Trust, Politics and US Health Care Policy

The ability to trust is not an unalloyed virtue. It opens one up to the possibilities inherent in a relationship. It can also make one scam-candy for the unscrupulous. Yet trust without risk is not trust.

So we have evolved to make snap judgments and hold them strongly, even in the face of contradictory evidence. We also extend trust, via a trusted agent, to new arenas.

Which is why it’s so hard to de-politicize big policy issues. We tend to trust one party line or another on major issues. Answers to “Do you hate Hillary’s health care proposals” are highly correlated with “Do you hate Hillary?” Thus, when it comes to complex issues, our blind ideological trust serves us badly.

What we need in such cases is a Nixon-to-China personage; someone to shake and confuse our ideologies in ways that lead us to look afresh. May I suggest Regina Herzlinger in the field of US health care policy.

Ms. Herzlinger is a Harvard Business School professor whose career focus has been on non-profit organizations—particularly health care. Her third book on the subject, Who Killed Health Care? , has just been written, and she’s interviewed in Is Health Care Making You Better; or Dead, part of the HBS Working knowledge series.

Depending on which quote you take out of context, you’ll think you’re reading either Michael Moore or Milton Friedman. Put them together in context, and you’ll think you’re reading blindingly obvious commonsense. It’s that good.

She succeeds in using the tools of capitalist analysis to create an indictment of our health care system—as a system that is bad for health and bad business at the same time. She pulls no punches, as she outlines the chillingly bad-business practices of the five health care “killers” (her term); health insurers, the US Congress, employers, hospitals and academics. (Pharma catches a break finally).

Another Nixon-to-China component of Regi’s approach is that she demonizes very few individual human beings; in fact, she clearly respects the devotion of many in all five “killer” systems. Yet this doesn’t detract from her indictment of the system. She also offers specific suggestions which, unlike Michael Moore, are quite hard to label as one or another ideological –ism.

I’ve never understood why Regi Herzlinger’s health care work hasn’t gotten the attention that went to, say, Michael Porter or Ira Magaziner. Perhaps it’s because they were easily classifiable into trust-proxy ideologies; she is not.

Joseph Califano, after the Clintons’ ignoble shot at health care in the 90s, said that health care reform wouldn’t come until after campaign finance reform, because of the same power-sustaining characteristics that Herzlinger points out. Perhaps her health care work may actually contribute to campaign finance reform, the new Supremes notwithstanding.

Sometimes our trusting instincts get complacent, and we need someone like Herzlinger to shake them up.

Full disclosure: Herzlinger was a professor of mine, I’m very proud to say.

0 replies
  1. Shaula Evans
    Shaula Evans says:

    Charlie, I certainly agree that bland adherence to party-line ideology can get in the way of making good policy — particularly here in the US.

    However, I don’t know that healthcare is necessarily a good example of a partisan breakdown.  Don’t know if you caught the news, but GOP pollster Tony Fabrizio of Fabrizio, McLaughlin and Associates just released poll data saying 51% of the Republicans they polled believe universal healthcare coverage should be a right of every American. Rank and file Republicans want it, rank and file Democrats want it, even big business wants it — everyone wants better health care but the politicians (along with the other health-care killers Herzlinger lists who profit from the current broken system).

    I hope you’re right that Herzlinger’s work may contribute to campaign finance reform, because that seems to be the major political sticking point for both health care and a lot of other common sense policy areas.

  2. Lark
    Lark says:

    Here’s a miasma of reasoning – presented as a cloudburst of slippery signs and symbols.

    ==> End private central bank control and do away with the Federal Reserve

    ==> Put the Federal government in receivership and declare bankruptcy

    ==> Abolish the personal income tax and corporate safe havens for legal tax evasion, like hedge funds and derivatives

    ==> Reform the tax code to tax only consumption across the board – for both citizens and corporations – including inheritance

    ==> Replace free trade with fair trade

    ==> End employer government-funded subsidies/incentives for employee healthcare insurance benefits

    ==> End all food, energy, pharmaceutical and agricultural subsidies (corporate welfare) to corporations

    ==> Outlaw all quid pro quo and/or financial arrangements between corporate and trade group lobbyists and  elected government officials

    ==> As the citizenry owns the airwaves, establish new licensing procedures which expressly grant access to candidates to air their message(s) when running for elected public office

    ==> Remove the corporate veil which shields corporate directors and their shareholders  from public scrutiny or accountability – especially as it relates to public business, like elections

    ==> If corporations are to be afforded the same protections as private citizens, they must share in the same individual responsibilities as ordinary citizens

    ==> Remove legal barriers for the creation of new insurance pools for those who wish to participate in private – alternative –  preventative (or maintenance) healthcare programs outside AMA restrictions

    ==> Increase competition for the average healthcare dollar at every turn – without sacrificing accountability or consumer safety

    ==> Place overall responsibility for healthcare back in the hands of consumers

    ==> Separate Big Pharma, Big Media, the AMA, and the FDA by eliminating all government intervention in the free market – except where public accountability and consumer safety are of concern

    ==> Perform a complete audit of all government agencies and their proxies

    ==> End all public welfare programs except for the truly destitute – to include housing and public education

    ==> Open up the free market to competition and tighten the rules for non-profit organizations and their overseers

    ==> Encourage localism and the values of self-reliance, free speech, the rights of assembly and gun-ownership in all spheres of influence

    ==> Empty the jails and prisons of all but the rapists, child molesters, thieves and murderers – then fill them back up with more thieves and murderers, including war mongerers and war profiteers

    ==> Keep all the doctors, lawyers, bankers and corporate officers busy by expanding whistleblower laws… and by raising the finders’ fees for those who expose the corrupt, unscrupulous, and morally bankrupt amongst us

    ==> Reward transparency in all governmental affairs… while safeguarding our  privileges, protections, rights and respect for privacy… and increasing our individual responsibilities as citizens

    ==> Encourage businesspersons to win public favor by garnering consumer trust and disavowing the need for government favor

    ==> Discourage polluters, cheaters, the  malicious, and those who would unfairly game the system or the marketplace amongst us at every turn – especially the high-and-mighty plutocrats and globalists who  prefer to enslave us

    Have a nice day, Charlie!

    I hope you and your readers will enjoy my rant –  I know I did.

  3. Ian Welsh
    Ian Welsh says:

    Have you seen Sicko yet Charlie?

    I haven’t, but my understanding is that Moore is less dogmatic than you might think in reccomendations.  All he does in the movie , as I understand it, is highlight how other systems work better.

    As someone who follows the numbers and debate, I have to say that it’s simply a fact that for most people the US system is more expensive and has worse outcomes.  That’s not an ideological statement, that’s as close to fact as you can get when speaking about a social system. 

    It’s also a fact.  And I do mean fact, that universal healthcare systems in 1st world countries have overall better results, for less money, than the US system.  One can find occasional areas where the US does better, but not many, and usually not, ummm, universally (ie. the US has lower wait times for optional surgery than does Canada; but not lower than the France or Germany.)

    People often use ideology as a curse word or as if it’s instrinsically bad, but an ideology is just a way of looking at the world.  It was ideology that lead to human rights, to many civil rights, to large chunks of the New Deal as much as it was ideology that led to the horrors of Communism.

    Ideology is just world view; and every world view is just a tool.  The problem comes when you think your hammer is a screwdriver and you try to apply it to everything (or when your ideology is the equivalent of a nuclear bomb).  Even Marx had things to say that were very worth listening to (almost all of the Communist Manifesto’s demands have been met in every western society, for example).

  4. Charlie (Green)
    Charlie (Green) says:

    Shaula, thanks for the stat.  It’s a hopeful one; the traditional linkage of the Republican Party to the anti-universal free healthcare platform is a classic example of dogmatic ideology.  If that’s unfreezing, it’s a good thing.

    Ian has probably forgotten more about healthcare than I know, but I know just enough to know he’s absolutely right about it being a fact that our national stats are nothing to brag about.   We just, simply, do not have the best of much of anything.

    I did see Sicko, just tonight, and found it very powerful.  It is perhaps the least likely to turn off non-Moore fans; it is in movie terms his best movie, IMHO; and he makes a very powerful case for Ian’s point–namely that we are doing much worse at serving our citizens, all of them, insured and uninsured alike, than are  many other countries.  And it is a damn shame.  I urge people to see it.

    Lark, you are a walking anti-ideologue, as I try to piece together the common themes of your rant.  A unique, though uniquely western American, combination of views.  I enjoyed.

    And Ian, yes, Marx was a superb sociologist.

  5. Shaula Evans
    Shaula Evans says:

    BusinessPundit has an interesting article up right now on selective perception that relates to the mechanics of blind ideological loyalty — and which probably explains in part the undeserved obscurity of Herzlinger’s work.


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