Are our representatives really listening?

It seems we are not going to see the end of this health care debate for a long, long, time. Most offensive is that the politics of the issues have become more visible, and seemingly more important, than the principles that should, in fact, be guiding the reform.

The New York Times hits the nail on the head when it states "In a day of desultory debate..." Desultory. Yes, the very heart of the problem. Without plan or purpose.  Except, of course, political gain for one side or the other. Good decisions cannot be reached without clear, agreed upon, purpose.

Health care reform. The guiding criteria that our elected officials should be using to frame such reform still remain unstated or they lack affirmation. What is the definition of health care -- not as an industry that insures, but as a service to this nation's citizens?  Is health care a right of these citizens? Should it be available to all, or only to some?

Instead of framing this reform in terms of these key elements, the "issue" of health care reform is being framed in terms of personal political gain: Make a name for oneself.  Win for one's party. Keep "the other guys" from making progress.  Manipulate and "pitch" to constituencies to ensure an election "win" in the future.  Leverage the "issue du jour" in one's own favor.


Is this "debate" for the good of the people?  No.  We can be but assured that it is for political gain.

Political primping and positioning are fomenting a feeling of resentment in the popular base, which our representatives should by now realize is the constituency most widely and directly affected.  This base is neither being represented nor heard by those who are "debating." Contacting elected representatives invariably results in electronic platitudes and form letters stating unwavering pre-set positions, which in turn indicate that opinions and comments are basically unheard.

Statements continue to be made about "affordability" and, in the same breath, those remarks are linked to others such as "no major increase in premiums will be made for the overwhelming majority of Americans who already have insurance."

Have our representatives completely swept under the rug the uninsured Americans, along with the reason for their being uninsured -- premiums that are, and have been, too high, i.e. beyond the range of "affordability?"

It is imperative that our representatives step out of their own shoes.  Most Americans do not have the ability to pay the same premiums or deductibles that these representatives encounter in their lives.  The insular world of Representatives and Senators, with salaries of $174,000 per year (with an annual cost of living increase) cannot be the basis of understanding the angst of someone with a minimum wage job earning $7.25/hour ($15,000 per year), who hears of "continued levels" of existing already out-of-range premiums or of $5,000/year deductibles.  These remarks reveal that the lawmakers are completely out-of-touch with reality.

For a representative, it must be considerably easier, if not "more important," to "listen" to those entities who make big contributions to one's campaign. However, individuals in this society, whether they make millions or make peanuts, should probably take heart in knowing that corporations may "vote" only with their money.  The hope here is that ballots on election day, cast by individuals, will remain the only ones that can return an elected official to their seat.

The business of making a nothing day into something "special"

Today is "Black Friday."  Once an ordinary day, business decided it was "an opportunity." It was bestowed with a special name, and a good deal of hype.  ("Cyber Monday" is another day recently given a business makeover.) "Black Friday"-- the moniker alone drives me crazy.  "Black" is not an adjective that conjures up joy or happiness.  The are but few applications, outside the world of accounting, when "black" is considered "good." I'm old enough to remember when the term "Black Friday" meant a financial disaster on the stock market. Yet, the implication is that businesses are going to financially move into the black -- reportedly by selling "cheap goods cheaply."   It is so blatantly commercial.  It truly is "black" in my mind.  The worst sort of "black."

Also disturbing is that this trumped up shopping frenzy is becoming even bigger than the holiday of Thanksgiving, which itself used to be centered on "thanks giving," and was not synonymous with a day to gorge oneself.  The focus on two days of excessive consumption speaks volumes.  And our nation, according to most news stories and polls, will apparently be in peril if we don't consume enough!! (We'll be hearing how "well" the country is on the news tonight when the "numbers are in.")

Perhaps the slowdown in the economy is giving us a chance to take stock of what we really value. All the stuff in the world is not going to bring happiness.

If each of us were to list the attributes of a perfect holiday, how many of us would list the need to feel obligated to spend money?  Must we be timed as to when we wish to be generous?  as to when we wish to say we love someone or are thinking of them? ("Tis the season!" --  It seems more a command to "Buy now!")

In Lewis Carroll's Through the Looking Glass, we come to know the "un-birthday."  There is something extraordinarily special when one receives a gift that comes out of the blue, that has not been purchased due to some either overt or subliminal sense of obligation.  How delightful is the gift that has been purchased or created and given free from commercial pressures!

In the Looking Glass world everything is "backwards."  In reality, I think this economic slowdown is showing us that things are backwards on this side of the mirror.

What could bar success?
In the news is the potential acquisition of Cadbury, England's famous chocolatier, by Kraft (with possible alternative offers by Hershey and Italy's Ferrero).  This acquisition provides a classic example of the need to examine what is at stake beyond merely the production of a product and how it is marketed.

There is no question that the name Cadbury, and the dreams that started at Bournville in the mid 1800s, resonate with more people than those who are just lovers of chocolate.  The Cadbury philosophy differentiated a business and was integral to its product's becoming iconic.

It is not unusual during such a purchase that focus turns to branding and the potential fallout of clashing cultures.  Most people foretold that when Schweppes entered the Cadbury picture in the late 1960s, the business would be more focused on pure business than the dreams of its founder.  Yet the components that are behind the iconic status of the Cadbury brand cannot be completely ignored. It is more than the taste of chocolate that is behind that name.

At the time any acquisition decision is made, multiple factors are at play. All participants need to understand the relative importance that image has alongside any other factors in the judgment.

A corporate suitor may be appealing for a number of differing reasons:

• Brings financial strength
• Brings management expertise
• Brings a cache in terms of image
• Opens up new market segments
• Has a culture supportive of the original founder's purpose

Those statements are all from the perspective of the party being bought. The potential acquiring entity might have similar, additional and/or differing desires that it hopes to gain by an acquisition.  They should also be elicited and weighted.

There are also concerns that each party will have about a merger or acquisition, and those concerns need to be uncovered and weighted, in terms of potential harm were they to occur, and in terms of probability of occurrence.

It is then, that the various potential corporate combinations can best be viewed.  Understanding each party's relative weighting of their own desires and concerns, along with each merged entity's collective ranking against both, would lead to the most robust final decision as to which is the "best" combination.

This exercise would benefit not only the party being acquired.  Any party doing an acquisition, who may also have other targeted acquisitions, would have a much more robust roster of potential purchases.  That buyer would also clearly know, and be able to plan for, the strengths and weaknesses of any particular acquisition.  More importantly, they would know that actions were being properly focused, based on relative importance.

Or will the banks be "ever thus?"
In 1905, George Santayana gave us the aphorism that "those who cannot remember the past are condemned to repeat it." Couple that with his remark that "To knock a thing down, especially if it is cocked at an arrogant angle, is a deep delight of the blood," and we have a pretty fair picture of the banking industry and the general public's response to the news about it.

Once again, we are confronted with reports about bankers and their bonuses, underscored with the old rationalization by that industry: "the need to prevent talent flight."  Matt Frei wonders if America is now becoming a nation less of "aspiration" and more of "resentment."

It is not surprising that attempts abound to re-ignite the old "fears" re government action to curb executive bonuses.  These actions are termed "meddling" in the "business of business," or worse representing the encroachment of "socialism."  Nor is it surprising that these statements are typically made by those in business.

Ordinary people are merely tiring of being condemned to witness the repetition of questionable practices. We are tired of arrogance. We are tired of being played for fools, and of funding those who have caused our current misery and who seem adroit in manipulating the system.

It is wise to remember that when one is tired, decisions made are not always the best.  We've heard the maxim to "sleep on it" before making a big decision. Not always a physical sleep, this can also mean simply stepping back from an issue to give it a rest. However, if each morning, the wounds are cut afresh as one picks up a newspaper, there is no respite from the indignation of being violated again and again.  For many people the mental weariness and the sense of powerlessness to effect positive changes grows. One's thought processes in such a state become less rational. Babies are likely to be thrown out with bath water.

The elected or appointed who assumed positions of power need to heed this rising anger.  "Resentment" is not quite the right term.  We are beyond bitter indignation.  We are feeling the hostility of raw anger, rooted in powerlessness and evidenced by lack of change.  On February 11, 2009 and August 5, 2009 I hoped that the banking industry might "cross off the list of reasons for bonuses" this constant reference to "preventing talent flight." The expression just does not sit well with those who can view only the incompetence that led to the current economic crisis in the world.  And the only flight we see is one from responsibility.  I now implore...can we just simply kill use of the expression altogether?

Viewpoints matter
Earlier this month (Oct. 9, 2009) I ranked the attributes of an "ideal" health care system that I, as a potential user of the system, would desire. The New York Times recently published the "features" of the differing proposals in committees and houses of Congress. I decided to weigh how well each proposal met my criteria.  (The chart to the right shows the outcome. Any not crossing the midline fall short of at least one very important attribute I weighted earlier.)  Additionally, as options, I included the status quo, as well as the UK and the Canadian systems from what little I know about them.

Congress' proposals were difficult to rank, because descriptions were primarily focused on the "rules of participation" and "penalties for non-participation." These descriptors were insufficient to understand the "offerings" given to user/patients of a system of health care, but were more about administration.  A potential user/patient is less concerned about the cost to the government or the effect on businesses (small or large).  While viable concerns of some constituencies, they are not reflective of the user/patient constituency.

For most individuals, a key area of concern is "affordability." But "affordability" remains nebulous in the descriptions:

• "Premiums will not be allowed to be raised because of pre-existing conditions." A noble statement, but one that does not address the fact that premiums may be too high in the first place.

• "Shopping at an exchange." If all prices at the exchange are too high, then "affordability" remains an issue for many.  As an example, has anyone "shopped around" for better interest rates at a bank recently? Does it seem as if one is dealing with a banking cartel?  In that light, do we think that there will be sufficient incentive for any insurance company to lower its rates if it can observe that its competition is profiting more?

• A "cap" of $5,000 per individual has been bandied about. Is this reasonable, given that the federal minimum wage ($7.25/hour) would only provide an individual with approximately $13,700/year after taxes?  How is that individual to survive on the remaining amount, if $5,000 is taken from it to cover health care costs?  Is this realistic? Even a tax credit for the full $5,000 would only put $63/month back in the pockets of these individuals.  What will that buy them?  Paying the $750 penalty that is suggested, would provide them with $1,081/month to deal with the immediate realities of life.  Would this not seem the more pragmatic action to take?

That said, is the Congress (having "offered" such a deal to these individuals that they then "refuse") going to return to their voter base with a clear conscience saying they created a "reformed" system?  That this was the best they could do?

Assessing the same proposals from the point of view of the insurance industry, is a more rosy picture:

• Under all proposed systems, the industry will have a captive market. Subscribing to insurance will be mandatory. 
• The government will police on the industry's behalf, through penalties. 
• There is no mention of regulations for or mandated lowering of pricing of premiums, or co-pays.
• There are no guarantees re personal choice of doctors.
• There are no regulations about qualifications for doctors participating in plans.
• There is a wide array of "levels" of care being spoken about. 
• There no longer is talk of the "right" to health care. Instead this has been replaced with "acceptable numbers" for the number of people uninsured. "Insured" can actually be insurance that plays out to be as one congressman deemed it, "pseudo-insurance." But, no one is mandating regulations to prevent this type of fraud. 
• The complexity itself in the descriptions of plans, in fact, adds to the industry's ability to manipulate for their profit. 

More is to be gained than lost from the insurance industry point of view.

Beyond these questions, going through the assessment exercise reveals some important aspects of this decision. The White House's "idea" for health care as initially assessed, due to our lack of knowledge as to specifics, is better than the actual proposals at hand. This is not unusual.  Concepts that are loosely defined typically are interpreted more generously.  It is always advisable to return to an assessment as details are uncovered about a project.  When "guidelines" evolve into specifics, we often see the more realistic ranking of a project.

If there are multiple constituencies involved in determining "what matters," the degree of influence of each (their voice's weighting) must also be factored in to the assessment.

In health care reform, we are dealing with multiple constituencies, with differing viewpoints: The citizen, as potential patient/user.  The citizen as taxpayer.  Big corporations.  Small businesses.  The private insurance industry.  The government as a representative of the people.  To get on the same page, we may need to start separately.  But instead of trying to convince the other constituencies of our own values as factors for their judgment, we need to integrate all viewpoints.  This does not mean homogenization of viewpoints, but it does mean a a type of "triangulation" in the judgment of options.  This is what is currently missing, and why pot shots can be so easily made about each proposal, and why one viewpoint, one that is an expert in getting heard but is not necessarily representing what is best, is beginning to dominate.

The buyer behavior is not surprising to me.  It does make me flinch to have it deemed "lying." It isn't at all.  The client has been asked for a list of things to describe deeper desires, but even they don't know that.  And, it is the deeper meaning of the features they might list that forms the basis for their decision or judgment. A buyer is looking for intangibles as represented by features.


In all practicality, a real estate agent needs a definitive starting point to find housing options to show to a client: a ball-park size in terms of bedrooms and baths, and perhaps some other features.  After that, the relative importance to the buyer of the intangible factors will be the real drivers of their final decision.

A list of these underlying intangibles emerge from questions such as: "If you had the features you describe, how would they make you feel when you are in that 'ideal' home?  How do each of the features you list, as you envision them in your head, make you feel? Describe the 'tones' or 'feelings' of that 'ideal' home."  [More critical than being driven by a list of features is understanding that other, completely unthought of, features might be able to satisfy these underlying desires.]

Examples of types of intangible statements are listed below:

• Feels cozy and warm.
• Gives a feeling of being connected with nature.
• Is peaceful.
• Is distinctive.
• Imparts prestige/importance.
• Showcases our personalities. (specifically, e.g. arty, intellectual, powerful, efficient, orderly, extroverted, introverted, fun-loving, etc.)
• Gives our children a cultural advantage.
• Gives our children an educational advantage.
• Feels luxurious.
• Provides a welcoming atmosphere.
• Provides privacy for all inhabitants.
• Is affordable without strain on our current/expected financial means.
• A place where we could stay for years. (e.g. this would cover a variety of more specific statements: "has space for growing family, or "could accommodate aging needs")
• Will provide us with financial stability/security. 

A buyer can weigh their relative importance, resulting in a "profile" of a "great home." All houses (the collection of their tangible features) would be weighed against these intangible attributes.  Every person on the planet tries to juggle multiple variables in their head.  However, when mentally juggling, it becomes more difficult, as more and more housing options or features are added to the mix.

At some point, cumulatively, more of these intangible needs will be met in the buyer's mind, until one housing option outweighs another.  This "build" of the internal assessment against components can be arrived at over time, or it can be done in a flash.

In any case, the buyer didn't lie.  They just described their "needs" by using features as examples of something deeper that they really wanted.  That "something" is a set of intangible, but completely valid, factors having relative importance.  It is the cumulative assessment against those factors that can make it seem as though a final decision was arbitrary.  I guarantee you, it was not.  The client has remained absolutely true to his internal set of intangibles and his personal assessment against them.

Who's whiffing now?
In a BBC article about Obama and his strategy for Afghanistan, Paul Adams reports on a small anti-war protest as "a whiff of the Sixties" with "some way to go."   Unfortunately, the main subject of his article is somewhat lost as he goes on to describe "elegantly coiffured Ms. Pelosi" and her "Senate colleague, the Majority Leader Harry Reid" who "put an avuncular - perhaps even patronizing - arm around her shoulder."

Ironically, the attempt to show sexism as alive and well in Washington was made in the first half of Adam's remark. In the comparison of the two, Pelosi is described in terms of her looks, Reid by his title.

Occasionally we can expect a relapse in perspective from the now-retiring or already-retired generations who needed awakening (yes, in the Sixties) to this type of verbal patronizing of women in the news.  But Adams is young, relatively speaking.  Astonishingly, it is both males and females of his generation that are perpetuating the demeaning of women's ideas and stature through frivolous reporting.

The Sotomayor hearings, as covered in the New York Times, fell victim to this same manner of reporting. Apparently some female reporters think they are still relegated to writing articles for the Style section: Kate Phillips': "Ms. Sotomayor wore a cobalt blue pants suit, a color often worn by Hillary Rodham Clinton." Sheryl Gay Stolberg's: "her flaming red jacket" and "her manicured nails painted a pale pink."

Judgments are decisions.  Decisions need to be made with facts that are relevant. Options, and even people, should be assessed against all facts deemed relevant.  Applying criteria to only some and not to others being judged is always seen as unfair.  It is the definition of "double standard."  It is also true for descriptors that cause judgment.  Not only are the judgments questionable, but the persons putting forth the case for and against are doubted as to their ability to be fair.

These reporters do not remember that this same issue, of having two standards for judgment based on gender, was brought forth during the Sixties. Overcoming this double standard allowed women reporters to move more easily from the Style section to the front page.  Reading this type of reporting...well, it is definitely a whiff of the Sixties, if not the Fifties.

Swimming with Sharks