Ned Lamont reached national prominence in 2006 as the Democratic nominee for the U.S. Senate from Connecticut. He spent eight years in local government, chaired the state investment advisory council, and served on many civic boards. Lamont will be speaking at the Take Back America Conference .
Sometimes big challenges require big solutions, and the jury is still out on whether Washington has the confidence and the will to take on the big problems we are bound to confront in the future. America was not always so cautious; from social security to the national highway system, from NATO to the Marshall Plan, our 20th century leaders were bold and entrepreneurial. Today, an earmark here or a tax credit there masquerades as a policy as our health care system and aging infrastructure and energy future become increasingly tougher to manage.
As an entrepreneur turned Senate candidate last year, I was struck by the lack of entrepreneurial spirit in the public square, where ideas are routinely discarded as "extreme" and problems left to fester. In the age of the mainframe, the PC was an extreme idea and the Internet an unthinkable fantasy; while music lovers have moved from vinyl to 8-track to mini-cassettes to CD’s and now the iPod, our government systems have been calcified and increasingly fail to keep pace. At the Take Back America conference in Washington D.C., I take an entrepreneur’s eye to one of these intractable political quagmires which are so resistant to change—the health care crisis.
It’s been said that we can always count on Congress to do one of two things—nothing or too much, and the word "crisis" attached to an issue puts it over the top. Health care has reached that stage when labor and management, old and young agree that we are on an unsustainable track with health care costs bankrupting working families, businesses large and small, and soon even government, and all the while the number of uninsured and underinsured is exploding. The political debate breaks down as we narrow the problem to one of cost, quality or coverage—as if the three are not part of the same problem.
The facts are inescapable: America spends twice as much on health care per capita as any other country, we have a life expectancy which is 29th worldwide, just below Bosnia-Herzegovina, and we have 46 million without health insurance—and growing. Half of the $2.2 trillion spent on health care is private insurance (employer based) and half is public (Medicare and Medicaid). As our population ages and health care technology gets more expensive, costs are going up faster than inflation and economic growth, which is putting the American economy at a disadvantage compared to our trading partners. Clay Christiansen writes in The Innovator’s Dilemma that large bureaucracies are immune to change since they have too many incentives to maintain the status quo , so change comes from the outside. Allowing a modernized Medicare system to compete with private insurance in providing health care for all may just sharpen the competitive juices for public and private providers alike and move our health care system into the 21st century.
A 21st century Medicare system will allow any individual or business to buy in, and it will invest up front in wellness, with a greater emphasis on disease prevention via earlier testing, diagnostics and screenings. High-deductible plans discourage use of these "elective" procedures; low cost walk-in clinics make prevention and early detection more, not less, likely. People without insurance wait until they are sick, requiring the most expensive and least successful treatment. Preventing preventable chronic disease—say diabetes or cardiovascular—from happening or getting worse provides better quality at lower cost. This is the makings of a core package which is required of all Americans.
In business, we entrepreneurs have the luxury of starting with a blank piece of paper and creating a new enterprise from scratch. In government, it may be politically easier to build off what we have, but that is no excuse for being timid. Opting in to a 21st century Medicare plan should be an option for families and businesses alike, allowing anyone regardless of pre-existing conditions to buy into a core health care package which promotes health and wellness as well as treatment for disease and injury. Too much of health care has not moved from the mainframe to the Internet (much never even made it to the mainframe); required electronic record keeping will prevent most of the duplicative and contradictory medications and procedures which cost our system hundreds of billions each year. This is the makings of a core package, which can not discriminate against any applicant; constantly updated for efficacy and new innovations, this core package will be the starting point for private and public systems alike; now let the plans compete: that’s the American way.
Over time, many believe that the private systems will be more efficient and will win in the competitive marketplace; others believe that the heavy administrative costs of the private systems mean that America will end up with Medicare for all. Government’s job is to level the playing field, set the rules: let the best plans win. Our 2007 health care system is a lot like General Motors—poorly managed with serious quality issues and burdened by legacy costs, all of which are slowly bankrupting the company. An executive recruiter looking for the next CEO of GM is not looking for a moderate who will manage by increment; he is looking for a bold visionary who will fundamentally change the company and allow it to compete in the 21st century. Our health care system requires just such leadership.