Another kind of processhandling for the Health Care reform in USA ?

Uppsala Tue 18th August 2009

Windows of opportunity for the USA H.C. Reform-

external, historical comparizons and evaluation of the opportunity today.

Seen from aside- from Sweden where everybody has the opportunity for a free or relatively lowpaid public healthcare and freedom of choice even for the private h.c. providers (or- with permission from the public Health Care office Försäkringskassan even get paid afterwards for done services abroad within European Community if the services are not able to get in Sweden )- it´s interesting to read in todays Svenska Dagbladet professor Erik Åsards historical comparizons about former USA-president Clinton´s tactical choices and the done choices so far of todays president Obama.In the following I´ll shortly take up Åsards points, but- for getting a better overview of the political- strategic situation or evaluation of the windows of opportunity to reform the USA-health care- structurate the material a little bit differently.

As Erik Åsard is professor in the North American studies at the English language department for the university of Uppsala, he has good knowledge of the historical data: made choices of presidentClinton and the nowadays one, Barack Obama. Let´s put first up the similarities.

President Clinton, as Obama too, has put forward the reformation issue on the stage soon after becoming elected as a president- surely knowing that in the beginning you have the choice of formulating the image of your presidency. Later on, both time and social inertia plus external ”happenings” or forces in the world can change your stage.

Second similarity is the power balance in congress where the democrats have majority situation. It´s important to use this historical context (more about the political situation below).

Thirdly, the economical background is the same: the downward slope or difficulties, which gives the reformation the image of strong handling. ”It´s a time to put the economy in order again- with the h.c.reform we can make it”. That means: make the needed change now as the nation needs new solutions- for new jobs, for new, more democratic rights (even for those who don´t have money to chose freely in the world´s biggest democracy), for diminishing the future costs. Compared with Clinton president Obamas and his team´s window of opportunity is at this point more constrained: overall downward slope is happening on the global context of financial crises, which drains the power of public economy by diluting it to many streams: to banks and helping various financial institutions and possibly major companies- which- if not supported by public money- would collapse the economy and make the strained situation the worst possible.

What are then the main differences between former president Clinton and nowadays to handle or get trough the historical reform of the USA- health care (note here New York Times good overview from 14th august ) ? Clinton wanted to go forward by the traditional, political way: by setting up a special group of experts and project owners (who were elected here is not mentioned by Åsard) which soon ”went overboard” as it usually does in all big projects is the project is not leaded by a strong or dedicated leader (this doesn´t mean that the leader is not open to criticism or new alternatives or evaluation of the process as the rolling change goes forward). President Obama has chosen the different way: by setting up the main principles (values) first, and then letting the congress to do the practical work of setting up the needed organizational structure (more about this below).

The second diffence is the focus of change: as Clinton wanted to build up a strong public superstructure of regional health care boards which would make the h.c. available to all, this kind of superstructure is not on stage in Obamas. Maybe he is more cautious here and waits how the congress will first put forward it´s solutions here, before making his selection?

The third difference is the attitude of republicans. In Clinton´s case they were more open in the beginning of the process, as nowadays- according to Åsard- they are more reserved even at the beginning.

The same with the fourth difference between Clinton´s and Obama´s. For Clinton the public opinion was more favourable in the beginning- 80 percent asked were positive, as in Obamas case the public opinion is more waiting, about 50 percent.

What about the evaluation of the nowadays situation? Becomes Obamas fate the same as Clinton´s in this issue, or possibly even worse: he solves the reform but the costs are huge and will make the federal budget deficit enourmous, raising the overall taxrate- the possible result which is mentioned by the oppositional republicians.

Here comes the window of opportunity for president Obama as he has put forward only the overall principles: free health care in priciple for everybody and diminishing costs for families.

Where is then the guiding ”red tape” or thread by which the presidential team tries to get the congress majority to make the needed organizational changes favorable for these principles ? As for now there are a lot of possible organizational solutions. The issue can be overloaded by political pros and cons- which makes the public popularity of the reform dubious. ”More of the same political gangs and fights as before” could people think – thus the daily chances for the positive reform are dimishing with the time as social inertia grows, as well as political popularity for the project.

Could the reform work be handled in another way ? Well- it could be done by taking another, more both abstract and concrete way to set up the structure of work according to me, a socialentrepreneur . By context – yes, the situation is given (se above). By process- not. Instead of structuring or analysing the process by stages and work agendas of the functional- political project teams, it could be handled by dimensions: the top of the reform triangle is given (the principles), the organizational levels of the process too (people at the bottom, various project interestgroups in the middle (public and private health care organizations, insurance companies, doctors and their organizations, various social organizations working for free health care, helping the poor), and presidential team on top of these. But by which forces is the synthesis made: for questions of access, for making the h.c. work more effective, for diminishing costs for families and and the same time leaving them the opportunity of free choice how to handle their unique situation ? And how to secure the financial pros and cons: make continual investments in h.c. sector profitable (by technology, by various insurance solutions, by organizational changes needed). How to pay the huge costs for changing the tradition, evenif everybody knows that it costs too much and will costs even more in the future if not getting the reform through ?

Hopefully I´m not accused or blackmailed as an public idiot or a socialist from Sweden, as I say: take a look of my company Vidorg´s logo: somebody (somebodies) moving freely (as consultants or ”avatars” between dimensions) in the pyramid: from top to bottom and between, as the process requires and carries the wagon forward.

No, I´m not putting forward the concrete practical solutions here if you wait for it: it´s the process it too, in a unique historical situation which happens or not. Before the window is closed, and everybody is unhappy. But no, I´m not ending this blog in this negative way, but put faith or hope in the traditional American entrepreneurship: open to everybody- even immigrants from abroad or their children- as the unique fate of president Obama shows and the strong words on the coin of the USA-dollar says: unity in plurality (of voices, possibilities of choice, of various solutions chosen by free people of The United States).


Lasse T. Laine

philosopher- social scientist

social entrepreneur in company Vidorg

Uppsala Sweden

Copyright: Lasse T. Laine, Uppsala, Sweden 090818


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