Saturday, June 4, 2016

Health Care Scale and  Ramrod Politics
If I’ve learned anything writing these blogs, it is this.
When it comes to success in health care,  size matters.  But when it comes to politics, size is often meaningless unless you have the backing of the public.
The most successful health care organization  have size.   The budgets of Kaiser Health,   the Mayo Clinic,   most academic health centers, and most integrated health systems exceed $1 billion.   They have economies of scale.
But  although budgets  the U.S. government and CMS are over $3 trillion and $1 trillion respectively, voters do not regard  their initiatives and programs as successful.     Examples  are the Accountable Care Act,  the Iran Deal, and the administration’s  immigration policies.
Why the differences?  
In the first place,  large successful health care organizations  generally have collaboration between  its leaders and its physicians.   It doesn’t matter if you are labeled as conservative or liberal or independent.
But in politics,  your political label matters.  It particularly matters  if  the President  or Congress practices ramrod politics,  Unilaterally forcing  policies  down the your opponents gullet until it sticks in their craw and leads to bitter partisan divides and gridlock and name-calling.    
Political ramroding , and duplicitous  ways around Congress,  are at the heart of today’s heated political climate.    Deleting of videos,  withholding of emails,   stonewalling,  secret negotiations with other nations, thinly-veiled seductions of friendly journalists,  and sidestepping of Congress through questionable executive actions  doesn’t help.  
Nor do insults from both sides of the aisle.    You  have to collaborate – to debate, discuss, and give-and-take – to get something done the majority of  the public will accept
Nor does it help to try to mimic the private sector by creating  politically motivated  large organizations  like Accountable Care Organizations which presumably have economies of scale that hospitals and private practitioners  may not have.

As Nancy Jacobson in the “Residue of Ramrod Politics” remarks:

l three branches of government must participate at all times, following the guidelines outlined in the Constitution. Major reforms warrant major debate – the public must see the necessity and the merit in reform rather than be force-fed changes.”
“This requires collaboration. It requires the next president to make problem solving a priority – there will be no shortage of problems once the dust settles from what is already an ugly campaign. And from that dust will rise an opportunity – a true leader will unite both parties around the idea that our nation is capable of great things, that issues like the national debt, Social Security and Medicare, employment, and energy security are not unsolvable issues. A true leader will remind us that our differences are as crucial as our commonalities, but that above all, we are united by our love of this unique nation.  The next president will have to resist the urge to follow Obama’s lead; this leader will have to clean the residue of ramrod politics from the Oval Office, and respect the legislative process.”

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