To make the point more strongly, President Obama had to deal with the collapse of the old world economy and its Ponzi financing; plus the new world order in which the Bush war on Islamic terrorism collided with the Arab awakening, in a region dominated by Israeli and Iranian politics.  How well he’s met either of these challenges is not going to be decided before November 4, but will be debated ad nauseam by those who haven’t had to make decisions of that magnitude and consequence.

On the other hand, Mitt Romney, the Republican candidate, has the record President Obama did not have in preparing for the office of president.  His father before him was an exemplary and successful businessman, governor of another progressive state and a national voluntary sector leader. Mitt Romney has sought out and successfully undertaken challenges in the private financing sector, in the Olympic Games, and in the executive office of a progressive state in which he was neither native nor of a dominant ethnicity or religion.  And his approach was inclusive.  More like the Reagan leadership style of the 1980s rather than the exclusive style of Republican opposition politics today.

If the American economy is the issue, and leadership for change we can believe in is the deciding factor in the next four years, President Obama’s chances of proving he has what it takes depends on our believing he can overcome the steadfast opposition of elected Republicans in Congress and the state level.  So far, national crises have not been enough to shake Republicans and their wealthy supporting interests free from their adamant opposition to the president.  Even the “fiscal cliff” predictions for 2013 aren’t likely to change this.

On the other hand, if Romney is elected, and there are 50 Republicans in the U.S. Senate, the shoes switch feet and it is Republicans who must seek out Democratic support for the kinds of spending, taxing and economic security policy reforms essential to the nation’s well-being.  Otherwise, they are left to deal with the fragile libertarian tea party moral values coalition that prolonged the Republican presidential primary and diluted the moral fiber of candidate Romney’s policy positions over the last two primary races.  Depending on which Romney plans to show up for the inaugural, we aren’t going to know the fate of the country either by November 4.

THE REPUBLICAN PARTY FINDS ITS SOUL

Minnesota’s last daily newspaper with the financial capacity to do in-depth news and analysis is the StarTribune, which is published in Minneapolis.  The Sunday, May 27, Opinion Exchange reflects the latest iteration in the Republican Party of Minnesota:  Ron Paul/Jason Lewis libertarianism.  There’s a piece by Lori Sturdevant on how one Republican State Senate chairwoman can stand on both sides of a critical tax issue, together with a Jason Lewis piece opposing Obamacare, quoting Ronald Reagan back in 1964: “government cannot control the economy without controlling the people and when it sets out to do that it must use force and coercion to achieve its purpose.”
 
Then the best read by Caux Roundtable leader Stephen B. Young of St. Paul is on the evolution of Republican Social Darwinism.  Steve quotes extensively from Herbert Spencer and his own grandparent Etta Ross Hubbard, a famous Social Darwinist in her time, and a host of history on the subject; as well-researched as anything you’ve read in a long time.  To reach the conclusion that today’s Republican Party “is enthusiastically behind Herbert Spencer’s demand for minimal government funded by minimal taxation of private wealth with an American Calvinist conviction to reward those who enter the lists of social and economic combat.”

WILL PRESIDENT OBAMA FIND HIS SOUL?

Tom Friedman in NYT 5/27  touches on the “missing link” in “change we can believe in,”  when he says President Obama’s 2012 campaign “feels as though it were made in a test tube by political consultants…selling poll-tested wedge issues. I don’t think it’s a winner for him or America.”  And so say we all.  We feel something in our souls that he doesn’t seem to feel. 
 
Friedman: “Barack Obama is a great orator, but he is the worst president I’ve ever seen when it comes to explaining his achievements, putting them in context, connecting with people at a gut level through repetition and thereby defining how the public views an issue.”  For me, and I’ve said it here on many occasions, if he believed in Obamacare, the way most of my MBA students did after three days in Washington in March 2012, why hasn’t he championed it?  The way I do, because I do believe.  What does he believe?  In his soul, where it’s important to me, and America?

DON’T AMEND THE CONSTITUTION

The nationalized Republican Party has turned to state constitutions to accomplish what elected legislators cannot.  In Minnesota, it is enshrining a religious definition of marriage and an exclusionary view of elections in our state’s constitution via constitutional amendments on the Nov. 4 ballot. If they could have passed a third – to outlaw labor unions in public employment – they’d have added that one.
 
I’ll vote against both amendments, but I’ll wish the rest of my votes for senators, Congresspeople, governor and legislators actually had the consequences they were intended to have by the state constitution.  Sex as a political obsession is something new.  Morality or lack thereof, is not.  But it’s become the uber-religious’ single issue obsession; just as race has been an obsession in the old confederacy since our founding as a nation and underlies every effort to make it as difficult as possible for universal suffrage to reflect the will of all the people of this unique nation and state.

THE BUSINESS OF HEALTH CARE VS. THE FUTURE OF OBAMACARE HEALTH POLICY

Americans are still as polarized as ever on the value of Obamacare.  A majority have probably yielded to the judgment of an ideologically polarized Supreme Court as to whether the new law is good policy. President Obama speaks rarely to this historic initiative, and those who know its value as policy better than he, are mute. Mitt Romney, who along with President George Bush’s CMS, advance tested it as Romneycare, has pledged to repeal and replace his Massachusetts model. Across America, health professional leaders are too busy applying for Obamacare funds to improve accountability of care and its financing, to risk sticking their necks out of their political foxholes.
 
The faces of health policy leadership in America in the last two decades belong to a bi-partisan group of HHS secretaries, Senate majority leaders and an independent M.D. who served Democrat and Republican presidents. For the next six months, HHS Secretaries Donna Shalala (Clinton) and Mike Leavitt (Bush 43), plus Senate leaders Tom Daschle (D-SD) and Dr. Bill Frist (R-TN), along with Dr. Mark McClellan, who served the Clinton Treasury, and then the Bush 43 FDA and CMS as administrators, have been employed by Accretive Health to diffuse the controversy over hospital payment and privacy practices. Leaving recently “retired” CMS administrator Dr. Donald Berwick as the lone, and nationally invisible, voice for the new law’s potential.

ACCRETIVE HEALTH CARE

Were I on the U.S. Supreme Court, I’d be deeply concerned about the impact of my constitutional judgment on the $3 trillion cost of unnecessary health care on Americans who haven’t the foggiest notion of why they pay so much for a system that makes so little sense.  Americans across the country are hassled in the hospital by bill collectors with Wall Street names such as Accretive Health; or outdoorsy names like Conifer.
 
Accretive is better known in Minnesota for the dilutive impact on its stock of our attorney general’s report on its practices.  And the termination of its contract by Fairview UMN Health System whose CEO will retire at the request of its board.  But that’s because ours is a not-for-profit health care tradition founded in faith-based stewardship of resources and of community. We’re also the home of “Minnesota Nice,” where we need people to take the fall for the heat others help to generate. We’re the home of the toughest “medical information privacy” laws in the nation brought on by a small group of docs who for generations have fought the “corporate practice of medicine.”
 
Accretive is one of the many for-profit, publicly traded companies who find it so easy to make money off a health care system that can’t reform itself.  And when it finds itself in trouble (Accretive stock went into the tank when Fairview cancelled its contract), the company blames “the health system” not its corporate practices. It calls on Chicago mayor and tough guy Rahm Emanuel to shut up the DFL attorney general.

HEALTH CARE LEADERSHIP LOOKS LIKE AN OXYMORON THESE DAYS

Minnesota has always been one of those American “places” everyone else looked to for leadership in health care delivery, financing and policy.  In Washington, D.C., where too much policy is always made – including by guys like me – the assumption is there’s something in our water that makes us different. And worth emulating to the extent the rest of the country was interested in doing so.
 
Not today.  Professional leadership for the kind of change an unaffordable $3 trillion system needs is all over Minnesota – from Rochester to Mpls-St. Paul to Duluth.  But you’d never know it if you relied on what’s making news in Washington and nationally.  Republican members of Congress are using us as an example of a state that is ripping off federal funds for our Medicaid program, while they ignore decades of real Medicaid rip-offs by Republican states like TX and LA and MS and propose to send them blank checks for private managed care companies’ “premium support”, or, like Erik Paulsen (R-MN3), leading an effort to defund Obamacare.
 
Democratic members of the Senate aren’t doing much better.  Amy Klobuchar and Al Franken, who helped pass Obamacare, are not doing much to defend it.  While busy trying to remove the one and only contribution to its coverage expansion that the medical device industry was asked to make to get tax-paid access to their products for 32 million more Americans, or conducting Senate investigations into a major hospital system’s employment of the new, for-profit, “business of health care” model to patient payment and data privacy practices.

OBAMACARED — SO LET’S REPEAL AND REPLACE IT AND HIM

I am inclined to believe that in another month, Chief Justice Roberts will opine that the Constitution provides for a nation like ours to choose to use private health insurance as a means of assuring all its citizens the equal blessings of liberty.  To make private insurance affordable for all Americans requires that all of us own a policy and that insurance market rules are essential to the kind of choices and competition that will reduce the costs of poor health and health care.  And the commerce clause of the Constitution provides Congress the authority to set those rules.
 
President Obama was five weeks into his presidency when he called the first health policy reform meeting at the White House, at which he received the pledges from representatives of nearly the entire industry to support 25-year old bi-partisan policy recommendations to move toward universal coverage using private insurance, reformed Medicare and serious cost containment.  It was at this point that the Republicans, the nascent Tea Party, Freedom Works, Club for Growth and other right wing “non-profits” went to work on what by the August Town Hall meetings became the Party of No Health Reform, No Obama.

ROMNEY REPUBLICANS WILL NOT REPEAL OBAMACARE

If they can figure out how to do it, they will come up with a “consumer-directed” conservative reform package which will reduce the costs of public subsidies for private and public insurance.  Not by federal support for local systemic reforms like those laid out in Obamacare, but by reducing coverage or shifting costs to health care providers. This has health care providers across the country deeply concerned.  We already know from experience that unless the savings from behavior change in the health system are shared with the people whose behavior you seek to change, it won’t work.

SO WHAT KIND OF A DEMOCRACY HAVE WE BECOME?

So much for elections, representative government and the separation of powers, all of which ranked much higher on the founding fathers and mothers “give me liberty or give me death” priorities.  Four years ago we voted in a general election to raise the state sales tax and dedicate it to arts, science and natural resources because legislators did not want to raise taxes without voter support.  This year our elected representatives decided to build a billion dollar professional football stadium and pay for it out of sales tax and gambling receipts because they didn’t trust us to vote the way the majority wanted to vote.

RANKED CHOICE VOTING

More than 140 Minnesotans showed up in George and Sally Pillsbury’s home on Lake Minnetonka last week to engage in a session on expanding “ranked choice voting” beyond Minneapolis and St. Paul.  They hosted this as a way to encourage more Minnesotans, of varied backgrounds and aspirations, to volunteer as candidates for public service.  As candidates, or for candidates, for election who may not be able to pass the extreme litmus tests of polarized partisan parties.  RCV simply provides voters the opportunity to vote for four candidates for each office, rating their preferences and requiring the winner to be chosen by a majority of those voting. . .  if only Egyptians had had the benefit of RCV when voting last weekend for president of that country!!!

THOUGHTS FOR THE RELATIVELY NEW THIRD AGE

An untypical single, white, straight, old Catholic priest, living in a religious community with a lifetime in academic and professional worlds is a friend to many of us.  Msgr. Charles J. Fahey was 79 on the day after he spoke to the Pan-American Health Organization April 12, 2012.  He shared his thoughts on the 20th century’s contribution to life after the period of reproduction, the so-called Third Age.  And then reflected on what most of us who are enjoying it would agree is essential.
 
“The importance of civic virtue both in regard to processes by which we make decisions, but also in regard to the values that undergird them.  If societies are to exist, to say nothing of flourish, there must be a degree of civility and conversation that are marked by humility.  We live in an era of rapid increase in knowledge and understandings that challenge us to absorb them.  No one has all the answers.  In addition to the processes we must also invoke and be committed to the importance of social justice and social solidarity, balancing autonomy and social responsibility, the development of the common good and common goods, of reciprocity and solidarity, of adequacy and equality.”

HAPPY 78TH BIRTHDAY TO DR. JOHN ‘JACK’ WENNBERG

I know Jack is famous for his research on small area variation and his devotion to the evaluative sciences.   Jack Wennberg used his research and analysis to create the Dartmouth Atlas, practice variation and the three definitions of health care quality failure. From all that came “Shared Decision Making” which has had the most profound impact on the doctor-patient relationship in its history.  Most of us now benefit from “empowering patients to make personalized, informed medical decisions.”  Happy Birthday, Jack!!

CIVIC SERVICE IS A VIRTUE MUCH TO BE ADMIRED

Jim Hetland died on May 23 after being hospitalized as a result of a fall in his home, where he lived alone since the death of his wife Bobbie two years ago.  Jim and I and a dozen other men and women learned the virtues of corporate contributions to civic service together in the 1960s and 1970s.  I served Governor LeVander (R-MN) as chief of staff during the most productive Republican legislative period in MN policy history.  When the legislature in 1967 created the Metropolitan Council, still a unique regional governmental entity today, Hetland was a Minneapolis lawyer and former Citizens League president who LeVander chose to be its first chair.
 
In 1971, he became senior VP and general counsel at First Bank System and I became counsel for Legal and Community Affairs at H.B. Fuller.  Both of us remained active and involved in the league, in regional associations and in something we called Public Services Options.  Our cause was to create opportunities for private sector delivery of public services.  Starting with school lunches and rubbish collection, and advancing to school choice and charters as well as employee choices of health plans, called “health insurance exchanges” in both Romneycare and Obamacare.

AND SO IS THE LIFE OF A MAN DEDICATED TO IMPROVING ACCESS TO HEALTH CARE

In our community, there is no one as well known and respected by as many people as Carl Platou, who died this week at age 88 of a terminal illness.  Carl began to change the face of MN health care delivery as CEO of Fairview Health System and guided a host of young professionals to careers in the field.  When I retired from the Senate, Carl was at the University of St. Thomas to welcome me as senior health policy fellow and helped us design the National Institute of Health Policy.  A few years later, he helped engineer the acquisition of the University of Minnesota Hospitals by Fairview and spent the rest of his life enhancing the relationships of community leaders with the University.  Please read the StarTribune Lori Sturdevant blog post and Mary Lynn Smith article for more background on Carl.