| 29 July 2016
Dear Interested Readers,
The Objective of This Week’s Letter
If you are a regular reader of these notes, you know that I frequently use the acronym VUCA, “volatile, uncertain, complex, ambiguous”. I have used the concept so often that I risk turning it into a cliche. I have thought that those four words were applicable to just about everything in life but sports. Now with “deflategate” added to the controversies over performance enhancing drugs, and the frequency with which football, soccer, boxing and hockey may induce dementia from even small unrecognized recurrent brain trauma, I now discover that VUCA is under the surface on the sports pages as well in the sections of the paper that cover foreign affairs, domestic policy or business issues. VUCA seems to be some elemental reality of existence, like gravity, light and entropy. It should be no surprise that something as volatile, uncertain, complex and ambiguous as the political process captures my attention and I see and hear shades of VUCA in every speech at both political conventions.
During the fascinating quadrennial fortnight of political conventions, I must take special actions and put safeguards in place. I must make sure that my addiction to politics and my loss of self control during this fascinating two week spectacle does not compromise my attention to good nutrition, personal hygiene and most of the rudimentary “activities of daily living”. I am almost like Ulysses who had his men stuff their ears with wax and lash him to the mast of his vessel so that he could listen to the Sirens’ Song but avoid sailing his ship onto the rocks as he and his men sailed passed their island.
As the header of this week’s letter proves, I did chose watching the Sox lose the first of three games to Detroit on Monday night over viewing the first night of the Democratic Convention in real time. Unfortunately that choice just created the burden of catching up. I took advantage of the wonders of our modern world and via YouTube I saw all the speeches and listened to all the commentary that I missed while the Sox were blowing an important game. I thank the people at PBS who made that possible. I love their commentators: Gwen Ifill, Mara Liasson, Amy Walter, David Brooks, and Mark Shields. I would have hated to miss Cory Booker, Michelle Obama, or Elizabeth Warren. They all gave great speeches. It would have been a shame to miss Al Franken and Sarah Silverman being harassed by the “Bernie or Bust” crowd. Through the miracle of YouTube I got to enjoy the elderly Paul Simon’s somewhat flat but sincere presentation of his “Bridge Over Troubled Water” as a part of a well orchestrated run up to Bernie’s eloquent effort to transfer his support to Hillary. Where was Art Garfunkel?
With both this week and last week’s letter I have tried to provide an objective view of the proceedings, with a particular focus on healthcare. A secondary objective is to make a small contribution to understanding and productive conversation that is worthy of your attention by ameliorating your sense of volatility, uncertainty, complexity and ambiguity as you think about the intersection of politics and your future. I know that your concerns include more than the fears for your personal economic and physical security. The stakes are high as you consider your worries about your family, your community, your organization’s mission, our nation, our world, everyone's healthcare and the future of the planet we all inhabit.
In healthcare we are always trying to solve problems. We like to get upstream from difficulties and look for solutions that consider the root causes of what concerns us. I am convinced that we all see the world in different, very personal ways. My concerns and my realities may or may not overlap with yours. Said differently, there is a broad spectrum of positions that are greatly simplified by reducing the spectrum of viewpoints to liberal and conservative or Republican and Democratic. If there has been any lesson available at both conventions, it is that there is no singular point of view or total harmony within either party.
The Republicans have not recovered from their seventeen candidate sweepstakes, as we saw as most of the losers boycotted Cleveland. That boycott included the host governor, John Kasich! On the Democratic side, the starting number for the primary season was smaller. Long ago we forgot about Jim Webb and Martin O’Malley. Even so, the resolution of the division between the forces of Sanders and Clinton seems just as incomplete as the disaffection in the Republican party despite much effort by Bernie to point out the wins in the party platform and his fear of the consequences of a Republican victory. After the Wikileaks confirmation that there was bias against Bernie at the DNC under the leadership of Debbie Wasserman Schultz, the feelings go deeper than the influence of a magnanimous Bernie can reach or than all the explanations and rationalizations on behalf of over enthusiastic party regulars from Mrs. Clinton’s camp can completely overcome.
Different points of view must be respected and not used as a source of vilification if we are to make progress toward what at least on the surface seems like shared objectives: improved safety, opportunity and health for everyone or as it says in the Declaration of Independence, the universal desire for “life, liberty, and the pursuit of happiness”. I hope that the letter will demonstrate a deep desire to contribute to the evolution of your vision, understanding, clarity and action, and that it will be a small contribution that adds to the momentum of all of us moving together toward the respectful conversations and collective health that are required if all of us and our children are going to continue to make progress together toward a more perfect union.
Just in case you missed the letter last week, it is abstracted on strategyhealthcare.com. Perhaps you have a friend or colleague, in or out of healthcare, who might enjoy this weekly missive. If so, please let them know that they can become an “Interested Reader” by going to strategyhealthcare.com. Finally, more than ever before, during the next 101 days as the conversation about the leadership choice for the next four years intensifies, probably in response to events that will occur in ways that none of us can now predict, please remember to send me your comments by just hitting “reply” on this letter.
From Cleveland to Philadelphia
As I was anticipating the shift from Cleveland to Philadelphia and reviewing what should go up on strategyhealthcare.com, I realized what an inadequate and incomplete job I had done in my review of the Republican presentation in Cleveland. It began when I realized that I had failed to notice the subtle significance or the irony of the choice of the pirated use of the Rolling Stones’ anthem saying that you can’t always get what you want but if you try sometime you find you get what you need at the end of Donald Trump’s speech as balloons fell from on high and the Republicans left Cleveland.
Listening to six or more intense speeches every night for four nights running is hard work. Even with the help of the commentators, the “talking heads”on MSNBC, CBS, ABC, CNN, and PBS, it was often hard to stay focused and understand why many of the speakers at the Republican Convention in Cleveland were thought to have a perspective that the nation should hear. In my dismissiveness I had missed a lot.
There were some noteworthy presentations on the way to the acceptance speeches by the candidates that were lost in the controversy over plagiarism and mixed in among an unusual collection of speakers: obscure “celebs”, mid pack politicians, the understandably sad family members of victims of violence and Trump’s own family members who were diligent in their efforts to tell us that Donald Trump was not really what he seemed to be. In retrospect the most remarkable speech was delivered by Ted Cruz who refused to endorse Trump.
Lost from much notice were the words of the Speaker of the House Paul Ryan and Mitch McConnell, the Senate Majority Leader. They were just about the only members of the the Republican inner circle who did show up. Speaker Ryan spoke for about thirteen minutes. If you listened then, or just listened by clicking on the link, you would have to be impressed with his self effacing humor. He began by commenting that students of trivia will remember that the last time he appeared before the convention it was because he was the party’s candidate for VP. He did acknowledge that he lost without mentioning Mitt Romney and said that in the interim he had needed to find something else to do. He did not mention why Mitt Romney and many of the participants in the 2012 convention were not present and speaking.
For me the highlight of his brief speech was his impassioned presentation of his conservative worldview and his expression of empathy for the impoverished masses who get nothing but “warehousing and check writing” from progressive Democrats. I agree with him that “democracy is a “series of choices”. I respect where he is coming from and have confidence that he is trying to be positive within the limits of his degrees of freedom. He must worry about those to his right who ousted his predecessor and who monitor his every move for the validity of his conservative credentials. I can understand how it must be so difficult to make progress within the limits that he must feel to make each time he must attempt to search for compromise when such a move would be a threat to his own political future.
I was not surprised by his prediction that the Democratic Convention would be a “four day infomercial of politically correct moralizing” that would inaccurately showcase how far we have come and downplay the cost we have paid for the mess we are in. What do you say at a political convention as you are trying to inspire the faithful after the party you love has been captured by an individual who is uniquely different than any politician you ever met before? Someone, a bully, whose rude behavior you continually to need to explain time and time again after each controversial ill advised utterance of disrespect to some group or individual?
I expected his finger pointing at both Hillary Clinton as the source of what is wrong with America and his warning that she, more than any other person or problem, is the greatest threat to the future that all Americans deserve. Again, that is the sort of rhetoric that you expect from a party leader who is both dealing with a disappointing outcome that occurred out of his control, and is simultaneously trying to energize his audience.
I was a little disappointed that he did not seize the moment to explain how his alternative plan to replace the ACA would work. I needed to know how it would meet the objective of providing universal health coverage at an affordable price. I have read his plan and would love to hear him explain why it does not directly discuss improving care delivery or how it will insure the quality of care.
This week I have listened twice more to his speech. My objective was to listen carefully for what he said about Donald Trump. To my surprise he mentioned Trump only twice. The first mention was simply to say that he hoped that at the next “State of the Union” speech he would be on the dias with Donald Trump and Mike Pence. In the most positive portion of his speech he implored Republicans to recognize that they must work to maintain their control of the House and Senate. It was here that he said that the election of Donald Trump, presumably in addition to the Republican control of Congress, was America’s only chance for “a better way”.
Speaker Ryan’s thoughts were in harmony with the speech of Mitch McConnell, the Senate Majority Leader since the 2014 midterm elections. Leader McConnell looked very pained as he spoke for less than seven minutes. His brevity was compounded by the fact that most of his time was spent talking about what a terrible job Barack Obama had done and that Hillary Clinton would be worse. Those remarks gave him little time to talk about the positive reasons for a person to vote for Donald Trump. After listening closely to the speech three times, I conclude based on what he said, that the prime reason that he sees for Donald Trump to be president is that as president he will sign the bills that are passed by the Republican majorities in the Senate and House, and that he will appoint conservative judges that will preserve conservative values and reverse much of the damage done by more liberal courts. I am a skeptic. What makes him so sure that Mr. Trump will cooperate with his vision?
The reticence of Ryan and McConnell underlines the absence from the convention of the Bushes, John McCain, and many of the members of the national leadership of the Republican Party. Republican Governor Charlie Baker had other things to do. South Carolina Governor Nikki Haley was lying low in Cleveland. Even though she attended, she kept a low profile. It seems like many “establishment Republicans” viewed the convention the same way they would think about a root canal. Like the speeches delivered by Speaker Ryan and Senate Majority Leader O’Connell some of the speeches that we did hear focused more on safety, the conservative platform and the failings of Hillary Clinton and Barack Obama than on the positives that Donald Trump would bring to the nation.
Governor Scott Walker of Wisconsin “mailed in" his endorsement by video. I had the sense that many were fearful of what their own future at the polls might be if they strongly expressed support for Trump. They seemed to prefer a strategy to protect their own future by warning us of the continuing malfeasance of Hillary Clinton and emphasizing their personal conservative values.
Governor Chris Christie was a unique case. He openly expressed his disappointment of being passed over for Vice President and seemed to channel that disappointment away from telling us why Donald Trump should be elected by focusing on a sham conviction of Hillary Clinton as a serial felon who should be locked up while simultaneously joining the chorus that implied that she is the cause of all that is currently wrong with America.
My observations aside, the Cleveland Convention was apparently an effective presentation that gave Mr. Trump a huge bump in the polls. The Republican nominee is now projected by the influential website “538” to have a 47.3% chance of winning. It is early, but as the Democrats gathered in Philadelphia, the race for the Presidency was looking like a toss up and it is plausible to anticipate that the election could end up as a tie in the electoral college with the outcome being a determined in a Republican controlled House.
The odds against the Democrats certainly got worse on opening day when a tone deaf Representative Debbie Wasserman Schultz was slow to realize that her moment had passed. Throughout the four days that unpleasantness was a subtle justification of the anger of the more recalcitrant Sanders supporters. Any examination of the Democratic Platform reveals that the Sanders movement had a profound effect on the platform of the Democratic Party. I urge you to read the healthcare section. I have copied the section of the table of contents that covers healthcare. |
| | It declares that healthcare is “a right and not a privilege” and calls for a “public option”. It suggests that everyone be eligible for Medicare at fifty five. It confirms the ACA and calls for its enrichment and the full realization of the Medicaid expansion in every state. There is more, including the promise to shun any attempt to privatize Medicare. It is brave enough to treat gun violence for what it is, a health hazard that kills 33,000 people a year.
David Brooks, the conservative author, columnist and NPR commentator observed that through the speeches of ordinary people, key politicians, victims of violence, proponents of “Black Lives Matter”, as well as “Blue Lives Matter”, the Democrats had positively embraced “conservative” values of patriotism, personal integrity, respect for the rights and feelings of others, and the realization that progress requires community activity and can not be left to the talents of one individual to protect us all.
Brooks and some of his colleagues who were also commentators, as well as many of the speakers including the President, acknowledged that throughout the country there is a great sense of fear for personal safety and a sense of realized or potential loss. These emotions are driving the attitudes of many Americans and explain much of what has happened this year. The speeches had the consistent theme that a demonstrated ability to work with people who have a different point of view “trumps” an ability to do it alone.
Just as the Republicans produced many witnesses to the business skills of Donald Trump the Democrats produced witness after witness to the ability and sincerity of Hillary Clinton. The witnesses that made the most difference to me were Michelle and Barack Obama. I realize that many people have just as many negative feelings about the President’s two terms as I have positive feelings. My goal is not to defend what has happened during his two terms or to place him on the list of Presidents who will be remembered as an achiever that advanced the greatness of America. I know that there are many people whom I love who see him as one of our worst Presidents. It is all a matter of your personal worldview. What I do hope is that many of the hopes that he expresses for a better America will come to pass. At a minimum there are 20 million Americans who now have healthcare.
There is no doubt that the Democrats pulled out all the stops to make their case that Hillary Clinton is the secure choice. Their objective was to shift the conversation away from the view that she is untrustworthy and toward the theme of working together. The height of this strategy for me was the presentation by a Muslim father whose son died defending this country. In slow and pained words he offered Donald Trump his copy of the Constitution so that he might understand how the founding fathers had envisioned government by the people and how those principles had evolved to be inclusive. Then asked what Donald Trump had ever sacrificed for America.
Hillary Clinton’s “relatively short” (fifty five minutes) speech focused on the theme of working together and that “love trumps hate”. She tried to move from “what” she has done in public service to “why” she was motivated to serve. She saw her family, as benefiting from the “kindness of others” and adopted the fundamental principle of service that she had learned from her mother and her faith “to do all that you can, for as many as you can, for as long as you can”. She admitted that she “sweats the details of policy” because the facts are a “big deal”. She reminded us that when a barrier falls it clears the way for everyone.
The trick for her was to celebrate the accomplishments of the last eight years and also acknowledge the persistent problems and the fact that so many people still suffer from the inequities of the distribution of opportunity. Her list of things to be done rejected the idea that in anyway the status quo is acceptable as she emphasized that things should change. “It is wrong for business to accept tax breaks with one hand and pass out pink slips with the other hand”. She hit all the hot issues from climate change to a fifteen dollar minimum wage and decried Citizens United. Her list was a list that was similar to Bernie Sander’s list of problems demanding resolution and President Obama’s list of unfinished tasks and emerging problems. There were many zingers directed at Donald Trump, like his ability to avoid and ignore his debts while not addressing the debts that students incur. What she never addressed was the fact that so many people say they do not trust her.
There is no doubt that both candidates contend that they can do the work of getting America moving. Getting anything done will require overcoming gridlock. Trump asserts that his business skills will do the job. Clinton points to her record of bipartisan accomplishments as evidence that she can do it.
They called Margaret Thatcher the “Iron Lady”. Those were the words that came to mind as she asserted the points of her strategy to defeat ISIS. She drew a roar from the crowd when she said, “A man you can bait with a Tweet is not a man you can trust with nuclear weapons!”. She talked tough to the NRA while promising to preserve the Second Amendment. She said she could not believe that we cannot find common ground on race, guns, and immigration.
Hillary Clinton was labeled as untrustworthy and duplicitous by almost every speaker in Cleveland. In Philadelphia she fought back and was on the offensive against Donald Trump. She presented a compelling picture that was an attempt to refute the Republican view of her. David Brooks thought her speech was a below average speech in an otherwise great production. He also added that neither candidate for president or vice president had given an exceptional speech. Other commentators were more charitable. As the fireworks exploded and as the balloons fell, the question ahead was articulated by one pundit as “we the people” versus “I alone can fix this”. In time we will learn who really made the best case to be given the honor and responsibility to lead America.
We have heard the opening arguments from both sides. I am sure that there are many on both sides who are energized and ready for the next round. I will continue to monitor the healthcare debate within the larger contest. An election is a chance to begin again and take advantage of lessons learned.
Finding an Aerobic Pace For the next Three Months
Like it or not, the next three months will be a marathon of negative political ads and abrasive debates, as we anticipate frightening unexpected events at home and around the world. We expect the ads and the debates. Waiting for events that we fear but can’t predict with certainty and are always followed by more ambiguity about what to do, is exhausting. Did the Russians hack the DNC to help throw the election? Will ISIS stage attacks designed to disrupt our internal political process? Will some deranged and self appointed agent of change decide to gain a few minutes of personal attention with an assault rifle instead of accepting the opportunity to cast a ballot as a way of participating in the orderly democratic resolution of the questions that concern all of us? The unknown will be the origin of a weariness that will grow as we get closer and closer to November 8.
I know about marathons. The key is a slow aerobic pace. The most useful way to be sure that you are running or walking at an aerobic pace, is to talk as you go. Every experienced walker or runner knows that if you cannot talk, you are not aerobic. I plan to do a lot of walking and talking as the next fourteen weeks roll by. If I don’t keep moving, I am sure that my concerns will overcome me.
I hope that over the next one hundred and one days you will pace yourself toward your own vote based on your best analysis of who will do the best job.
|
| Be well, stay in touch, and don’t let anything keep you from doing the good that you can do every day,
Gene
|
| | | | | |
