, also mentioned the importance of understanding the cost and efficacy of pharmaceuticals prior to paying for drugs at the pharmacy counter and DPC physicians who act as more efficient gatekeepers for a flat monthly rate without insurance claims. As politicians struggle to find enough middle ground to reform the nation’s ailing health care system and litigate their strategic vision, I take solace in knowing there are many market innovators who aren’t waiting for a government solution or consensus. If enough of these disruptors keep at it, then hopefully we’ll all be able to turn private insurance on its head, unleash competitive forces and find better solutions that save both lives and money. Now that Democrats won back the U.S. House of Representatives, they’ve wasted little time shining a spotlight back on health care reform. That’s an important development, and I applaud them for doing so in the face of Republican inaction since Donald Trump began occupying the White House.
But a leading proposed solution from the party’s progressive wing takes us in the wrong direction, at least for the time being. I’ll elaborate a bit later as to what I mean. Knowing the Affordable Care Act (ACA) is on life support, several high-profile members or leaders of the party are supporting a Medicare-for-all proposal. The moniker replaces calls for a “single-payer” system, whose wonky jargon always sounded as opaque as the perverse system that both parties agree needs fixing. Not surprisingly, Republicans are scoffing at such an idea. Even former Starbucks CEO Howard Schultz, whose potential 2020 presidential run would be as an independent, has dismissed the Medicare-for-all plan as unrealistic and financially unfeasible. The ACA’s irony is that it rendered health care unaffordable for many American citizens who don’t qualify for federal subsidies. A new analysis by economist Robert Genetski, for example, found that health insurance premiums soared by 84% for individuals and 126% for families last year above what would have been expected without the landmark legislation. Here’s my bottom line assessment: Let’s not decimate or eliminate choices for Americans who want to keep their doctor or health insurance plan, or employers who have the option to fully insure or self-insure health benefits as a recruitment and retention tool, earmark dollars for them to shop for coverage in the individual insurance market or not provide anything at all. To do so would be downright un-American, especially considering how choice drives the U.S. economy. Look no further than the Amazon platform. People are used to shopping this way for everything. Democratic candidates running for president in 2020 who have called on dismantling the entire private insurance model are promoting a concept that would toss the proverbial baby out with the bathwater. While removing options that place profit ahead of people is desired by policymakers, business people and consumers, let’s instead breathe enough life into the free market to render inferior plans obsolete. The best solution is to preserve and promote parts of the private system that are working. Examples include self-insured and pooled health plans offered by employers or organizations comprised of like-minded individuals with innovative approaches to containing costs and improving outcomes. These entities, which provide coverage for roughly half of all Americans, are employing a number of strategies that include reference-based pricing, patient advocacy, direct primary care, value-based purchasing, fiduciary pharmacy benefit management and more. Health care is now teeming with disruptors that are entering the field at a frenetic pace with an emphasis on technology that includes medical applications for artificial intelligence, software, data analytics, telemedicine, etc., along with the emergence of electronic medical records that vastly improve efficiency. Also look at Amazon’s partnership with Berkshire Hathaway and JPMorgan Chase, which has led some insiders to speculate that the largest online retailer intends to test market health care cost containment strategies on its own workforce that it hopes to turn into a profit center. Let’s give these innovators a chance to revolutionize the industry and not reinvent the wheel. I’d also like to see so-called skinny plans added to the legislative mix across all states so that people at least have the option of buying affordable catastrophic coverage while self-insuring routine doctor visits. The rap on these products is that they provide inadequate benefits, but there are many people like myself who are healthy and/or self-employed, and we don’t need all the bells and whistles. Again, let’s expand choice. But make no mistake: The status quo is unacceptable. So let’s reform parts of the system that aren’t working. Those efforts largely revolve around reducing the sky-high cost of prescription drugs, particularly specialty scripts, by importing more medicine from so-called tier-one nations whose quality control standards mirror those in the U.S. Another area that’s ripe for massive improvement is to manage the wild cost variation of inpatient and outpatient services by requiring transparent pricing and credible quality standards, as well as tying physician compensation to outcomes vs. volume, known as value-based purchasing. The same thinking applies to a handful of large insurance companies (Blue Cross and Blue Shield, UnitedHealthcare, Cigna, Aetna and Humana), whose costs are also soaring each year. If the pharmaceutical industry and health insurance carriers keep jacking up their prices with no end in sight and little to show for it in terms of better outcomes, then they’ll at least face price controls somewhere down the line. We need to pass legislation that introduces more competition in these areas. One idea has been to allow insurers to sell plans across state lines, though how such a move would be regulated with 50 different insurance commissioners is scary to ponder. There’s one area, however, where I think the federal government can continue to play a role as it has under the ACA. In a nutshell, the focus clearly should be on widening access to affordable health insurance through Medicaid expansion. Block grants allow states to cover uninsured populations as they see fit in keeping with the spirit of an old industry expression suggesting that all health care is local. This approach is far preferable to stretching one or more entitlement programs across the entire population, and I think it’s a fair compromise between liberal and conservative proposals. But if these incremental steps fail to expand access to health insurance, tame rising costs and improve health outcomes, then I think the U.S. will need to re-examine its options and give serious consideration to government-run universal health care or in partnership with the private sector. Ultimately, the voters will have their say on this at the ballot box in 2024 or 2028. But let’s at least try to give the free market a fighting chance to resolve these systemic problems. In the end, we must be realistic about the prospect of government intervention. The federal bureaucracy cannot be trusted to do an efficient job paying the nation’s health care bills or managing the system. Look no further than the disastrous website rollout of the ACA, as well as countless other examples of wasted and inefficient use of hard-earned taxpayer dollars. Health care is complicated, and thus, I believe it’s best fixed by industry experts vs. policymakers and bureaucrats who don’t fully grasp its complexity. We’re taxed enough. Can the public really stomach even higher taxes to pay for everyone’s health care? I think not based on how unhealthy a country the U.S. is, which would make for a steeper financial commitment than people expect. Howard Schultz is right. A government-run solution would be unrealistic and financially unfeasible. The ACA offers a glimpse of how government intervention has struggled to contain health care costs. Then again, we have to figure out a way to reverse course because we can no longer sustain rising costs and poor health outcomes. Whatever happens, it’s plain to see that we need a bipartisan fix, not one-sided solutions like the ACA, which passed without a single Republican vote, or any repeal-and-replace scenario that doesn’t appeal to Democrats. Common ground can be easily found in efforts to protect patients with pre-existing medical conditions and rein in the high cost of prescription drugs, which are low-hanging fruit on the money saving tree. I believe there could be many more modest reforms enacted that please both political parties if only our elected leaders would put aside the partisan rancor for the good of the country. Health care reform is critically important to the health of our nation, which spends nearly one-fifth of its gross domestic product on medical products and services, but trails in health outcomes relative to other developed nations. Lives literally hang in the balance, so it’s vital that we make it a top priority. Three weeks – and counting – on a partial federal government shutdown that’s at least tied for the longest one on record in U.S. history. But that dubious distinction is a mere symptom of a much larger problem that has been brewing for decades, though some may argue centuries.
Our two-party political system has been seriously impaired by a culture war pitting so-called social-justice warriors on the left against make-America-great-again foot soldiers on the right. Democrats and Republicans alike have waged long-fought internal battles over the heart and soul of their respective public-policy platforms. And extreme elements on both sides of the political aisle are shouting past one another without listening or negotiating in good faith. The resulting stalemate isn’t really about border security and safe communities. It’s about gamesmanship and scoring political victories. It’s not about fulfilling promises to constituents. It’s about obstructing the other side. It’s not about governing within reason. It’s about advancing a baseline cynicism that passes for acceptable political strategy in a blood sport built on opposition research each time there’s a so-called free election. In short, it’s disgusting. In times like these, I’m relieved to have long been a registered independent voter leery of both established political parties, but I’m also deeply embarrassed to be an American. We’re better than this as a country – much better. We’re the best example of governance in world history, albeit far from perfect and certainly mired in serious social ills, but we now struggle in simple conversations with those with whom we disagree. There’s no longer any civility or mutual respect, nor are there any Ronald Reagan-Tip O’Neill-style summits where we can agree to disagree, strike important political compromises somewhere between opposing positions and then grab a brew together afterward at our favorite local pub. Instead, we let perfectly good friendships wither on the vine and allow philosophical differences to tear apart our own families. It’s about us vs. them. This is the new normal from both a political and sociological standpoint. The fact is, it’s unconscionable that the Democrats and Republicans we elected to Congress and the White House are incapable of solving this problem. Both parties are to blame. It’s not that hard to meet halfway. That’s how nations govern. Is it so important to be right all the time that it’s acceptable to bolt the office door for millions of civil servants and prevent lawmakers from actually passing laws? This has to end. I’m not sure exactly how that happens, but if we all want to move forward as the United States (the former being the operative word), then we have to tone down the heated rhetoric on both sides, find common ground and live the Golden Rule in every conversation we have, whether it’s with a high-ranking government official, business associate, your spouse, sibling, child, friend or acquaintance. Only then can we have a fighting chance to continue competing on the world stage and set an admirable example for everyone else to follow. |
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