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Why America is So Mad!

Stanley Feld M.D.,FACP,MACE


I have not had many guest writers. However, I received this essay from a long time reader of my blog, Matt Modleski. Matt is a strategy consultant in healthcare. He has hit the nail on the head. His essay is a worthwhile read.

Somehow the new media (Blogs, You tube, Twitter and Facebook) got America to wake up. Once this happened independent citizens are outraged. They have been expressing their outrage to the dismay of President Obama’s administration.

President Obama’s administration is trying to suppress the outrage by calling ordinary citizens right wing extremists. I would hardly call former New York City Mayor Ed Koch a right wing extremist. He wrote a brilliant commentary on August 10, 2009 about his recent cardiac bypass surgery. It is called:   “ Falling Out of Love With Barack Obama.”

Now that America’s have finally woken up to President Obama’s strategy and true goals, I hope he cannot intimidate or seduce the public to sleep again. 


 As a former Air Force Fighter Pilot and strategist, the political race leading up to the election of President Obama was great fodder for teaching the art and application of strategy. David Axelrod and the Obama strategists are very bright minds; so let’s look at what the overall objective is in reforming healthcare and then look at their strategy for getting there. America is right to be nervous about the proposed legislation because for the most part they don’t want more Government intervention in their lives and clearly that is the strategy behind this legislation.

First of all let’s use the Presidential campaign as our template for understanding strategy. The political climate at the time of the 2008 election cycle was mounting frustration with the status quo of politics and specifically the George Bush presidency in the final 2-3 years. We were engaged in two wars, one elective, the other forced upon us, the economy was crumbling; and we had been duped by the banking system (and the government agencies charged with regulating it). The clear objective for the Obama strategists in Specific, Measurable, Actionable, Realistic and Time-bound (SMART) terms was to get elected as President on November 4th 2008.

Looking at the competition, the strategy of “hope and change” seemed to resonate with most voters across party lines and no-one could tactically out execute then Senator Obama when he stood before America to deliver his message. Life was good for the Obama team. (As an aside, the vulnerability of any competitor lies in their strategy for if you defeat it, you defeat them, Sun Tzu. The Clinton’s are [or hire] brilliant strategists but by the time they figured out how to defeat Obama’s strategy, and they had, they ran out of states and time to accomplish their objective).

Let’s take that template and move on to the healthcare discussion. The state of the union on healthcare is that it is broken. Most people are unaware of how broken it is (we kill between 4000 and 8000 people per month due to mistakes and errors and we waste billions if not trillions each year for a wide variety of reasons). By 2075 if we do nothing and leave Medicare in its current form, it will consume 90% of ALL FEDERAL REVENUE. Those who look at Medicare as the model to copy simply ignore that we aren’t paying for the model they want to copy. That’s a fact that’s typically left off the table.

The bottom line is this, everyone knows the system is broken, but few people know how broken it is and if we delve into all the pieces that are broken, a short term fix becomes impossible. So, rather than put all the broken pieces on the table and explain through the evolution of healthcare how we arrived here, the Obama team has the objective of “reducing the consumption of healthcare” in the US and a strategy to achieve it. I actually believe that is the right objective but I disagree with their strategy and tactics.

In order to meaningfully control the consumption of healthcare, we need to reform the demand side as well as the supply side of healthcare. For ease of discussing this, let’s simply say that talking about both sides of healthcare consumption and how we arrived where we are today puts some politically unpopular topics on the table. Issues such as personal accountability for your health, end of life spending, tort reform, reimbursement reform, insurance reform, care delivery model reform (the list goes on and on) all must be discussed. It’s not one issue, it’s all of the issues intertwined. If we begin talking about all of those issues that plague our current system, imagine how messy that gets politically. Eugene Robinson of the Washington Post articulated this nicely in a nationally syndicated column on August 10, 2009.

So the Obama strategists let the very left leaning Congressional Leadership craft the legislation on their own (which gives President Obama an opportunity to distance himself from the current outrage) and in its totality over time the original legislation would have given the government increasing control of both the demand and supply sides of healthcare consumption. So “government control” is the strategy to meet the objective of reducing healthcare consumption but the tactics required speed in their execution to avoid what’s happened which is America woke up! Fool me once with TARP, but don’t fool me twice with healthcare.

Meaningful reform of healthcare will take a 3-5 year plan, maybe longer, with an educated public and a congress held accountable for making hard choices by their constituents. The care delivery models and reimbursement models alone will take years to overhaul so that care can be delivered more strategically and reimbursement can pay for results not activity. America can handle the truth, but they can’t and won’t tolerate being misled and taken as fools. Our Representatives are learning that the hard way.

Obama’s team miscalculated the fallout and anger of America, but the distancing from the crafting of legislation was not accidental, it was calculated. One of the tenets of being a good aviator is to never let your next decision be your last good option. Obama’s team understands that. This may have been a huge miscalculation or merely a hiccup, either way they will survive; they were all raised in Chicago politics where political survival is an art form and as I have said, they are not dumb.

Here’s the real kicker. Adding access for millions to the current dysfunctional system seems likely as a result of compromise on the current legislation. None of the underlying issues will be meaningfully reformed and we will have huge new costs and the same problems at the core.

America can handle a “big-boy” discussion about the challenges in healthcare and a full-blown discussion of how we arrived in the mess we’re in. They could really handle someone telling them that we will take a long-range strategic approach to fixing the issues and that most of what we like about our system can remain intact. What they appear unwilling to accept is the government running healthcare or someone telling them that we have to reform it in a 3 month span of time when it’s taken 40-50 years to arrive here. America is mad because they’re tired of being misled by their leaders. The 2010 elections may well reflect that anger.”

Matt Modleski


Thank you Matt

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alon

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