Hospital Food for the Mind

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Okay, let’s get one thing straight. This post is not about hospital food even though I work in said institution and eat its food almost daily.

I’ve decided to create a new sometime feature on Extreme Thinkover that I’ll write on my lunchtime sitting in our dining room eating hospital food. That’s the hook. Pretty simple, but these posts will mostly be short on account of the time constraint of my lunch time.  Get it? Good.

Here is intallment #1:

The debt ceiling.

If I were a member of congress, I’d vote no.  Why?

If Sen. Mitch McConnell is smiling, anyone with the slightest leaning toward progressive and responsible government should be running screaming in the opposite direction.  That smile means he just defeated the White House and the Democratically-controlled senate.

Put that all together and you have guaranteed a horrendous piece of legislation that will generate some of the worst intended and unitended consequences in the history of the country!

I agree with NYTs columnist Paul Krugman that this bill is a disaster. I’d add a disaster based on a delusional Zeitgeist fueled by those whose political self-centeredness creates a whole new clinical diagnosis above narcissism. Perhaps it could be named TEA: Terribly Egopolitical Agitators.

 

I strongy disagree with PK, however, that the only stance is to be a stiff-backed progressive, and being a centrist is a bad thing. If we had a significant number of centrists in Congress supporting the president, I contend we might not have ever gotten into this ugly extremist versus extremist battle-royale to begin with.

Update:I received a note from one of my readers that my use of the phrase “tea bag” is a code word for a particular sexual act, something I was not aware of. So, yes I rewrote part of the post. I wanted to convey my consternation, not make a veiled peurile insult. Even though both Houses passed the bill and President Obama will sign it, I still would have voted “no.” DW.

Boehner Blink?

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Question #1 regarding the Federal Budget Debt Ceiling Limit Talks is are we hurtling toward a disaster on August 2?

Although the actuality for the U.S. Government and economy (depending on which pundits you choose to believe), may be more political than a real fiscal disaster, the political war of words has escalated to an incredible intensity.

Anyone paying the least attention to the rhetorical clashes between the political parties–and their internal factions–knows that the positions on both sides have been hardening, although perhaps ossifying (even fossilizing) might be more appropriate.

August 2, 2011 has become an temporal Great Wall of China (yes, I get the irony of the comparison).  Imagine two opposing armies charging headlong toward it from different directions, oblivious to fact the wall is not going to move.  Even though they hit the wall at the same time, the damage they inflict upon themselves will be enormous.  Evidently, only in the split second after the crushing blow of charging warriors into the wall begins, will the generals of both armies realize the magnitude of their mistake.  The Wall, though, won’t be hurt much at all.

In this game of chicken with an unmovable object, however, something unexpected has just happened.  Rep. John Boehner, Speaker of the House, perhaps, has blinked. The New York Times reports (9 July):

Citing differences over tax revenues, House Speaker John A. Boehner said on Saturday night that he would pull back from joint efforts with President Obama to reach a sweeping $4 trillion deficit-reduction plan tied to a proposal to increase the federal debt limit.

Huh.

Now.  Who’s paying attention?  Will the Republicans, both the Mainline and the Tea Party factions trust Boehner’s judgment and unexpected move?  Is their iron-will to resist compromise, in the end, a strategy they can hold up as a prize, not only in congress but with their base?

Will the Democrats pull back from their headlong rush into the wall as well, and trust that the President’s growing pressure on Boehner to soften his position is having an affect that will meet their political goals regarding the deficit cap, as well as those for the Federal Budget and the economy in general?

We’re going to find out in just a few days.

Landing the Health Care Reform Bill: It Feels Like Apollo 11 Redux

The voyage of the legislation to create a Health Care Reform Bill has all the

Sen. Harry Reid Launches Health Care Reform in U.S. Senate. Photo credit: C-Span

emotional elements of landing Apollo 11 on the Moon in July 1969.  Health Care reform has been a long, complex mission with an uncertain outcome.  Is it an overstatement to say that landing on the Moon and returning to Earth was an easier and safer endeavor than getting the Health Care Reform Bills passed, conferenced and onto the President’s desk for signature?

At this moment, it seems almost to be the case.

When Neil Armstrong took manual control of the lunar lander to find a safe spot to set down, a thousand different things could have gone wrong.  In fact, alarms were going off in the cockpit.

As the Eagle’s landing radar acquired the surface, several computer error alarms appeared. The first was a code 1202 alarm and even with their extensive training Armstrong or Aldrin were not aware of what this code meant. However, they promptly received word from CAPCOM in Houston that the alarms were not a concern. The 1202 and 1201 alarms were caused by a processing overflow in the lunar module computer. As described by Buzz Aldrin in the documentary In the Shadow of the Moon, the overflow condition was caused by his own counter-checklist choice of leaving the docking radar on during the landing process. Aldrin stated that he did so with the objective of facilitating re-docking with the CM should an abort become necessary, not realizing that it would cause the overflow condition.  Source: Wikipedia

Eagle Lunar Lander just seconds after separation, Apollo 11, July 1969, Photo: NASA

It’s one thing to read about it.  As we close this 40th Anniversary of the Apollo 11 Landing, it really is much more satisfying to watch it.  This video is one continuous shot of approximately the final 10 minutes of the descent and landing, viewed from the right window of the LEM.  The audio is quite good, as well.  Watching it still stirs in me that sense of excitement I felt as a 16 year old kid glued to the TV set with my family.

[For a similar, but NASA produced video, click HERE.  This is the final approach, and included is an inset window that tracks the Lander’s progress crater by crater.  It provides a sense of perspective for the approach.]

Regarding the impending passage of the Senate bill and then the conference process, if you tend more toward the pessimistic side, you probably agree with Jonathan Cohn of The New Republic:

If your standard for comparison is your ideal health care reform, then of course this will be disappointing. Like every bill that’s moved through Congress, this one would leave millions uninsured even after full implementation–and leave millions with coverage facing substantial, although generally not crippling, financial burdens. It would introduce some reforms to the delivery system and, according to the official cost estimates, generate budget surpluses over time. But it’s not going to radically turn American health care into a paragon of cost efficiency.

If you tend more to the optimistic side, you probably agree with Paul Krugman of The New York Times:

Let me say that I get especially, um, annoyed at people who say that the plan isn’t really covering the uninsured, it’s just forcing them to buy insurance. That’s missing not just the community rating aspect, but even more important, it’s missing the subsidies. And we’re talking about big stuff: between Medicaid expansion and further support for families above the poverty line, we’re looking at around $200 billion a year a decade from now. Yes, a fraction of that will go to insurance industry profits. But the great bulk will go to making health care affordable.

So how anyone can call a plan to spend $200 billion a year on Americans in need a defeat for progressives is a mystery.

I wish there were a public option in there; I wish there were broader access to the exchanges; I wish the subsidies were even bigger. There’s lots of work to be done, work that may eventually culminate in a true, not simulated, single payer system. But even in this form, we’re looking at something that will make America a more just, more secure nation.

If you are a Republican or Tea Party Advocate, you are most likely hoping and praying the Health Care Reform bill will suffer the fate of the Soviet Luna 15 Lunar Lander Probe that was launched three days before Apollo 11:

Luna 15, launched only three days before the historic Apollo 11 mission to the Moon, was the third Soviet attempt to recover and bring lunar soil back to Earth. The spacecraft was capable of studying circumlunar space, the lunar gravitational field, and the chemical composition of lunar rocks… After completing 86 communications sessions and 52 orbits of the Moon at various inclinations and altitudes it began its descent. Astronauts Armstrong and Aldrin had already set foot on the Moon when Luna 15 fired its main retrorocket engine to initiate descent to the surface at 15:47 UT on 21 July 1969. Unfortunately, transmissions ceased only 4 minutes after deorbit at a calculated altitude of 3 kilometers. The spacecraft impacted the lunar surface on July 21, 1969. The spacecraft had probably crashed onto the side of a mountain.   Source: Wikipedia.

Launched 3 days before Apollo 11, the USSR's unmanned Luna 15 crashed onto the Moon's surface just hours after the Eagle had safely landed with Armstrong & Aldrin on board.

I’ll give House Minority Leader, Rep. John Boehner (R-OH) the final word…

Photo courtesy Politico.com & BlueStateDigital.com

No, I think I’ll give this Tea Party protester the final word.  Just like the rest of us loyal and patriotic Amurricans, life without spell-check is worse than…oh, wait, he spelled the word right.  In high school he clearly decided to protest which sections of Mrs. Dewey’s English classes were not patriotic enough, because he was getting this way-too-liberal education paid for through public taxation.  And those unacceptable sections happened to include homonyms and writing complete sentences.  I think his pointy hat needs to be cone not a tri-corner.

A Tea Party Protester: The Epitome of the Well-Educated American. Photo: ImageShack

Radiation Sniffer: On Alert for the Nuclear Option

In my post of July 3, I made the bold suggestion that the various Big Medicine groups could very well be planning to “drop the bomb” on the whole effort toward Universal Health Care, either before the legislation was finalized and voted on, or perhaps even after.  I called this the “Nuclear Option.”

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.

The question is, in all fairness, even though my hypothesis using organizational theory predicts the likelihood of an attempt to prevent UHC from becoming law, or destroying it after it is passed, is there any evidence to support it?  I also stated,

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 political and economic environment is volatile and turbulent.  What I needed was a “radiation sniffer,” so to speak, a virtual monitor that would look for “leakage” that might be evidence of the Nuclear Option being planned.  At the same time, I needed an operational definition for “sniffing radiation” that would naturally provide boundaries against my finding “evidence” under every rock just to prove my hypothesis.

That set up two basic choices.  One would be to look for evidence that claimed outright that this group or that was planning to use their version of the Nuclear Option.  The other was to look for evidence that the players known to be facing the biggest losses were playing their game very close to the vest; in other words to look for evidence where what was not being said was more important that what was.

I chose the second.  This is why:

Therefore, if the individuals on the [Big Medicine] Boards and their 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.

And, the status quo has been for decades to work politically behind the scenes through lobbying and other forms of influence.  The job of the Public Relations department is to create a public face for the organization that oozes altruism and the common good over the corporation’s true mission to make as much profit as possible using every Machiavellian principle in the book.

Preparing the Nuclear Option requires planning, stealth, subterfuge, and sleight of hand.  In Board rooms around the country listen for the clink of glasses filled with expensive hooch, accompanied by the toast, “They’ll never see it coming!”

Am I skeptical and mistrusting of organizational motivations?  Of course I am.

Here is my first example for possible radiation, in a piece written by David Herzenhorn and Sheryl Gay Stohlberg for the New York Times, July 7th, titled “Health Deals Could Harbor Hidden Costs:”

Rather than running advertisements against the White House, the most influential players in the industry are inside the room negotiating with administration officials and leading lawmakers, like Senator Max Baucus, chairman of the Finance Committee.

“The very groups we have been talking to have been the most vocal opponents of health care reform; they are now becoming the vocal proponents for health care reform,” said Rahm Emanuel, the White House chief of staff.

How very “chummy” of them.  Sniff, sniff.

The Radiation Sniffer is now fully operational and on-line.  Watch for more to come.  Or if you find something interesting, send to me and I’ll check it out.

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.”