Interpreters of the recent election results have been pointing fingers in many directions about alleged successes and failures of policies and messaging. Having run a consulting business for more than 10 years I see a parallel between how people vote and how people and organizations making hiring decisions. That is, people voting for their elected officials are essentially making decisions about who they want to hire to run their government.
Politicians certainly want the people who voted for them last time to vote for them the next time. This is a fundamental tenant of business success, i.e., getting your current clients to become repeat customers. In business, a sure fire way to make a customer happy and come back is to over-deliver. This is easier if you can also under-promise, but that’s not always possible if you’re competing with others for the same customer. Which is why politicians almost always go the opposite way, i.e. WAY over-promising in an attempt to outdo their opponents, while also using negative messages to undermine the credibility of their opponent’s promises.
The result is that elected officials, (and by extension “government”), WAY under-deliver on their promises. This has been true for almost every elected official, with a few exceptions whose over-delivering was generally not due to their own actions. (For example, the budget surpluses at the end of the Clinton Administration were largely due to a booming economy, which may or may not have had that much to do with the Administration’s actions.) And in situations where governments do deliver on promises, actions often takes longer than people think they should. (In fairness to government agencies and officials, this is because rules for transparency and accountability require lengthy processes for implementing new programs or changing existing ones.)
Under Delivering = Political Upheavals
Over the past 10 years, perceived under-delivering has driven dramatic swings in elections. At the most fundamental level, economic and employment downturns and sluggish improvement drove Obama into office and the Republicans into control of Congress. And because it became apparent that neither party seemed able to deliver on their promises for actual economic recovery, the Tea Party has risen as a “plague on both your houses” solution.
Whether the Tea Party will survive and flourish in our political system, be assimilated, or wither and die remains to be seen. The actual outcome will likely depend upon the state of the economy, job growth, and the military situations in Iraq and Afghanistan over the next 2-6 years – as well as how the Democratic and Republican parties shift their own actions and communications about their promises. (Although I highly doubt any politicians will start under-promising as a strategy for then being able to show how they over-delivered.)
Whether the Tea Party Machine comes to resemble Terminators, Cylons, or Borg will be determined by their own actions and the economic and political environments in which they will be competing. But what does seem clear is that if the economy and employment don’t improve then voters will continue to look for new alternatives to those who have a track record of over-promising and under-delivering. Businesses that do this don’t last long and get pushed aside by innovators who can deliver. Will that happen in the political marketplace? Only time will tell.
What This Means for Health Reform
The resurgent Republican party – in part fueled by the Tea Party movement – has promised to dismantle, defund or repeal the health reform law as it’s being implemented. But some of the specific components – particularly the basic insurance reforms – are generally liked by people on an individual basis… once they understand what they are. In this instance the Republicans have put themselves in a tough position, because if they actually deliver on their promises, they may find that people aren’t very happy with the results, i.e. no increased assurance about their ability to get or maintain health insurance. So if philosophy and a commitment to fulfilling their promises trumps political wisdom, whatever they can undo they will. But if they seek to maintain their political momentum, they will be best served by undoing or stopping only those provisions that don’t have popular appeal and/or are not fundamental to improving the security people have about their health insurance, such as the 1099 reporting requirements.
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p.s. Sorry to have not posted in so long. I’ve been busy helping a community in the Midwest launch a community-wide multi-stakeholder initiative to transform health delivery and financing in their region. Very interesting work and a great real-world implementation of what I and others have been writing about for many years. More on that later – and I promise to write more soon on specific health issues. Best Wishes, M
I am full of hope that the Tea Party Machine will be successful in all their endeavors. Like healthcare or insurance and that the people shall be enlightened and see the truth for it is only the truth that will set the people free. I hope that you will flourish.
David – Thanks for the great comments. A couple of things to note. First, the community-wide efforts I’m helping with are getting a lot of support from the federal funding for health information technology that was in the stimulus bill – and these activities are being directly linked up to the quality improvement and delivery system innovation provisions of the PPACA. And while these activities are being supported by federal funds, they are being designed and implemented at the local level. And second, your characterization of the PPACA as one-size-fits-all – which is certainly widely opposed – illustrates the counter-messaging about the substance of the bill. Like Medicare Part D, or Medicaid, there will be a wide array of options in the implementation. These will occur inside a broad national framework, but most of the consistent provisions are things like the option for parents to cover their children under their insurance policy until they’re 26. And contrary to one-size-fits-all, a concern with implementation is that there will be too many options leading to consumer confusion via information overload – which was a challenge with the launch of Medicare Part D.
This is an interesting commentary that I would only add one thing to, which is that your actual work and the goals of the Tea Party are quite congruent. Local control of local decisions is a fundamental tenet of the libertarian approach. If a community or a state can develop a solution that gets wide community support and improves services, then this is far superior to a one-size-fits-all national approach that is roundly opposed.
If people such as you are successful in these endeavors, then other communities with similar situations can emulate your work. Some of the lessons learned may be able to be generalized at the national level and others not. But the wide support of the independent voter for the Tea Party did not stem from opposition to all things governmental. It came from a belief that the solution that was being ramrodded through was a bad one and that the people doing it were not listening to their constituents.
The 71% vote of bellweather state Missouri against the healthcare mandate was not a vote against messaging. Massachusetts voters had experienced their own state healthcare mandate. They replaced one of the chief architects of national healthcare with an avowed opponent of it. It is doubtful that either Missouri or Massachusetts will suddenly be up in arms about the repeal of portions of this law, which they consider on the whole to have been poorly drafted.
It is possible that you are right that as the repeal effort continues, support for total repeal will fade. But the nation will still be sorely divided on the issue even if the numbers change somewhat.
This is something that absolutely did not have to happen. Instead it was the adamant refusal of either side to compromise that led to this situation. Just as the winning libertarian faction was firmly against national healthcare, the liberal faction was adamantly opposed to anything but single payer. The result was an extremely contentious, high-profile struggle that got boiled down to the buzzwords socialism and free enterprise.
There was initial hope for something good to come out of the debate. Ron Wyden and others in both parties tried hard to create an alternative from 2007 onward.
http://wyden.senate.gov/newsroom/press/release/?id=9ccc1c11-908f-4272-9144-f468a7129786
However, Wyden’s plan was doomed because the proponents of single payer healthcare insisted that there must be a “government alternative.” The opponents saw this as a backdoor to single payer and dug in their heels. And you are absolutely right that Obama overpromised when he said that the PPACA would bend the cost curve down while letting everyone keep their own insurance and not hurting Medicare. A Democratic governor, Phil Bredensen, and the Centers for Medicare and Medicaid Services showed that major elements of this claim were untrue.
Even most opponents see that there are major issues with healthcare delivery that should be addressed. For one, hospital healthcare information is hopelessly siloed. The Dossia Project, powered by informatics software from Harvard Medical School and MIT, is an effort by major healthcare customers to force open the closed system and expose poor service delivery so that the best cost performance can be achieved while protecting patient privacy. Dossia wants to provide their service to the general public for a nominal charge. There are alternatives out there that were not considered in the rush to jam this bill through. If the Administration believes that the election meant something other than a failure to communicate it can embrace alternatives to its failed, divisive approach.
Another important step is to ask consumers whether they are willing to pay more for continuing the fantastic improvements in medicine that have occured in the last 15 years. A system where 25% of first heart attack victims die is far less expensive than one where only 8% die. Getting there involved high cost, as most of the low hanging fruit was picked long ago. Even outcomes of nonfatal illnesses such as GIRD have dramatically improved but Aciphex costs a lot more than the 2nd-most effective drug. If we truly bend the cost curve down it will necessitate some major sacrifices on the part of patients.
This should be made clear up front with any reform. The fact that the PPACA was portrayed as sacrifice free, when people rightly suspected otherwise, is one of the biggest reasons that it failed.