These are not separate issues, and I am frustrated every morning when I check the Post or the news outlets online and see the same mischaracterizations repeated again and again. CNN’s Ed Henry says, for example, “The president is facing competing pressures from liberal Democrats who are demanding that he not abandon the push for a major overhaul of health care in favor of a scaled-back bill and conservative Democrats who have said the Massachusetts special election was a wake-up call that should force Obama to put a much heavier focus on job creation.” But in my view, health care and the economy simply are not mutually exclusive issues, and any eventual improvements to either cannot be approached independently with any real hope of success.
James Carville said on ABC's "Good Morning America" that President Obama hasn't done a good enough job explaining to the American people "a coherent strategy" for fixing the economy and creating jobs. He’s right. Americans think of health care and job creation as two competing focal points for the administration, and it’s time the president made it clear to everyone that we won’t really fix the economy, in the long term, if we can’t get control of our health care costs. Does this mean a government-run national health care system? Not necessarily. I don’t think there is only one solution, and I am no proponent of some overnight nationalization program. But let’s face it, this looming problem has been with us for years and no one has done a thing about it. In fact, the 2003 prescription drug bill made the problem much worse – much more acute, yet many in congress simply wish to derail the whole process of reform. I find it very difficult to put confidence in those who shout criticisms from their pinnacles of inaction.
David Walker, former comptroller general of the United States, has been making the rounds in Washington delivering a sobering message on health care and our bleak economic future for years. Insiders have indicated to me, however, that this president is one of the first who’s really listening. Walker says "It's the number one fiscal challenge for the federal government, it's the number one fiscal challenge for state governments and it's the number one competitive challenge for American business. We're gonna have to dramatically and fundamentally reform our health care system in installments over the next 20 years.” What would happen in 2040 if nothing changes? "If nothing changes, the federal government's not gonna be able to do much more than pay interest on the mounting debt and some entitlement benefits. It won't have money left for anything else - national defense, homeland security, education, you name it," warns Walker.
Now let me be clear (I love this phrase): we must approach health care reform in this country with a vigilant eye toward greater efficiencies and more cost reductions, not just expanding access. I believe we as a nation, given our disproportionate spending versus other developed nations, can cover more people, more effectively, and at a lower cost. Today, the way we care for patients is simply wrong. They are just transactions, reimbursed by the drink, and administered in an archaic and expensive manner. Once out of bed, they’re off the radar screen. But institutionalized follow-up care, phone check-ins by an RN after hospital discharge, old fashioned doctor home-visits and local clinics… these can all reduce emergency room admissions and re-admissions once patient problems become acute, which are enormous cost-drivers of our current system. Further, many of our health care companies have been around for generations, and anyone who has worked in corporate America for the last twenty years can tell you that such massive companies are slow to modernize, have large clerical staffs that do outdated and unnecessary jobs, don’t share information well internally as silos have become iron-clad, and retain entrenched employees & managers who refuse to abandon practices that are maddeningly inefficient. My wife and I get a piece of mail that is an “explanation of benefits”, which is practically in another language, and then a second piece of snail mail that is an “explanation of benefits” plus a paper check. First, why isn’t this email? Second, why send it twice? And third, why a check – why not an electronic transfer? How much are they spending to annoy us with all that unnecessary paper? I’d think seriously about firing anyone who proposed such an arcane methodology today. Little start-ups would never put in place a process like that… but then again, they can’t afford to!
So how does health care reform impact the economy? We’ll count the ways:
1) Controlling health care costs reduces our unfunded national liabilities, allowing us to spend our money on all the other things we need.
2) More effective coverage programs and methodologies lead to healthier people. And healthier people will cost less, work longer, and produce more.
3) Companies that spend less on health care are able to spend more on improving plant, equipment, and human capital. This all means better products and services, which results in increasing market share and rising exports.
4) I could go on and on but you get the picture.
So why hasn’t anyone done anything about health care? Kent Conrad of North Dakota is the chairman of the Senate Budget Committee, and he lays it out pretty well. "Because it's always easier not to. 'Cause it's always easier to defer, to kick the can down the road to avoid making choices. You know, you get in trouble in politics when you make choices," says Senator Conrad. But isn’t delaying the tough choices what Americans seem to do best these days? We’ve done it with our personal finances, our infrastructure, our childrens' health problems, and their vapid culture (I feel another rant coming on).
I’ll end with this: we Americans need to quit yelling about the fact that jobs didn’t just reappear five minutes after we had a global financial train wreck, and we need to quit being so myopic about our fiscal and health care problems, and instead think about how much more painful and destructive these issues will be in 10 or 20 years if we do not make the choices we know we must eventually make, and just go ahead make them now. It’s only going to get worse.
p.s. thank you Baby Boomers. I liked the music, but you could have just stopped there…
Monday, January 25, 2010
Thursday, January 21, 2010
What Tiger Gave Us
My wife said something over dinner recently that struck me as probably one of the more insightful things I’ve heard in quite a while. She said, “Without Tiger, do you really think we’d have Obama?” She’s on to something there. Since the late 1990s, Tiger has been exerting a profoundly positive influence on sports, popular culture, and the way we view race and place in America.
Tiger did something on a grand and unprecedented scale (aside from being the first billionaire athlete). Tiger burst into the spotlight like a company of U.S. Marines on an unsuspecting beach. He brought with him qualities that are quintessentially old-school American, and universally admired: strength, effectiveness, humility, sportsmanship, and grace under pressure. He took the sport of golf to a new level in both competition and public reach, and generally did it with a matter-of-fact, down-to-business attitude. Golf, an old and reputable game known for its genteel nature and the ladies & gentlemen who have played it, welcomed Tiger happily and graciously, reaffirming its aforementioned character and demonstrating to an often skeptical world that America truly is the meritocracy it professes to be. Tiger, in turn, played on, steadily winning and always accepting his accolades with a slightly embarrassed smile, a nod to luck & the game, and kind words for his fellow players. He stayed out of the off-course limelight, and away from controversy. Tiger’s tearful embrace of his father after his 1997 Masters victory is one of the most memorable images of the decade. As a model for us in our sporting lives and daily personal conduct, what more could we ask?
I believe Tiger’s pervasive presence in golf, our most prestigious of sports, made America – already on well its way to being less rigidly stratified in race and class – even more comfortable with the idea of someone of diverse parentage being at the very pinnacle of achievement where an “old guard” had reigned longer than anyone’s memory. The fact that he mixed a natural excellence with a usually easy & gentlemanly conduct undoubtedly bolstered the better parts of us that eschewed the more unfortunate preconceptions of race. Personally, as I reflect back upon my own attitudes during the fall of 2008, I suppose it wasn’t any longer such a stretch to envision a black man as president. After all, if he can wear the green jacket, and moreover can graciously help another into his own green jacket from the comfortable chairs of the club’s champions, why can’t he move effectively within and among any other of our most elite circles?
All the more distressing, therefore, is the revelation of Tiger’s long list of dubious pursuits, for this simple truth: he seemed to be the best of us. Tiger possessed that rare and estimable ability to lead the sporting field, and to inspire with few words but skillful actions; he has been a steady hand at the game in an unsteady decade in our country’s history. He was someone we could count on – an ideal to be held up in front of young athletes everywhere, as well as us old guys who occasionally want to snap a five iron in half.
It would be disingenuous and wrong to expect Tiger to be wholly without personal failings – we all have them – but being Tiger, and occupying the Olympian pedestals of sports and fame that he does, I expect most of us had hoped he would heed his added responsibility to maintain a doubly high standard of personal behavior and ethics. Sadly, history will likely remember him as yet another extremely talented but flawed man, leaving us to resume our search for the modern day Clark Kent… incorruptible, unwavering, and unstoppable. Perhaps Tiger will resume his own pursuit. We should all wish him well in that.
Tiger did something on a grand and unprecedented scale (aside from being the first billionaire athlete). Tiger burst into the spotlight like a company of U.S. Marines on an unsuspecting beach. He brought with him qualities that are quintessentially old-school American, and universally admired: strength, effectiveness, humility, sportsmanship, and grace under pressure. He took the sport of golf to a new level in both competition and public reach, and generally did it with a matter-of-fact, down-to-business attitude. Golf, an old and reputable game known for its genteel nature and the ladies & gentlemen who have played it, welcomed Tiger happily and graciously, reaffirming its aforementioned character and demonstrating to an often skeptical world that America truly is the meritocracy it professes to be. Tiger, in turn, played on, steadily winning and always accepting his accolades with a slightly embarrassed smile, a nod to luck & the game, and kind words for his fellow players. He stayed out of the off-course limelight, and away from controversy. Tiger’s tearful embrace of his father after his 1997 Masters victory is one of the most memorable images of the decade. As a model for us in our sporting lives and daily personal conduct, what more could we ask?
I believe Tiger’s pervasive presence in golf, our most prestigious of sports, made America – already on well its way to being less rigidly stratified in race and class – even more comfortable with the idea of someone of diverse parentage being at the very pinnacle of achievement where an “old guard” had reigned longer than anyone’s memory. The fact that he mixed a natural excellence with a usually easy & gentlemanly conduct undoubtedly bolstered the better parts of us that eschewed the more unfortunate preconceptions of race. Personally, as I reflect back upon my own attitudes during the fall of 2008, I suppose it wasn’t any longer such a stretch to envision a black man as president. After all, if he can wear the green jacket, and moreover can graciously help another into his own green jacket from the comfortable chairs of the club’s champions, why can’t he move effectively within and among any other of our most elite circles?
All the more distressing, therefore, is the revelation of Tiger’s long list of dubious pursuits, for this simple truth: he seemed to be the best of us. Tiger possessed that rare and estimable ability to lead the sporting field, and to inspire with few words but skillful actions; he has been a steady hand at the game in an unsteady decade in our country’s history. He was someone we could count on – an ideal to be held up in front of young athletes everywhere, as well as us old guys who occasionally want to snap a five iron in half.
It would be disingenuous and wrong to expect Tiger to be wholly without personal failings – we all have them – but being Tiger, and occupying the Olympian pedestals of sports and fame that he does, I expect most of us had hoped he would heed his added responsibility to maintain a doubly high standard of personal behavior and ethics. Sadly, history will likely remember him as yet another extremely talented but flawed man, leaving us to resume our search for the modern day Clark Kent… incorruptible, unwavering, and unstoppable. Perhaps Tiger will resume his own pursuit. We should all wish him well in that.
Living on the Edge
I’m struck by the public outcry at all those who are deemed responsible for the current financial mess. The banks and investment banks on Wall Street, the federal government, mortgage brokers, rating agencies… they are all in the cross hairs of public resentment. And they should be. All contributed bringing us to the precipice on which the economy now rests. It’s a little disingenuous, though, and perhaps hypocritical is a better word for it. After all, they haven’t done anything we didn’t do ourselves.
Look at the trappings of the typical American lifestyle. How many people don’t have a flat screen TV? Yet what is our savings rate? I’d bet more people have a flat screen TV than contribute to their 401(k). We didn’t sock it away, and neither did corporate America. In the best of times, we let our savings fall, companies operated at the edge, wasted precious capital, and ultimately failed to make the changes to plant, product, and personnel necessary to weather a storm that we all knew would eventually come.
Banks didn’t help the situation. They did what we did – they leveraged to the hilt. We bought houses our grandparents would never have purchased; did we really believe grandma was wrong? After all, she’s bailing many of us out now that we’ve blown it. Banks bought securities that were garbage, knowing that the ratings agencies were complicit, and turning a blind eye to the shady practices of mortgage brokers that encouraged people to spend well beyond their means. But it’s not all their fault. Someone on the other side of the table had to be dumb enough, or greedy enough, or both, to sign on the dotted line.
There are some basic principles that we Americans ignored, and these are things that had been established fact when “the Greatest Generation” was in charge:
1) Save your money for a rainy day. It will always come.
2) Don’t take undue risk with investments. Be the tortoise, stick to a formula, plod along, and you’ll win in the end.
3) Don’t live beyond your means. Don’t buy a house you can’t afford, don’t blow your money on things that lose value. You’re lying to yourself, and everyone else.
Somewhere along in the 1980’s, we seem to have veered off course from those three maxims that our grandparents espoused. We began to live in the moment, believing that either the rainy day would never come or that if it did, someone else would pull our rear ends out of the fire. We have now had two bubbles burst within a single decade, and I still do not get the sense we’ve learned our lessons. It occurred to me back around 2004 or 2005 that if consumers were pulling money out of their homes as they’d already depleted any savings they had, and their fantastic stock portfolios of the late 1990’s were already gone, then what would hold things together when real estate corrected? The answer? Nothing.
When the financial crisis hit in the fall of 2008, there just weren’t any good tools left with which to fix things. Consumers had nothing to fall back upon. Homeowners had nothing. The federal government had nothing, and has now created something from nothing in order to correct our course, and we will pay for that many fold down the road.
The situation is not unrecoverable, and I think the answer is pretty damn simple: consumers need to start saving again. Growth rates may suffer for a while, but take some pain economically, though it will be politically unpopular. Get deficit spending under control and begin to reverse the debt levels of the United States, both individually and as a country. We can return to the more simplistic and realistic lifestyles of our grandparents, and I think they’d be proud of us for doing it.
Look at the trappings of the typical American lifestyle. How many people don’t have a flat screen TV? Yet what is our savings rate? I’d bet more people have a flat screen TV than contribute to their 401(k). We didn’t sock it away, and neither did corporate America. In the best of times, we let our savings fall, companies operated at the edge, wasted precious capital, and ultimately failed to make the changes to plant, product, and personnel necessary to weather a storm that we all knew would eventually come.
Banks didn’t help the situation. They did what we did – they leveraged to the hilt. We bought houses our grandparents would never have purchased; did we really believe grandma was wrong? After all, she’s bailing many of us out now that we’ve blown it. Banks bought securities that were garbage, knowing that the ratings agencies were complicit, and turning a blind eye to the shady practices of mortgage brokers that encouraged people to spend well beyond their means. But it’s not all their fault. Someone on the other side of the table had to be dumb enough, or greedy enough, or both, to sign on the dotted line.
There are some basic principles that we Americans ignored, and these are things that had been established fact when “the Greatest Generation” was in charge:
1) Save your money for a rainy day. It will always come.
2) Don’t take undue risk with investments. Be the tortoise, stick to a formula, plod along, and you’ll win in the end.
3) Don’t live beyond your means. Don’t buy a house you can’t afford, don’t blow your money on things that lose value. You’re lying to yourself, and everyone else.
Somewhere along in the 1980’s, we seem to have veered off course from those three maxims that our grandparents espoused. We began to live in the moment, believing that either the rainy day would never come or that if it did, someone else would pull our rear ends out of the fire. We have now had two bubbles burst within a single decade, and I still do not get the sense we’ve learned our lessons. It occurred to me back around 2004 or 2005 that if consumers were pulling money out of their homes as they’d already depleted any savings they had, and their fantastic stock portfolios of the late 1990’s were already gone, then what would hold things together when real estate corrected? The answer? Nothing.
When the financial crisis hit in the fall of 2008, there just weren’t any good tools left with which to fix things. Consumers had nothing to fall back upon. Homeowners had nothing. The federal government had nothing, and has now created something from nothing in order to correct our course, and we will pay for that many fold down the road.
The situation is not unrecoverable, and I think the answer is pretty damn simple: consumers need to start saving again. Growth rates may suffer for a while, but take some pain economically, though it will be politically unpopular. Get deficit spending under control and begin to reverse the debt levels of the United States, both individually and as a country. We can return to the more simplistic and realistic lifestyles of our grandparents, and I think they’d be proud of us for doing it.
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