Sunday, June 26, 2016



Perfect Political Storm
In 2010,  in November 210,   7 months after ObamaCare’s passage,  I wrote this blog.
“In 1997, Sebastian Junger, an author and journalist, wrote the best seller, The Perfect Storm, later a movie. The book told the story of fisherman off the New England Coast trapped by three converging weather systems.
Three Weather Systems

• Warm air from a low pressure system coming from one direction.

• Cool, dry air generated by a high pressure system coming from another direction.

• Tropical moisture provided by Hurricane Grace.

An Analogy

This is a good analogy for today’s perfect p health reform storm.

• Warm air, suddenly heating up as evidenced by the midterm elections, from a low pressure system coming from outside the Beltway, with conservative Americans calling for smaller government, less interference in their lives, lower taxes, less spending, less debt, and “taking our government back.”

• Cool, dry air provided by a high pressure, dispassionate, scientific, management-oriented Washington insider elites speaking in cool, dry terms about the need for a rational restructuring of the whole system from above.

• Tropical moisture (both sides claim the other side is all wet) producing a hurricane of opinionated bilateral rhetoric speaking in apoplectic and apocalyptic terms about the abyss that lies ahead if their respective opinions do not prevail.

Caught in the Middle

Caught in the middle of this perfect reform storm are physicians and patients who fear the worst, who feel they have no reform voice and no control over impending colliding weather systems.

On the one hand, American health consumers have high expectations, fueled by the high tech performance of the current system, and the promise of a new entitlement system providing more care at lower costs. They expect the best medicine has to offer at more “affordable” price. These twin expectations are central elements of the perfect storm.

On the other hand, a centralized government is saying the whole system must be overhauled and restructured, and physicians must offer less costly care under a system of expensive regulations with which they must comply at lower reimbursement rates without protection from tort reform.

On the third hand, sometimes called the third or the center-right way, there may be a middle way out the storm, through disruptive innovations using cheaper care at decentralized locations, like the home, provided by less sophisticated personnel using electronic , and downsizing of the whole medical enterprise.

Time Not on Side of Those in The Boat

The problem with all of these scenarios is that with an imminent perfect storm, time is not on your side, the reckoning is at hand, and physicians in the boat with patients, must cope with the consequences – the impact of the perfect storm on their professional and personal lives.”

Today’s  Political Storm

Which leads to the present blog.    The health reform storm I described  6 years ago now involves  3 world-wide weather systems  colliding with one another.

First  are forces of globalization, standardization, and socialism.  These forces call for international economic integration,    top— down remote  political  organizations  dedicated to leveling  and closing economic gaps  between nations,   all acting together in harmony   to  combat climate change,  and  to promote immigrations  across nations without borders- all led by experts and elites and bureaucrats using information from cyberspace  and deploying  algorithms to elucidate and  to crystallize complexities to make the world more efficient, rational, and equal.   The elites, the young,   the well-educated, and the IT-skilled tend to belong to this movement.

Second are forces of  nationalism and cultural preservation. These forces, sometimes marching under the banner of populism. maintain globalization has not delivered on its promises , is destroying national identities,   is stifling innovation and business with bureaucratic shackles, is ignoring common workers  and the middle class  while feathering nests of the elite,  does not meet the needs and destroys the traditional life styles of common folks  and  has little idea  how the real world works, and fail to realize mass integration changes their ways of life.   Older people, those left out by globalization, automation,  IT-displacement belong to this school.

Third are forces of economic reality.   These forces say there is something badly wrong  with current forces and trends ,  which have  produced  deep  unemployment , massive migrations,     a world-wide recession from which the West has yet to emerge,   political instability and uncertainty, and  rise of terrorism.   Something profound, even revolutionary,   has to happen.  This change can no longer be ignored or placed in the hands of traditional elites, who say the answer lies in patience with  the status quo and  incremental progressivism.     Hence the rise of Trump,  Brexit,   populist movements in Europe,  socialism among the young,  and  the call for a radical change of direction. 

The political question is:   Has the time come for fundamental change, or should it be steady as she goes with incremental fixes at the edge? 

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