Universal Health Care Confronts the Nuclear Option

The Nuclear Option (just for those of you who are stilled mired in Bush-speak, it is pronounced “new-klee-ur” not “new-cue-lar”).  In this case I’m not talking about the U.S. Senate rule called “reconciliation.”

No, in this case I’m wondering what is going on in the minds of those who have so adamantly and vociferously have opposed Universal Health Care in the United States.  Yesterday, Paul Krugman New York Times columnist, wrote in his blog,

Yes, we can

Get more or less universal coverage, that is. The CBO scoring on an incomplete bill sent everyone into a tizzy — and also led to an avalanche of bad reporting, with claims that it said terrible things about the public option. (There was no public option in the bill.)

Now the real thing has been scored — and it’s OK. Something like 97 percent coverage for people already here, at a total cost somewhere in the $1 trillion range. Bear in mind that the Bush tax cuts cost around $1.8 trillion over a decade. We can do this — and have no excuse for not doing it.

In the minds of the opponents of UHC, however, nothing has changed.  That’s what worries me.  In fact, as the evidence mounts that assuring every American has access to health care can be a reality and not doom the economy (as they have so desperately hoped), the opponents are realizing the End-Game is upon them.  They are losing.  Not only has every traditional method of obstruction not worked, or not worked well, the vast majority of Americans are solidly against them.  Heard any good anti-health care spin from Rush, Karl, John Boehner, or Mitch McConnell in the past couple of weeks?  If they were gaining ground with their argument, neither the election in Iran or Michael Jackson’s death could drown them out.  Not even South Carolina Governor Sanford’s adventures in Wonderland would diminish their clarion call for Big Medicine.

Their voices have faded to background static.

Do not assume for a micro-second they have given up.  They are preparing the Nuclear Option.  One all-out attack on universal health care, with no regard for collateral damage, just the health of America.  In the Board Rooms of the Insurance Megacorps, Big Pharma, Corporate Hospitals, and dozens of other stakeholders firmly anchored in the Status Quo, they are planning to bring this down.  Once and for all, to obliterate the very notion of universal health care so completely, that  it will never threaten their companies and profits again.

Am I paranoid?  Well, even if you are not paranoid doesn’t mean they’re not out to get you anyway.

I’m not paranoid, actually.  I’m well read in organizational theory (it was the corner stone of my doctoral dissertation in educational policy and management), and I understand how organizations respond in unstable ecologies and economic turbulence.  When resources are threatened, the people running the organization will tend to react in predictable ways.  When the operational environment changes more quickly than expected, or in ways unanticipated, the predictable management responses are more and more stressed.  If those responses lack the ability to guide the organization through transformational change (like, oh, General Motors), the likelihood of the company failing is very high.

Keeping all that in mind, when the entire global environment, e.g., the country’s health care system, begins to collapse because of a rapid set of ecological changes so powerful the only way to survive is to change transformatively (an analog of the evolutionary concept of “punctuated equilibrium”), only those institutions that have the capacity to change at the same rate and direction required for survival will likely survive.

How, then, does the Nuclear Option fit in this model?  Organizations use their resources to influence and improve their ability to survive in the existing ecological conditions, and eliminate competition for both the resources they need to exist and to improve their chances for greater access to those resources.  But here’s the rub: Organizations are “communities of fate.”  They are actually aggregates of individuals whose investment (personally and professionally) in the success of the organization varies from person to person.  In a corporation, those who have have highest investment are typically the Board of Directors and the Shareholders.  But they have to rely on managers and workers, to both produce and protect their investment.

The managers and workers have a much different perspective on the degree to which they consider the company their community of fate.  When the organization encounters increasing turbulence in its environment, the willingness of the people actually doing the work to cast their fate to ensure its success is much less certain.  If the situation worsens to the degree the survival of the company is in question, the confidence the managers and workers have in the Board’s decision making ability to, specifically save their jobs, can change very quickly.  Some workers will leave the company and look for more stable employment.  Others will stick with it until the bitter end, if it comes to that.  But if you work for an Enron, the house of cards can collapse on top of you regardless of your loyalty.

The pressure on the Board and the managers to keep the organization both alive and solvent can increase rapidly, especially in the situation where the environment and resources are changing at a rate unprecedented in history.  Even organizations that survived earlier transformational evolutionary changes may not survive the current one.  Because of the anxiety generated by the environmental turbulence, the shareholders put more pressure on the Board and managers to preserve their investment and continue to pay dividends.  The workers who are loyal to the company also put pressure on their supervisors to help preserve their jobs.  But loyalty to the community of fate by the worker is always much riskier, because the Board and the managers can, at  any time, cut positions that can eliminate the most loyal employees under the stated intent of protecting the viability of the organization by reducing personnel costs.  This trauma to the community of fate, however, is no guarantee the organization will survive the changing ecology.  It may, instead, guarantee its demise.

Now, here’s the part, as I build the case for the Nuclear Option, that I as an organizational theorist suggest sets the stage:  The critical decisions of the Board over time to adjust to the turbulence is a not a function of taking the most conservative stance in context, but is a function of the individual members of the Board and the Executive Managements’ ability to manage their anxiety in the midst of the turbulence, and at the same time abandon the mimetic* solutions traditionally used to control that anxiety across the organizational or industrial environment.  [*mimesis: from "mime."  A concept in organizational ecology that says Company A will observe Company B, and adopt a successful process to "avoid reinventing the wheel."  Over time this mimed process may become an industry standard.  The down side is that when the environment changes, continuing to adopt the mimed process may limit innovation and increase the chances of organizational failure.]

Therefore, if the individuals on the Board and the Executive Management fail to manage their anxiety about the turbulence and the implications of transformative change in motion, and as they realize their historical resources for influence (i.e., lobbying) are waning, they will tend to take the most conservative stance to defend the survival of the organization, and that stance will tend to be to preserve the status quo at all cost.  As organizational rigidity increases, adaptibility and innovation are stifled.

The door for the Nuclear Option is now open.  Why?  Because the real-life environment to which we are applying my theory is not  just one company; we are applying it to a multifaceted industry that has for decades successfully resisted and obstructed the move toward universal health care.  And they know that by conspiring together and pooling their resources, they can potentially create a huge wall of resistance.  This strategy has a flaw, however.  A significant percentage of companies in the industry are supportive of UHC, and are already changing the practice of their organizations to successfully ride the transformative wave.  This fact only serves to increase the opponents’ anxiety.  Who has the most to lose?

The portion of the industry that opposes UHC has powerful political and social connections.  The Republican Party, although reduced in its influence at the last election still has significant resources at its disposal, as well as a core of voters, who for numerous reasons at least state they don’t want to pay for UHC.

This set of circumstances, powered by huge finances, politics, ideology, and desperation creates the possibility that those who have the most to lose as they perceive it are going to try and “drop the bomb” on the universal health care.  Whether they make their move before the Congress acts, or, have a strategy to destroy it even after it has been signed into law, I can’t tell.  But I believe they are well into their planning and will indeed act.

A final note.  Another principle, not from organizational theory, but from psychohistory, is also undoubtedly in play in this situation.  Speaking not literally, but figuratively:  “Violence is the final refuge of the incompetent.”

About these ads

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s