Jane Hamsher wrote about the 11 Dimensional Chess approach to health care legislation that the Obama administration tried. That sent me back to some earlier thoughts I had shared about how we visualize the political spectrum. The simplest way to view things is one dimensional. Like the opening image here it breaks down into a right/left, red/blue, conservative/liberal, Republican/Democrat, or another single-axis spectrum. Many people recognize how inadequate such a simplified view is and various people (including myself) have sought to devise two-dimensional representations of the political landscape.

Of the many maps out there I think the easiest to comprehend is this from the Worlds Smallest Political Quiz:

With an axis measuring personal freedom issues and an axis measuring economic freedom issues it is not difficult to grasp the lay of the land according to this graph. Unfortunately this two dimensional representation, like all other two-dimensional representations, falls short of accurately describing reality.

I don’t know how many distinct axis may usefully divide the political landscape to understand the many varied perspectives that play into our national political debate but I have identified at least one more axis besides the personal and economic freedom axis – there is the power axis that deserves to be considered. How much political power a person has seems to have a distinct influence on their political outlook. Unlike the personal and economic outlook axis, which are virtually independent of each other, the power axis tends to insert some biases into people. The more political power a person attains the more likely they are to gravitate towards some degree of Big Government statism. I’m not sure which is the cause and which is the effect (I suspect they are simply intertwined) but there definitely seems to be a correlation between rising power and rising acceptance of statism. (I wish I could come up with a visual representation for this.)

While it is important for us to recognize that third dimension, perhaps another important insight can be gained from simply accepting the existence of any new axis – our perspective can be deceptive as to the view of others. From whatever your vantage point in the political universe your understanding of other viewpoints will be greatly enhanced anytime you are able to acquire a description of the other viewpoint from a vantage point that is not substantially the same as your own. Without that different perspective your view is reduced to two dimensions or less and you may fail to discern where others differ in their perspectives, or you may fail to recognize the significance when two people (perhaps as different as Ms. Hamsher and myself) agree on a particular point.

Back in October I wrote about the dangers of a crisis mentality and tried to show that the abuse of crisis was not a one-party trait. I see that Will Wilkinson did a better job of showing that this month in Let the next crisis go to waste:

The Aughts began in crisis when the second plane hit the second tower on Sept. 11, 2001. The Bush administration, loath to let a serious crisis go to waste, managed to parlay the nation’s alarm and credulity into an ill-conceived invasion of an entirely unrelated country, wasting over a trillion dollars and many tens of thousands of lives, all while losing control of the fight in Afghanistan and failing utterly to bring down Osama bin Laden.

Bush’s botched attempts to capitalize on crisis—the ugly aftermath to which Obama is heir—might have made an alert leader wary. But instead, Obama set up shop in the Oval Office and proceeded immediately to use crisis as (Emanuel’s words again) “an opportunity to do things you’d think you could not do.”

Rather than acting as a prudent guardian of the public good in a time of economic turbulence and hardship, Obama and the Democratic Congress have hurried to check the boxes on their partisan wish list precisely when the nation most needed a restorative break from transformative ambition.

When Obama was campaigning he promised change – the only change we got was that the president was officially affiliated with a different party than before. His opponents during the campaign were vocal about the fact that they could not believe he would deliver the promised change. Since his inauguration some of those who supported him have found that they no longer believe in the change he promised. We were promised an end to “politics as usual.” Instead some left wishing for the politics of the 90’s – nasty as they were – rather than the politics of today. As Mr. Wilkinson put it:

This marriage of incompetence and craven opportunism is so much in the familiar spirit of the age that one must conclude that the age itself remains unchanged.

The “crisis as opportunity” mentality can lead to only one thing – criminal behavior. It is the same mentality that leads to looters during the L.A. race riots of the past and the Hatian earthquake of the present.

I have concluded that regardless of whatever other rhetoric a candidate may offer in the future the biggest change I want to see will be a candidate who promises to treat a crisis as a crisis and not as an opportunity.

After the town hall meeting I attended on Wednesday I have been thinking about pension plans generally. The state of Utah is looking at changing their pension offerings for new employees to save the state from future financial ruin. I have seen other companies go through that process already. As a nation we have seen the cost of defined benefit pensions contribute mightily to the downfall of GM and Chrysler as well as having a hand in the struggles throughout the airline industry not so many years ago.

As I thought about all these examples I realized that even a fully funded defined benefit pension program is a gamble for any organization. Employees like the security, but it is an inherently risky proposition to offer such a plan.

I decided to look into the history of pensions and as with so many other systemic problems we face, the problem of widespread pension offerings really took root as a result of a poorly conceived government intervention, namely wage freezes during WWII where companies began exploring new ways to compensate workers besides simply using salary as compensation. Notice that this is also at the root of our dysfunctional employer-dependent health insurance boondoggle. The fact that both of these crippling trends were incubated by government wage interference and nursed along afterward through favored status in our tax policy should be a major red flag against further socialist economic moves by our government – no matter how good it might look now there is bound to be a crippling downside that will rear its ugly head later.

These days everybody wants to help the poor people of Haiti – and that’s obviously a good thing but when I think about Haiti it makes me wonder what the proper course of action is for outside nations to help that struggling country. I’m not talking about the proper course of action to help after the earthquake last week – that’s relatively simple to answer: get aid in supplies and personnel on the ground quickly to restore order and save lives (even though it’s not an easy task). I’m talking about the real fundamental problems that have been plaguing the nation of Haiti as demonstrated by their history of the last 20 years.

In the last 20 years there have been four regular elections – the winner of all four has alternated between Jean-Bertrand Aristide and his good friend René Préval. As far as I understand they never ran against each other so this is not a matter of oscillating between political parties. Both times that Aristide was elected he was later exiled. The first time he was eventually returned to power thanks to U.S. intervention – the second time it was the U.S. that sent him into exile. Hence my question – what is to be done for Haiti?

Regular elections in Haiti should be scheduled for late this year. Perhaps at that time the people of Haiti can start fresh trying to bring stability and prosperity to their nation, but if they elected the same man twice in ten years who they then accused of corruption and gave him a vote of no confidence I’m not sure that they know how to solve their problems.

Assuming that their recent history holds and they continue to face corruption and poverty long after the devastation of the earthquake is behind them, what is the proper help that other nations might offer? In that case I doubt that perpetual aid is the solution. What they seem to need is ingenuity and I don’t know of any way to lend such a crucial commodity. We are well practiced at impeding constructive ingenuity, but not so successful in fostering it.

When I wrote about the importance of investing in yourself I was having trouble trying to find the words to convey what I meant. I finally found a way to explain what I mean so that nobody should be confused (I hope).

Virtually every book on financial planning or wealth building I have ever encountered says something to the effect that there are two ways to have more money. The most obvious being to make more money and the too-often overlooked being to spend less money. When I wrote about investing in yourself my expectation was that readers would assume I was talking about the things that amount to making more money – increasing your education being frequently cited. That kind of self investment is focused on being better able to produce more goods, or more valuable goods for others to purchase in an economic marketplace.

What I was trying to advocate before was to not forget about self investments that amount to spending less. I would generalize those kinds of self investment as focusing on being able to produce for yourself those things which you have become accustomed to purchasing in the economic marketplace. That may be producing the same thing, or it may be producing a substitute.

The doctrine of the free market and the value of specialization to produce more total goods (Friday catching fish to trade with Robinson Crusoe for the coconuts he was harvesting) seems to have been repeated so much that we fail to recognize and properly value the dangers of over-dependence. No matter how much more Friday and Robinson Crusoe can produce together, either one of them needs to be able to survive alone should something happen to their partnership. That means that there is value beyond compensation for Friday to know how to get his own coconuts or something to replace them.

The first step in this kind of self investment would be taking the time to acknowledge what things you depend on that you do not produce yourself, and more importantly recognizing which of these things you are unable to produce for yourself.

Meanwhile, over at Fire Dog Lake (again) I find another insightful post from a staunch liberal, this time it’s from Jane Hamsher (yesterday it was Jon Walker) who is talking about what she calls the left/right populist wrap around.

There is an enormous, rising tide of populism that crosses party lines in objection to the Senate bill. We opposed the bank bailouts, the AIG bonuses, the lack of transparency about the Federal Reserve, “bailout” Ben Bernanke, and the way the Democrats have used their power to sell the country’s resources to secure their own personal advantage, just as the libertarians have. In fact, we’ve worked together with them to oppose these things. What we agree on: both parties are working against the interests of the public, the only difference is in the messaging. (emphasis added)

This is another example of the media missing the boat. They play everything as Left vs Right. They promote the notion that anything which angers both the radical right and the radical left must be pretty good policy – that’s their definition of centrist. In contrast, Ms. Hamsher pits the left/right populist wrap around against the beltway insiders – or as some of my commenters have called them, the corporatists.

Being able to unite the left wing and the right wing in opposition to a policy does not make that a good policy. After all, the German Fascists were able to unite the American Capitalists and the Soviet Communists in opposition against them, but you won’t here anyone (except neo-nazis) arguing that the German Fascists were good because of that.

We’ve had a perfect example of that here recently. I consider myself to be more conservative than the “conservatives” in Congress. Charles considers himself to be more liberal than the “liberals” in Congress. We disagree on many issues, but we’d both like to see a government that represented the people of the United States. I don’t see how it can be argued that Congress is getting it right when I want to see my Republican senator defeated and have him replaced with a real Conservative and Charles want to see his Democratic senator defeated and have her replaced with a real Liberal. (Excuse me for putting words into your mouth Charles.)

There is a disconnect between the roots of representative government and the tree of elected officers. Anyone who thinks that is a positive sign or healthy in any way is definitely missing the boat.

P.S. Having two hits in two days means I will now be following Fire Dog Lake rather than waiting for others to point out their latest articles.

Are the people there less healthy? No, they have higher rates of some health conditions than average and lower rates than average of other conditions. Overall health fails to explain the cost differential.

Was the quality of health care being provided higher than average? While they were not lacking for available medical technology or facilities the quality of care was, once again, nothing unusual.

McAllen costs Medicare seven thousand dollars more per person each year than does the average city in America. But not, so far as one can tell, because it’s delivering better health care.

Gawande went to dinner with some McAllen doctors and showed them the data on health care costs in McAllen:

Some were dubious when I told them that McAllen was the country’s most expensive place for health care. I gave them the spending data from Medicare. In 1992, in the McAllen market, the average cost per Medicare enrollee was $4,891, almost exactly the national average. But since then, year after year, McAllen’s health costs have grown faster than any other market in the country, ultimately soaring by more than ten thousand dollars per person.

He then asked them why they thought the care was so costly there. One suggested the cost of malpractice insurance but then they admitted that since Texas had passed caps on malpractice lawsuits they had virtually no lawsuits to drive up the cost of care.

Finally a general surgeon among the dinner party declared that the issue in McAllen was overutilization.

Everyone agreed that something fundamental had changed since the days when health-care costs in McAllen were the same as those in El Paso and elsewhere. Yes, they had more technology. “But young doctors don’t think anymore,” the family physician said.

Anecdotal evidence and agreement is fine, but Gawande went in search of more concrete evidence.

To determine whether overuse of medical care was really the problem in McAllen, I turned to Jonathan Skinner, an economist at Dartmouth’s Institute for Health Policy and Clinical Practice . . . I also turned to two private firms—D2Hawkeye, an independent company, and Ingenix, UnitedHealthcare’s data-analysis company—to analyze commercial insurance data for McAllen. The answer was yes. Compared with patients in El Paso and nationwide, patients in McAllen got more of pretty much everything—more diagnostic testing, more hospital treatment, more surgery, more home care.

Having identified the cause of the high costs the search was on for an explanation of why there was so much overutilization. The answer was in the culture of the medical practitioners in McAllen – they were very profit oriented rather than results oriented. I believe the one place that Gawande’s article falls short is that he stopped with exploring the cultures among the medical community and failed to examine whether the general community culture in McAllen helped to foster that inefficient mindset among the medical practitioners in the area. I’m willing to bet that such a short-sighted culture in the medical community might not need encouragement from the local culture, but could not survive if the local culture were one that actively discouraged a similar outlook in the community at large.

Talking to a surgeon from McAllen, Gawande concludes that whether we have a public option, single payer, or private health insurance will not matter if the culture in McAllen continues to become more common as it has been doing.

In contrast to McAllen, Gawande explores the cultures in the Mayo Clinic and the Medical community of Grand Junction, Colorado and finds that both of these low-cost, high-quality health care systems took very different approaches to each arrive at “accountable-care {organizations} . . . {where} leading doctors and the hospital system adopted measures to blunt harmful financial incentives  {and} took collective responsibility for improving the sum total of patient care.” He also lists four other high-quality low-cost health care systems each of which has a culture of accountable care – the Geisinger Health System, the Marshfield Clinic, Intermountain Healthcare, and Kaiser Permanente.

Whatever approach Congress tries to take to reform our health care system they and the American people need to understand that we cannot successfully plant a Health Care tree. The only workable approach will be to plant Health Care seed and help it to grow into a health new health care system.

In the midst of a recent comment the author revealed a fundamental assumption that he and I don’t share that clearly explains why we have differing views on government:

Federal mandates are about the only power the government has to prevent a race to the bottom. . . THE only way to get some states to do what needs to be done is to simply mandate it. The race to the bottom has got to end.

I should start by saying that federal mandates truly are the only power that government has to prevent a race to the bottom – also that I don’t think such mandates are sufficient to prevent such a race (in other words government is powerless to stop that race). After exploring the assumptions that serve as the foundation for that statement about a race to the bottom I quickly concluded that I could not accept that view of the world for myself.

The view that government must use federal mandates to prevent a race to the bottom seems to be built on the belief of Thomas Hobbes that people are basically selfish and evil. People who act as Hobbes expects will naturally engage in a race to the bottom on any issue. It is possible to believe that states will engage in a race to the bottom while still thinking the people are not basically selfish but to hold that combination of beliefs requires a belief that politics is basically corrupt and that it is mainly those who would engage in a race to the bottom who hold public office.

The alternative, as best expressed by Jean-Jacques Rousseau is that men are basically good. Basically good is not the same as absolutely good so there is still a need to have government operating in society, making sure that the worst of people are not allowed to freely plunder from the rest of people and providing structure in matters that are not issues of right or wrong, such as establishing weights and measures and defining what side of the street to drive on. Translated into the arena of government this view suggests that anytime government does things beyond what it is meant to do it is much more likely to be impeding a race to the top than it is to be preventing a race to the bottom. Those who believe in the basic goodness of their fellow men should be naturally cautious about inserting government into all facets of life, even if they believe that those holding public office are acting on the best of intentions for the good of society.

Late in October a comment by Jason sparked my brain to recognize a subtle but fundamental difference between conservatives and progressives. Perhaps it should have been obvious simply by comparing the definitions for “conservative” and “progressive” but the implications seem to be  both subtle and profound.

The word “conservative” can be reduced to essentially seeking to maintain a static foundation. The word “progressive” can be reduced to essentially seeking to promote change from the status quo. Notice that, contrary to what some people believe, progressive and conservative are not antonyms. There are times when change from the status quo may be towards an earlier static foundation, but I think it is obvious why these two views would generally not be in harmony with each other.

When it comes to political goals these fundamental differences alter the approach to political calculus. For progressives, where change is a fundamental tenet of their philosophy, having a majority, or at least a minority large enough to have real influence on legislation would naturally tend to be more important than strict adherence to any single principle. For conservatives, where their foundation is fundamental to their philosophy, sticking to that foundation is generally more important than attaining a particular level of influence.

The differences between these philosophies have a natural implication that serves as a roadblock to conservatives. Those with a progressive philosophy are more inclined to compromise in order to make things happen because movement is an end, and not simply a means to an end in that philosophy. Because compromise is a political necessity progressives are more comfortable actively entering the fray than their conservative counterparts. Also, because conservatives are more concerned with maintaining their foundation than with  making a change, they are more likely to be satisfied (or complacent) with holding their ground even while they are outside the circles of real influence where their principles could have a positive impact on more people. After all, simply climbing the ladder so that your voice carries further means that you have to put something between your feet and your hallowed ground. (It also increases the chances that you could eventually fall outside that trusted position.)

There are two political cultures that we need to change in order to have a healthy “government of the people, by the people, and for the people” in this country. The first is the culture among the voters as defined by how thy perceive those who hold political office. The second is the culture among lawmakers as defined by how they perceive the purpose and role of government.

Our Pit of Dysfunction

I got thinking about these culture issues during a brief discussion with my brother in which he mentioned an ex-politician that now works for the same company as he does whom he described like so:

He’s the kind of guy who leaves you with a sense that not all politicians are scum sucking bottom dwellers.  He’s a really great guy.

That is a great example of the voter culture that leaves voters not wanting to participate in politics because the whole process feels dirty. That perception makes you feel that anything more than voting might contaminate you by association and has the added effect of making your vote feel useless anyway.

Among politicians the dysfunctional culture is one that views government as a powerful multi-tool which is adaptable to help deal with whatever problem the nation is facing at the time. The perception that government can be so adaptable is dangerous because it causes an excessive reliance on government (a hammer) so that we use it for tasks it was not meant to address (like cutting aboard and wondering why the edge is all jagged) while overlooking other available tools (any number of saws) that are better suited to many of the challenges we face.

The reality is that neither of those cultural perceptions is correct. Many politicians (possibly even the vast majority although my own experience is too limited to prove that conclusively) on both sides of basically every issue are good people who really do want what they think is best for their constituents and the nation as a whole. That fact may explain why, when confronted with their individual elected leader at whatever level, voters find it easy to send the incumbent back even while holding a very low opinion of the elected body they are sending them to participate in. Because government is not a multi-purpose tool to address a wide variety of problems, even well-meaning people (politicians, lobbyists, voters) trying to use it as such will create at least as many problems as they solve and they will be dissatisfied with the results of all their hard work.

A Functional High-Ground

The problem is not so much that most politicians are bad as it is that most of them succumb to a system that promotes the centralization of power – which is inherently destructive if not held firmly in check. Government power operates much like gravity – the more mass you have concentrated in one place the stronger the pull of gravity – thus attracting even greater mass. It is a natural process, not some insidious conspiracy. In that way the neoconservative view expressed by Irving Kristol that they see the growth of the state as natural is true. What they fail to acknowledge is that it is not desirable – that it is, in fact, dangerous. As nice and or good as many politicians are they don’t understand that they must be ever vigilant against the concept that the government is a solution to a wide range of problems. Once you accept that notion you start cutting wood with a hammer and act surprised when you can’t make a straight cut.

The natural gravitational pull of government power is one of the reasons that we can benefit so much from an establishment of term limits. True, there are some few individuals in history who would be able to stand in the halls of power without losing sight of the limits of the usefulness of that power, but far more common are those who get a tool and eventually they see that tool as adding value to every project. As my father in law is known to say – when you have a hammer, everything begins to look like a nail.

The truth is that government is only good for policing the legal system , in other words making sure that they don’t exceed the proper bounds of government (unfortunately most politicians today don’t understand this so it doesn’t happen enough), and for providing a justice system that treats everybody fairly (but since government is involved in so many things our justice system frequently treats many people unfairly – either granting unfair advantage or inadvertently punishing those who they are not concentrated on helping).

The reason our government and political system are broken is not so much because the actors are bad as because they are working off the wrong script. I believe that any nation where these two cultures are in their proper form can sustain a healthy government so long as they avoid the pitfalls we are currently in. The voters and elected officials must always respect the limits of what government can appropriately do and they should also remember to respect those who disagree with them – are at least respect that their opponents rarely have sinister intent.