Health Care

It was an unusually busy August! I’d like to update you on a few goings-on – most importantly, the Greater Good Gathering that I described in my last update. This is the first annual “Greater Good” conference, Democracy, Citizenship, and the Greater Good: Charting a Path in Changing Times, part of a larger, long-term effort aimed at the future.

The Gathering is now set for October 20-22 (Friday evening through Sunday lunchtime) in Providence, Rhode Island. We are in the process of finalizing the program, with a fantastic lineup of speakers already confirmed, and other panelists we are waiting to confirm. Most importantly, the Greater Good Gathering official website is now live, where you can stay up-to-date on the program, register and book your hotel rooms at the historic Biltmore Hotel, Providence, Rhode Island, where the Gathering will be held.

As you’ll see, confirmed speakers already include a former governor, a law professor on cybersecurity advising the World Intellectual Property Organization, a nationally-recognized communications expert, award-winning advocates for their work addressing human trafficking, the CEO of a major health care reform organization, the author of the nation’s first “Medicaid-For-All” legislation, the first woman and youngest person ever to lead a major AFL-CIO labor federation, one of Foreign Policy Magazine’s Top 100 Global Thinkers, and the co-founder of the Boston Mayor’s Office of New Urban Mechanics – among others.

We’ll be discussing:

-Public Sector Innovation:  Can Government Be Saved?

-Defending Democracy & The Future of the Public Good

-Technology and Power: A History of the Future

-Up and Coming Innovators

-Public Good Beyond the Public Sector

-Application & Illustration: Health Care

There will also be plenty of time for networking and mentoring. Conference registration includes a welcome dinner, and healthy full breakfasts and lunches, at the Biltmore Hotel. Space is limited, so please register today.

Meanwhile, in the last month, our country has been fraying in ways unseen since the civil rights and Vietnam War era. As I wrote a few weeks ago in Government Untethered: “Some people find frightening the notion that countries as we know them – including our own – are on the verge of splitting apart. Others find it crazy. Scrolling through my news feed on a single, representative day last week … I found it simply to be the new normal.” Concluding with the story of the Venezuelan opposition’s attempts to create essentially a parallel, virtual democracy in the face of an increasingly-authoritarian government, I asked whether, in the long term,

a government, and its army, [can] hold territory where it has lost large swaths of the population? As people increasingly find the means to unite and construct self-governing mechanisms outside of “government,” can they actually opt-out of governments that don’t represent them? That’s a proposition that Venezuelans will be testing in coming weeks…. This isn’t just esoteric futurism anymore: It’s the daily news.

But, despite the new-technology veneer, all of this has roots that go back to the very beginnings of human civilization. In The Age-Old Rural Conflict, I wrote about the famous story of Cain and Abel as allegory for the triumph of settled agriculture – the New Economy of its day – over pastoralism. Cain is then portrayed in the Bible as, not coincidentally, moving on from murdering his herdsman brother to founding a major city.

The Cain and Abel story reflects a particular incident – the transition to settled agriculture and, as a result, urbanism – in the long history of technological change killing off prior economic, and attendant cultural and religious, arrangements. Such transitions aren’t peaceful, and they haven’t ended. The resulting sense of threat and hostility can reach Biblical proportions.

I’m thinking about both Good and Evil more right now, as I’ll be teaching a new course about them – called “Deep Policy” – this winter at Union Theological Seminary. Instead of talking about what policies might best address the challenges we face in such areas as crime control, inequality, discrimination, repression, environmental destruction, or a host of others, the course will ask, What drives these challenges to begin with and what – if anything – can we do to prevent them? To do this, we will draw upon and attempt to synthesize a wide range of disciplines, from theology and philosophy to chaos and game theory, ethics to evolutionary biology, psychology to economics – and, of course, public policy. In short, we will take an interdisciplinary approach to how wrong occurs – and how to right it.

I’ll have more on these subjects – and a few other upcoming conferences I’m organizing – in future updates.

As always, I look forward to hearing from you in the comments below.

Quick Links:

• Greater Good Gathering official site
• The Age-Old Rural Conflict
• Government Untethered

A project at Harvard’s Kennedy School of Government, under the direction of noted public-sector leader Stephen Goldsmith, has compiled what it regards as the 30 best reports on “Operational Excellence in Government” – and my firm, Public Works, is the author or co-author of three of these. Harvard cited our government-wide efficiency and management work in Iowa, Colorado, and Louisiana. This confirms what we’ve always said: Although we’re a small firm, we can match our record in this area against any of the largest consultancies in the world.

Meanwhile, in Washington the Trump Administration has unveiled plans to down-size government in a manner very different from how we pursue our efficiency and streamlining work. It’s the difference between hiring a surgeon to cure your ills – or a guy with a chain saw and hockey mask.

I wrote about this larger “hollowing out” of government at which the Trump Administration aims in The Hollow Men in U.S. News & World Report:

The Americas Bannon and Trump envision are depressing, but not totalitarian: One is illiberal but not necessarily authoritarian, the other authoritarian but not necessarily illiberal. Both lead to a society embodying not so much the banality of evil as the evil of banality. And where they overlap is not the creation of a fascist state, but rather the opposite: The hollowing out of the state as a viable institution. And, in that, they represent not a radical departure from the modern trajectory of the U.S. (and most other countries today) but an acceleration of it.

“All of this should be concerning,” I concluded, “but, while liberals have been warning not to ‘normalize’ Trump for the last year, the mistake is to ‘abnormalize’ him.” I elaborated on this theme in my next piece, Parallel Universe of Trump-World: “Right now, the opposition is focused on furious assaults against the very tar babies that keep Trump’s supporters in his column; such attacks will do nothing to weaken his grip on his alternative universe,” I argued.

I simply don’t agree that becoming your enemy is how to defeat him – a sentiment liberals argued vehemently in opposition to Bush-era depredations of civil liberties in the “War on Terror” but now deride as comic-book morality in the Age of Trump. How quickly our values have collapsed into not opposition, but conformance, to Trump’s.

So how should we respond to the pathologies of the Trump Administration? By focusing on policy, of course:

The real question is, What will create economic growth for the huge numbers of Americans being left behind? What will salvage the communities of an alternative universe being ground under by the advance of what is, to them, an alien culture and destructive economy?…

You really want to save truth, justice and the American Way? Stop seeing every Trump outrage as a cause for, well, outrage: Stop “ab-normalizing” him. Embrace the pathetic reality: He is a politician like any other, to be judged by his vacuous policies that fail even his supporters. Offer real policy alternatives that will protect the families of those who wrongly believe he is their hope. Start doing that, reality will take care of itself.

And that takes us to this week’s policy-oriented post – on the appallingly bad, long-awaited Republican alternative to Obamacare:

[T]he Republican health care bill concerns itself mainly with stripping millions of their coverage, recreating those halcyon health care days of the Bush years for most, and providing massive subsidies to – get this – the wealthiest. That ultimately makes plain the real Republican philosophy of government.

There are three basic conceptions of government’s role in human affairs. Some believe it is properly a force for collective good. Rightly or wrongly, that’s the vision liberals propound today.

Others believe – and this is, of course, a deep strand in American political thought – that while government might indeed be used for good as well as ill, in practice it tends to reflect what Francis Fukayama has called the “stationary bandit” theory of the state: It is a coercive force for extraction and exploitation of the many by the few, and thus to be constrained wherever possible. And then there are those who do the extraction and exploitation and recognize government as the best institution for achieving that.

Republicans love to talk like they fall into the second category. The chief virtue of this health care bill is that it makes transparent that they actually comprise the third.

You can read the whole analysis, The GOP’s Health Care Shock, here.

Easy links in this update:

30 best reports on “Operational Excellence in Government”

U.S. News & World Report: The Hollow Men and Parallel Universe of Trump-World

The GOP’s Health Care Shock

As always, I welcome your comments below!