Views of the “Health Care Reform Summit”

by Dave Schuler on February 9, 2010

This morning I ran into two contrasting views of President Obama’s “Health Care Reform Summit”. Jonathan Chait of the New Republic see the proposal as a great example of what he refers to as “the Obama Method”:

Obama uses a similar approach toward Republicans as foreign enemies like the Iranian regime: take them up on their claim to some shared goal (nuclear disarmament, health care reform), elide their preferred red herrings, engage them seriously, and then expose their disingenuousness…

while Bruce McQuain of QandO sees it as a somewhat different sort of political theater:

After months of behind closed door negotiations, it’s suddenly “sunshine” time. Why in the world wouldn’t Republicans be suspicious? It’s hard not to conclude (especially after the results of the televised meeting at the GOP retreat) that this is nothing but political theater designed to show the Republicans as “obstructionists” and the “party of no”.

What the televised “summit” will likely consist of is Obama and the Democrats pushing for acceptance of the same bill now pending and the Republicans saying “no”. The desired outcome is to have them say it right there in the open on TV.

Note that both seem to see it purely as a sort of political theater and that might well be the case.

However, I think that another explanation might be considered. Healthcare reform is a wicked problem. Three approaches to solving wicked problems include vesting the power to solve the problem in a very small number of hands (recruiting a “blue ribbon panel”), a competitive strategy in which those with differing views propose their own approaches. This allows the various approaches to be compared.

A third approach for dealing with wicked problems is the collaborative strategy, in which all stakeholders are engaged to find the best solution for each stakeholder in the hope that these solutions can be combined to produce the best solution for all stakeholders.

I think that something along the lines of the collaborative strategy may have been tried a year ago. Remember the announcements about representatives of insurance companies, pharmaceutical companies, physicians, and hospitals meeting and arriving at an agreeable solution? That sounds very much like the collaborative strategy. That some of the players may not have shown all of their cards or that the Congress wasn’t willing to play along goes some way to explain why that approach died so quickly.

The “Health Care Reform Summit” could be an attempt at employing the competitive strategy. It might just be a sincere attempt at identifying different approaches to reform which could be compared and evaluated.

There’s something about wicked problems that should be remembered. Sometimes the best you can do is bring the various parties together on an ongoing basis in the hope that new relationships could result in breaking the logjam or that something else may change.

IMO it’s very late in the game to start doing that. If you think that our fiscal problems are bad now, wait until you see what happens when as Medicare’s expenses grow beyond its revenues.

{ 5 comments… read them below or add one }

PD Shaw February 9, 2010 at 1:10 pm

“Sometimes the best you can do is bring the various parties together on an ongoing basis in the hope that new relationships could result in breaking the logjam or that something else may change.”

Here, the Democrats and Republicans feel that they’ve been ill-treated by each other, so you either need a series of trust-building exercises or the intervention of an outside party. For Obama to be that outside party, he would need to establish his independence from the Congressional Democrats and give color to GOP concerns — neither of which I believe are likely or perhaps even prudent for him politically. The trust-building stuff ain’t going to happen on TV. TV is like oxygen for political grandstanding.

PD Shaw February 9, 2010 at 1:12 pm

I’m curious about the prospect of Obama calling Scott Brown to the White House to figure out what he believes would make either of the health care reform bills work. I’m not sure he’s the brightest crayon in the box, but he seems better than the ladies from Maine, who strike me as blue state Ben Nelsons.

Drew February 9, 2010 at 1:31 pm

“The “Health Care Reform Summit” could be an attempt at employing the competitive strategy. It might just be a sincere attempt at identifying different approaches to reform which could be compared and evaluated.”

Wow. And I need more than a standard ruler to measure me schlong.

All the evidence to date points to the fact that this crew, the Chicago politics crew, is playing Chicago politics. I see no reason or evidence to believe that this would be anything more than a variant on a monkey trial .

steve February 9, 2010 at 3:05 pm

“Wow. And I need more than a standard ruler to measure me schlong.” I just use a yardstick.

Yes, there is some theater, but this is one of our last best chances. People do not watch C-span or read about what is actually in the proposals. The Republicans will have the chance to offer real proposals that will have to be answered seriously. Obama will have to defend Dem ideas. If nothing else, it should give voters a chance to see who is serious about HCR.

If they do it right, they would have a big board behind them with the pertinent numbers. At least Ryan has conceded that HCR is the most important issue in resolving our debt issues, but I am not sure the rank and file agree with that. The only two items Republicans consistently cite in their proposals are malpractice and interstate competition. As a physician, I dont believe the Republicans are serious about tort reform. Their children are all plaintiff’s attorney like the Dems. The Senate bill has the exchanges which could allow that competition (I doubt it does anything), and in return for support, I suspect they could be modified to make Republicans happy enough.

If they can have the brighter folks lke Ryan make their case it should be especially good. If they let airheads like Pence, or in Congress Bachman, talk it will be a waste of time.

Steve

Brett February 9, 2010 at 11:46 pm

Yes, there is some theater, but this is one of our last best chances.

If it’s fully televised, there will be more than “some” theater. Television is an awful medium for this type of thing, guaranteed to generate sound-bites, posturing, and endless horse-race commentary.

Personally, I’d rather they just publish the complete transcripts of the summit.

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