Friday, June 11, 2010

The Obama Comprehensive Health Reform Offensive

As Editor-in-Chief of Minnesota Medicine, I once wrote a satire “Healthcaremanship.” I began by quoting Stephen Potter of Oneupsmanship fame. Potter said, “Ordinary health, remember, is highly gambit-prone.”

Little did I realize my little essay would prove prophetic in the Obama era. Little did I realize the health care gambits I described then would become essential political tools.

The gambits were:

The Saxon Sidestep - Words of Saxon origin are short. Their Latin versions are long. Never use a short word when a long one will do. Always say care coordinator (18 characters) rather than nurse (5 characters). implementation (14 characters) rather than start(5 characters), integrated delivery system (27 characters) rather than hospital ( 8 characters). In other words, always twaddle rather than tweet. Go for the long ball, perhaps I should say elongated spheroid.

Management Maneuver – This gambit is more subtle because it rests on this assumption – your opponent knows so little about the arcane art of management that you can baffle him with managerial terms. This works well on physicians. The physician can make decisions on one person. That’s what diagnosis and treatment are about. But he can’t grasp decisions that involve many people. That’s management.

The Management Maneuver is a variation of the Double Dawdle. Maneuver the situation, e.g. a political debate to where a decision must be made involving more than one person. Then drop a pair of managerial words out of the blue. Useful pairs are - feasibility studies, demonstration projects, long-term planning, integrated objectives, coordinated resources, systematic analysis.

Computer Connection – It is always good gamesmanship for the Healthcareman to show what he’s saying has some connection with computers. In the first place, not many physicians know how computers work. Second, computer talk is impressive for its own sake. Thirdly, the computer is a logic machine – impersonal, objective, impartial. There is nothing subjective – or human – about it. Any of the following words will do (in any combination): adjectives (digitized, programmed, binary, compatible, algorithmic,electronic ), nouns (systems, programs, records, feedback, bytes, memory, interface).

Science Screen - Here you simply send up a scientific smoke screen so your opponent will not know what you are saying. Medicine , after all, is a Science not an Art. It is evidence-based. It rests on comparative-outcomes data. Use words or phrases with a scientific ring. Parameter is a good word to unfurl. A parameter is a mathematical concept meaning a variable constant which varies with the circumstances of its application. A scientific word connoting a variable constant is an ideal Science Screen. It will keep your opponent going around in circles.

• Comprehensive Offensive -
This is the single most powerful gambit at the political gamesman’s command. It has rational appeal, it puts the opponent on the defensive, you rarely have to define what you mean, and it produces documents so long nobody has time to read them. Here you use words like universal, international, regional, complete, organized, and, of course, comprehensive. Never say incremental. Obfuscate, do not illuminate, Complicate, do not simplify. Do not gamble, ramble.

Here is the comprehensive offensive at work in the Obama administration, as explained by George Will, the conservative columnist.

“Progressives generally, and Obama especially, encourage expectations as large as the 1,428-page (cap-and-trade), 1,566-page (financial reform) and 2,409-page (health care) bills they churn out as "comprehensive" solutions to this and that. For a proper progressive, anything short of a "comprehensive" solution to, say, the problem of illegal immigration is unworthy of consideration. For today's progressive president, the prospect of a jobless recovery is a comprehensive nightmare. “

In all events, use these gambits often. You’ll find them ideal for obtunding sharpt-witted opponents. Indeed, if you use these gambits often enough, you may even induce complete cerebral shutdown.

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