Stretch goals. Remember those? I hated them. They were impossible and rarely met. People felt set up for failure. They gave up. The organization did poorly and got crummy morale to boot. When I left corporate America, I thought I was done with those. Well, here we go again.
Welcome to Medicare for All, the ultimate health care reform stretch goal.
The Harvard Business Review, in an article called The Stretch Goal Paradox; confirmed the perils of putting forth impossible dreams unless you are already successful (that’s the paradox). Those who are in dire straits seem compelled to set out to accomplish the impossible, a Hail Mary pass if you will. But setting stretch goals, aiming for the impossible, is exactly what a group that is already at risk, shouldn't do. The criteria for success: a group with resources, people to support it, a recent history of success.
Oh, and the authors warn that it will be extremely difficult to achieve even in the best of circumstances.
So the question for the Democratic Party and its allies is: What kind of “company” are we right now? The one looking for a Hail Mary pass or the one well-positioned for success already? If we aren’t in a position to achieve a stretch goal, then being strategic with something that is a reach but not a moonshot, might be more likely to mobilize citizens beyond the base, and get something meaningful done on health care reform.
What do we know so far about the Sanders Plan, the "Medicare for All Act of 2017”? Have you read it? I have. All 96 pages. I’m going to explore the details of the bill in future posts, but this one is about setting the vision, the “stretch goal” for Democratic health care reform.
First, full disclosure: I’ve spent my life in health care. As a hospital staff nurse. As a senior health insurance executive who managed all the cost control initiatives and medical policy for multiple health plans and employers. As a health care consultant to hospitals, doctors, union trust funds, and insurance companies. And as a nurse practitioner. I’ve seen it all. From all sides. I know how the system works. Or doesn’t. I’m not an insurance company apologist. Or a patient advocate who wants whatever I want without consideration for cost or quality. I’ve had to navigate on behalf of myself and my patients. I’ve had to say “no” to ineffective and unproven treatments. I’ve been on the front lines in countless scenarios trying to manage competing agendas. Guess what? It’s complicated.
I believe in a universal health care system that provides access to affordable, quality health care for all. Unlike Bernie Sanders, I believe there are many responsible ways to get there. In fact, while Bernie likes to say that all Western, developed nations like ours have single payor programs that are just like his proposed one, there’s a wee bit of truthiness going on in that statement.
Germany’s system is multipayor, not single payor. From Wikipedia, Germany’s is a national social health insurance system. It incorporates both public and private payors and is the oldest system in Europe. Oh, and it introduced copays to control overultiization so they wouldn’t go broke. Oh, those mean, responsible Germans.
France has a government funded and managed universal health insurance system too. It doesn’t pay 100% of the cost and citizens pay premiums based on many factors, including ability to pay. You can buy supplmental private insurace to cover what the public plan doesn’t or where the coverage is less extensive (like for vision, dental, drugs). In other words, it works more like our current Medicare plan, which is not, by the way, like the one Bernie proposes.
So how about Canada? Bernie goes on and on about how wonderful it is. Does it look like his plan? No. There is no coverage for prescription drugs, home health, long term care, vision or dental care. If you’re a Canadian, those costs are your problem or ... you can buy private insurance to cover them. In other words, the universal care that Sanders says Canadians have is less extensive than our current Medicare.
So what is Bernie’s Medicare? It’s everything. For everyone. For free (no copays ever no matter how rich you are). All services: hospital, doctor, home health, long term care, drugs, vision, dental, hearing, durable medical equipment. It folds in Medicaid, SCHIP, Tricare, the current Federal employee plan, maybe more.
Listen to Democrats discuss this new bill. Here’s a place to start. Supporters admit that this has no chance to pass in the current environment. That it’s “aspirational”. And far too often, Democrats who do object, who have different ideas about how to get to universal coverage or a different legislative strategy, are labeled as traitors to Progressivism. They are advised to shut up or be primaried. Nice.
Just like the failed Republicans, Democrats are now forcing litmus tests on fellow Democrats, shouting down other ideas, pushing for the most simplistic and disruptive solution to health care even though they acknowledge that they can’t achieve that stretch goal any time soon. This is not how Democrats are supposed to work. But the minions lining up behind Bernie are no more concerned about the actual grind that goes with legislating than Trump and his followers are. This is toxic. Ineffective. Guaranteed to foster disunity.
Bless his heart, Bernie Sanders and the Democrats he has enlisted to support him, are pursuing a simplistic and enormously disruptive solution that is going to face monumental opposition. If you think Hillary Care and Obama Care were a stretch, wait until you watch what happens with Medicare for All once people actually understand what it means.
Democrats would be wise to heed the folks from Harvard: pursue excellence, take risks but don’t aim for the impossible if you aren’t equipped to achieve it, be strategic, and above all ...
Shoot for greatness. But greatness doesn’t always come from dramatic leaps. Sometimes it comes from small, persistent steps.Is anyone listening?
