Llewellyn King: Rigidity can be deadly to wonderful innovation

Magazine cover in 1928, when radio was becoming very big but inventors were already thinking ahout television.

WEST WARWICK, R.I.

Simple advice to innovators and policymakers: Don’t worry about collateral needs or they will distort your good growth and policy efforts.

If we look back, the development of the automobile had collateral effects beyond the ability of the auto pioneers to conceive. Yet there were those who would have restricted automobile development because they worried about the collateral effects, including that there wouldn’t be enough gasoline, oil would run out, cars were dangerous and fueling stations would explode.

The lesson wasn’t that those were minor concerns, but that they were giant and reasonable concerns that didn’t take into account that there would be as much creativity in solving those problems as there was in creating the primary product in the first place.

If the Wright brothers had worried about how we would keep aircraft from colliding with each other, well, we would have more trains and passenger ships.

The message is that innovation begets innovation. Invent one thing and then invest in something else to support it.

Yet there are reactionary forces at work in the creative arena all the time.

To continue with the automobile example, there are naysayers to the electric car everywhere. Sometimes they are driven by economics, but often they are just worried about great change. I can hardly pass a day without reading alarmist pieces about the disposal of batteries, a possible shortage of lithium from friendly suppliers, or that there won’t be enough charging points.

To all that, I say piffle.

History tells us that these seeming problems will be solved by the same inventiveness that has brought us to this time, when we are seeing a switch from the internal combustion engine -- faithful servant though it has been -- to electricity.

The danger is rigidity.

Rigidity is the seldom-diagnosed inhibitor of good science, good engineering and good policy. Rigidity in policy, or even just in belief, restricts and distorts.

A rigid belief is that nuclear waste is a huge problem. I would submit that it is less of a problem than many other wastes we are leaving to future generations. Rigid concerns and rigidly wrong radiation standards led the electric utilities to turn to coal, and now to wind and solar to move away from coal and its successor, natural gas.

Medicine is beset by rigidities and it always has been, from excessive use of bleeding therapy to surgeons who believed it was ungentlemanly to wash their hands. Those who suffer from less common diseases -- Myalgic Encephalomyelitis, also known as Chronic Fatigue Syndrome, is one -- are hurt by medical profession rigidities. The doctors try to fit disease into what they know and treat patients with known but inappropriate therapies.

Even such great innovators as Henry Ford weren’t without their crippling rigidities. Henry Ford was opposed to 6-cylinder engines and wanted all cars to be black.

Political rigidities are perhaps the most pernicious. I would suggest that the fear of the bogeyman of socialism has prevented America from developing a sensible health-care system — one that is less expensive and has better results. It doesn’t have to be modeled on Britain’s National Health Service, but it could borrow from Germany or The Netherlands, where the health system is universal but provided by private insurance. Ditch the rigidity and start fixing the patient -- in this case, the whole system.

Our educational system is plagued with rigidities. At the lower end, the public schools, children aren’t getting the basics they need to function in our society. At the high end, the universities, there is a new kind of aristocracy where the favored faculty are coddled, shielded and underproductive, while the cost for students is prohibitive.

Our most productive, most gifted graduates are compelled to align their careers with jobs that will pay enough to free them from the debt burden we start them in life with. This might cause a bright student to go into computer science when he or she longed to study astronomy, certainly a less well-paid future.

Rigidities kept women from seeking new roles and responsibilities, and from seeking their own personal and professional identities rather than have them defined by the outside, male-dominated society. Homemaking, yes; corporate management, no.

Rigid doctrine is always at work and is an unseen impediment to future innovation in science, social structure and, above all, in politics Watch for it.

Llewellyn King is executive producer and host of White House Chronicle, on PBS. His email is llewellynking1@gmail.com and he’s based in Rhode Island and Washington, D.C.

Web site: whchronicle.com

There’s long been pushback against the world-changing innovation of electric cars.

Negin Owliaei: No one should have to bargain for health care

Via OtherWords.org

Nearly 50,000 members of the United Auto Workers began striking earlier this month, demanding that General Motors pay them their fair share of the billions in profits the company raked in last year.

The response from General Motors was shocking. The automaker, which accepted billions in government bailouts during the last recession, cut off its payment of insurance premiums for the striking workers.

As the news broke, former Vice President Joe Biden was at an AFL-CIO event, campaigning against a single-payer Medicare for All plan that would replace employer-provided insurance. “You’ve broken your neck to get it,” Biden told the crowd. “You’ve given up wages to keep it. And no plan should be able to take it away.”

But what if that’s actually the problem? Why should union workers — or anyone — be breaking their necks to get health care, a basic human right?

Health care has been a constant subject of debate among Democratic presidential candidates. Biden and others have argued that a single-payer system would be unfair to union workers who’ve taken pay cuts in exchange for better health care plans.

But, as GM showed, our current system turns health coverage into leverage for employers. What could unions could fight for if they didn’t have to constantly play defense against employers trying to gut their health care?

If we already had Medicare for All, the United Auto Workers could be using their collective power to fight for higher wages and better benefits. Instead, GM gets to use the health of its employees as a bargaining chip.

Auto workers aren’t the only union workers fighting for health coverage.

West Virginia teachers kicked off a strike wave last year thanks, in large part, to their own fight over insurance. The state offered educators two options: use a fitness-tracking app that forced them to earn a certain number of fitness points, or watch their premiums rise. They chose to strike instead.

Meanwhile, Americans already lose their health insurance all the time. That’s actually one of the biggest problems with the health care system as it stands.

Tying health care to employment is a terrible idea. In addition to failing anyone without a full-time job, it forces people to stay in bad positions just to keep their coverage. And when workers lose their jobs, they lose their insurance too.

That wouldn’t happen under Medicare for All, which would allow workers to make decisions about leaving a job or working part-time without panicking over their insurance coverage.

Then there’s the cost.

Health insurance alone makes up, on average, 8 percent of total wages and benefits, according to the Bureau of Labor Statistics. But workers are seeing their share of the costs rise at a higher rate than their wages. They’re getting stuck with a larger chunk than ever before.

Data shows that this burden falls heaviest on low-wage workers, who are already forced to spend a much higher share of their income on extra costs like premiums and out-of-pocket expenses.

By contrast, the Medicare for All plan now before Congress would cover all medically necessary services without co-pays and deductibles — an advantage critics like Biden rarely address.

Right now, the U.S. spends about two times as much as other high-income countries on health care, only to have poorer health outcomes. It’s obvious that the current system isn’t working — for union workers, or for anyone else.

No one should have to bargain for a human right.

Negin Owliaei is a researcher and co-editor of Inequality.org at the Institute for Policy Studies.

Martha Burk: Employees have 'religious' freedom, too

Via OtherWords.org

When Obamacare — aka, the Affordable Care Act — became law in 2010, it mandated coverage of birth control without co-payments.

Some employers didn’t like the rule, and Hobby Lobby hated it so much that the company filed a lawsuit to stop it. Company owners said they didn’t believe in contraception and claimed that covering it for female employees violated their religious freedom.

Understand, the Obama administration went to great lengths to exempt churches and church-related institutions from the rule, while still guaranteeing their female employees the right to birth control if they wanted it.

Then the Supreme Court stepped in, siding with Hobby Lobby and ruling that “closely held” corporations with religious objections could join religious employers in excluding birth control from their insurance plans.

Now the Trump administration has gone a giant step further. They’re now allowing any and all businesses, including publicly traded ones, to also cite “religious or moral objections” in denying their employees contraception coverage.

Wait a minute.

Corporations not only have religious freedom but now moral principles, too? I didn’t even know they went to church, and I’m pretty sure I’ve never seen one get down on its knees and pray.

On the other hand, I know women — who are actual people — have religious freedom under the Constitution, too. What about their right not to be forced to bow to their employers’ religious beliefs or highly suspect “moral” principles?

Massachusetts, California, and the ACLU have filed lawsuits to stop the rollback. Good luck. Besides Hobby Lobby, the conservative majority in the Supreme Court ruled years ago in the Citizens United case that corporations have constitutional rights, and they’ve consistently ruled in favor of their corporate buddies over women in employment discrimination cases.

On top of that, six of the nine justices are male, and most of them of rather conservative religious persuasions. The odds look to be stacked against women.

Expanding so-called corporate citizen rights deeper into health care could ultimately affect everybody, not just women.

Christian Scientists are opposed to all kinds of medical treatment, including for diabetes, cancer, and meningitis. Jehovah’s Witnesses don’t believe in blood transfusions. There are undoubtedly other religious taboos on medical procedures.

Enterprising businesses that want to save money could cite “religious freedom” to exclude virtually any medical treatment from their insurance plans. Surgery, antibiotics, immunizations — you name it.

Where will it end? We don’t know. Even if the lawsuits are ultimately successful, a decision could take years.

All I know is that I don’t want my neighborhood corporate citizen making my health care decisions.

Martha Burk is the director of the Corporate Accountability Project for the National Council of Women’s Organizations (NCWO) and the author of the book Your Voice, Your Vote. 

Llewellyn King: Look around the world for what works best in health-care systems

''Nothing is ever done until everyone is convinced that it ought to be done, and has been convinced for so long that it is now time to do something else. ''

— F.M. Cornford

There are no simple solutions to complex problems — unless they’ve become so complex that only a simple solution will do. Welcome to health care and insurance in all of their complexity.

Engineers like to say that if a new machine of structure has too many parts, it’s not ready. Not a bad idea to keep in mind when creating a societal structure like health care. One should know where one wants to go; knowing what one doesn’t want isn’t a starting point.

I submit that the goal of health policy, stripped of its advocates, denigrators and rentiers, should be to get everyone insured for the minimum amount of money and best care result. Simple, eh?

Some aspects:

There ought to be enough money for the United States to have universal health care, not a patchwork — a crazy quilt with holes and weak seams. We spend 19 percent of our GDP on health care, but Germany and the Netherlands spend just under 12 percent of theirs on hybrid public/private, comprehensive systems.

Insurance is a probability game, ergo it’s not unreasonable to ask the able-bodied to pay for the sick.

Mandates are not alien to us. We are mandated to pay taxes, drive with licenses and even wear clothes.

The more people covered by insurance, the lower the cost to all.

There seems to be no good explanation in the public record as to why medicine is so expensive in the United States — so much more expensive than elsewhere on earth, under wildly different systems.

The United States is the only country that leans on employers to provide health insurance to employees and to administer the policy and deal with issues that arrive with disputes.

The cost of the service patients receive is opaque once a third-party payer is responsible: the insurer. The basis of a hospital charge is hidden from the patients and policymakers. The patient has little idea what a procedure costs and who benefits from the expenditure, including doctors who own imaging companies, testing labs and even operating theaters. At the time of delivery, as Norman Macrae noted in The Economist years ago, neither the doctor nor the patients has an interest in the cost.

Hospitals are burdened with emergency rooms that can’t refuse the uninsured and hide this cost by overcharging elsewhere.

For more than 30 years I operated a publishing business and provided health care for my employees. It cost. It cost in time. It cost in premiums. It cost in employee well-being because as the premiums (well before Obamacare) rose by 15 percent to 25 percent, I was forced to shop for providers — which meant, in many cases, new doctors for my employees every year.

After salaries, health care was the big expenditure. I thought I was in the publishing business, but I was also, reluctantly, in the health care business.

I was keen that people have the security that goes with not having to be frightened of getting sick or falling off a bicycle. Some of my employees were on a spouse’s policy as well as mine and didn’t tell me. One man, a printer, said he didn’t like to fill in forms, so he, his wife and three children just told the hospital emergency room that the family had no money. He wanted me to give him what I was paying the insurer so he could spend it.

None of the proposals now before Congress, nor those codified in Obamacare, address the fact that as a nation we backed into health care and created complex set of stakeholders — some of whom should leave the field.

For someone who has wrestled with health care as a provider, as in other things, I believe that if the purpose is not defined, you’ll get the wrong result no matter how hard you try.

The big questions Congress should be asking of the House Republican health care plan, backed by President Donald Trump, are: Will it save money? Will everyone be covered adequately? From my point of view, Congress is proposing to replace a monster with a monstrosity.

That’s no prescription for a healthy nation, free from fear of accident or illness. Time to grab a clean sheet of paper and start again, maybe check on what works around the world, if that isn’t too damaging to our self-esteem.

Llewellyn King (llewellynking1@gmail.com) is host and executive producer of White House Chronicle, on PBS, and a veteran publisher, columnist and international business consultant.  He's a frequent contributor to New England Diary. This piece first ran in Inside Sources.

What really is meant by 'patient engagement'?

  Cambridge Management Group (cmg625.com) senior adviser <a href="http://www.cfah.org/blog/2014/what-physicians-told-us-about-patient-engagement">Marc Pierson, M.D., had some pithy things </a>to say when he and other experts were recently interviewed by the Center for Advancing Health.

Here are some of the remarks of Dr. Pierson, who is also retired vice president for clinical information and quality for PeaceHealth's St. Joseph Medical Center, Bellingham, Wash.:

<strong> CFAH: ''Here is the CFAH definition of patient engagement: 'Actions people take to support their health and benefit from their health care.' What's missing from this definition? What would you add, subtract or word differently?''</strong> <strong> Dr. Pierson:</strong> ''....Defining {patient} engagement is very much the product of who is doing the defining. If from within health care, then the key question becomes for what or for whom is 'patient' engagement primarily intended to benefit?...I would prefer thinking of 'people' engaged in their health and health care. However, I do like that this definition recognizes that both health and health care require people's active participation...Medical care is not the same as health. Health is much more than the lack of illness...We need to incorporate more perspectives from real people and ask them what they need to become more engaged with their medical conditions, their health, and their well-being.'' <strong>CFAH: ''If a person is engaged in their health and health care, what difference does that make? To whom?''</strong>

<strong>Dr. PIERSON: </strong>"Typically, engagement is defined by health care insiders as paying attention to what you are told to do and being compliant with 'orders.' The current non-system of health care plays into this by being disconnected and difficult for people to understand or navigate....

''Health care offers technology and knowledge but is set up for the people that work inside it, not for its clients' ease, safety, or affordability. Payment for health care is based on professionals managing clients' ill health, not on engaging with people to prevent illness, create well-being, or for self-care of illnesses and chronic conditions.

''People are scared of what they are not allowed to know or understand. They don't want to be more dependent. They don't want to end up going to an emergency room. Their primary relationships are with family, friends, neighborhood, and community — not professional service providers.''

Partners president links health care and higher ed

  Gary Gottlieb, the president of Massachusetts behemoth Partners HealthCare, recently discussed the similarities of the challenges facing higher education and health care.

He called  higher education and health care the civil-rights issues of our time.

He spoke at the "Summit on Cost of Higher Education'' run by the New England Board of Higher Education (www.nebhe.org) and the Davis Educational Foundation.

This story and video originated on NEBHE's Web site.