The Republican promise to make it all better rides on a promise to change the role of government in helping Americans meet their needs and drive away the pain of the last four years. The Republican promise has been to repeal President Obama, and all his works and all his teleprompts, and replace him with an experienced financial industry executive, using the “private equity” provided by the Citizens United to do it. There should be little doubt Republicans believe Romney-Ryan can do it. Every single elected Republican has spoken the same policy language for the last four years, hoping by doing so we would all be less well off until they took over.

MITT ROMNEY HAS DONE LEADERSHIP

Much has been made by many over Mitt Romney’s Etch-a-Sketch approach to the presidency. Those who know his approach to leadership positions in the past (Transaction Man, New Yorker, Nicholas Lemann, 10/1/12) suggest this is simply a necessary calculation by those to whom he has entrusted the job of getting him to where he is today. This leaves us uneasy, but Romney does have many of the qualities we expect in leadership in America. Qualities that we have recently found wanting in those in positions of leadership in American business and finance.

No doubt that Romney has integrity and character. He is a man, father and husband of prudent judgment. He plays by the rules with little evidence he has tried to bend them. He appears to have a gift for strategy and execution, for inclusiveness, for listening well, and for the courage to make choices and decisions and take responsibility for the results. He is a man of faith and his life is a model for what that means to him and others. He plays to win; he is bipartisan when necessary in his politics.

REMEMBER 2009

Early in 2009 more than a million people braved the wintery Washington cold to wave goodbye to President Bush as Air Force One flew him to his home in Texas, and to welcome the leader they hoped would change the city’s business model forever. That same month, 800,000 Americans lost their jobs. Having bailed out the financial industry, a Democratic Congress was preparing a spending bill designed to save the jobs of millions more and prevent a great recession from becoming a worldwide depression. Shortly thereafter, the Swedish Nobel Committee awarded its annual Peace Prize to the as yet untested president. He accepted.

Republicans were preparing a national strategy to make President Obama a one-term president and to elect a Mitt Romney (or Mitch Daniels) candidate in 2012. The strategy depended on creating a big enough political tent to cover everyone from Ron Paul libertarians to Rick Santorum evangelicals to Sarah Palin/Michele Bachmann/Fox News tea partiers, to RINO Romneyites. It depended on outstrategizing the president and his party on the economy by blaming it on government at all levels and fighting every effort to spend or tax. By raising more special interest money than “hope” or “change” could raise. By contesting every move the president made from executive and judicial nominations to his national security decisions, using the Senate rules to stymie every effort at progress and to use the 2010 election to test drive their campaign strategy in 2012.

HOW WILL YOU JUDGE PRESIDENT OBAMA’S LEADERSHIP?

Will it be judged by the fact that the financial collapse of 2008 has not taken down the industry that caused it?  The fact that the country has been in economic recovery for three years, and that a new kind of employment in new industries has demanded new skills many Americans do not have?  Is it the fact that efforts to improve public understanding of federal spending and regulatory decisions have been consistently undermined by the polarization of the news media in America?  And by the fact that Republican refusal to help Democratic leaders lead has created a field day in Washington for big money’s influence on special interest and single issue domination of policy, opinion, news and policy.

This has always been President Obama’s election to lose and his campaign has capitalized on our concerns for the radicalism of Republican leadership. To the undecided however, the issue is no longer change you can believe in; it is executive leadership you can believe in. With our future on the line, and neither team able to convince us they have a winning game plan, we go for the leadership we think we need. We might take a chance on changing leaders. Hope, not confidence, could decide the election once again.

OBAMACARE

When the presidential post-mortems are complete we will find that President Obama’s experience in the Senate led him to believe that if we were ever going to get genuine health policy reform, it would have to come early in a president’s first term. That it would have to start with a bipartisan approach in the U.S. Senate to overcome both the ideological and industry resistance in the House. Two such bipartisan proposals existed:  a bill by Ron Wyden (D-OR) and Bob Bennett (R-UT), and a Senate Finance Committee proposal co-authored by chair and ranking members Max Baucus (D-MT) and Chuck Grassley (R-IA). All they needed was for a popular new president to bring the health care industry on board. Obama did just that on March 4, 2009.

The Democratic House passed a variation of Baucus-Grassley and Obama’s industry deal. The Republican 2010-12 campaigns declared war on “death panels” and “socialized medicine,” and the Senate limped helplessly into a water-downed version of its proposals at the end of the year. The White House had to decide whether Democrats could win the battle to right the economy and pass Obamacare. President Obama decided to do both at the expense of each and as a result he and his party have been playing defense ever since.

What we all know now is that President Bush and Governor Romney both helped design, fund and pass Romneycare in Massachusetts. We also now know, as a result of the first presidential debate, that a President Romney is likely to preserve, not repeal, as much of Romneycare/Obamacare as he can, while reducing federal spending on health insurance coverage expansion, Medicare, and Medicaid in order to close the budget deficit. State governments and the health care industry will have to pick up the costs incurred by the uninsured. This is exactly the problem the industry sought to avoid when it cut the deal they did with President Obama in 2009. Romney has asked for nothing but trouble and, if elected, he and we are going to get it.

OBAMACARE ENABLES MARKET-BASED SOLUTIONS TO COST, QUALITY AND AFFORDABILITY

The problem is that no one in his little circle in D.C. has bothered to inform President Obama. I thought he got it from the start; apparently not. Last week he used the Independent Payment Advisory Board in Obamacare to defend his reform. I sat in a meeting of Minnesota county administrators and almost threw up. “He’s playing into their hands” I screamed at the TV. It is government-run health care he wants!  Maybe Bachmann and Palin are right about his love for death panels as well!

Health care markets have been trying to reform themselves for decades. In some parts of the country it’s for-profits doing the change work. In others, like ours, it’s nonprofits working to align payment policy with value-based results. In 1985, Congress launched a bipartisan Medicare privatization experiment using private insurers called HMOs and it worked to reduce costs and improve quality where it was tried. Medicare used “vouchers” to provide “premium support” for private plans. This is not an evil Republican scheme to undermine the elderly.

It is built into Obamacare’s health insurance reform and its health insurance exchanges, payment policy reform and accountable care organization approach to focusing the system on keeping people healthy and reducing the costs of illness. Hapless Congressional Republicans have tried to dilute its impact by allowing every state to decide what rules should apply, how health exchanges should work and what role Medicaid should play. My friend David Brooks diddles with the issue in NYT 10/9/09 but doesn’t really “get it” any better than does our president who may give up his presidency because he lets the MA inventor of Obamacare get the best of his historic accomplishment.

THE FISCAL CLIFF FOR OBAMACARE

The threat to the future of Obamacare comes not just from Republican repealers or from health industry leaders. It comes from the “fiscal cliff” which Republicans in Congress created in 2011 by their refusal to raise either the debt ceiling on federal borrowing, or the taxes necessary to cut a deal on spending cuts with the Democrats. The most attractive targets for spending cuts will be the 10 “out-years” of anticipated payments to health care providers for Medicare, Medicaid and the coverage expansion in Obamacare.

WHY THIS MAY BE AN INEVITABLE OUTCOME

The latest Associated Press poll of Obamacare shows seven out of ten Americans expect Obamacare will not be repealed. Only 12% of us want it repealed. The latest MN poll shows President Obama leading Romney in MN by seven points, but Obamacare supporters trailing repealers by two. Why?   Because neither the president who made Obamacare his legacy nor the Democratic Senators and Congressmen who gave him their votes to make it happen have ever made the case for the new law. Health reform is already happening in Minnesota. A system which is higher quality, more accessible and affordable is evolving. It needs a payment system which rewards reform. That’s Obamacare. But re-elections have trumped good policy once again.

BUDGET BATTLES: NATIONAL SECURITY V. YOUR ECONOMIC SECURITY

Something you learn early in decades of annual federal government budget battles:  “You can’t have your cake and eat it too.” We have all become dependent on our national governments to keep us safe and secure; safe from foreign and domestic enemies; secure in our ability to finance our personal needs in times of unemployment, disability or retirement. In good times we find a way to afford both. In times such as we are in now, we want our representatives to make the hard choices we can’t make. “Guns or butter” the pundits call it. You decide.

The November election will not decide how to deal with an unconscionable government debt and budget deficit. Members of Congress must decide. They don’t have a good track record at decision making. There is something called a Bowles-Simpson plan for reforming our biggest economic security/social insurance programs. It suggests we change the age of eligibility for Social Security and Medicare, reduce automatic inflation adjusters, reform health care and Medicare, and raise income tax revenue by eliminating tax-breaks designed by the financial industry to reduce the risk of personal and corporate investment.

National security is more complicated. Most of us know little about what it takes to reduce threats to our homeland or to our economic interests abroad. People who do know graduate from our national security forces into the industries that supply the techno weapons those forces are accustomed to using. Industries which are located in every congressional district in this country and they use their presumed expertise to lobby the decision-maker’s spending decisions. Dana Priest at the Washington Post is an expert on this sort of thing. Take nukes for example. She writes about a $25 billion path the defense establishment is on to preserve an obsolete B-61 nuke delivery system. If you want even more insight, read her recent book on the explosion of homeland security spending, Top Secret America.

TAX REFORM CAN BE BIPARTISAN

Everyone in a leadership position in Washington who is concerned about the deficit has come to the same conclusion:  the amount of public purpose spending used to justify exceptions to a uniform rate of taxation on all earned and unearned income is obscene and must be changed. There are flat-taxers in both parties and advocates for reducing rates by broadening “the base” abound. The main difference between Republicans and Democrats is how progressive the income tax should be to protect the economic security of the “middle class.” In other words, how many rate brackets are necessary to avoid the “cliffs” built into a two or three rate system?  Or what kind of tax credits can be built into a flat tax to protect low and moderate income earners?  It is “income testing” if you will.