Manage v Lead Part II

Jack Welch summed up his philosophy at General Electric succinctly:

“I don’t run GE,” he said, “I lead GE.”

The first half of this two-part post unpacked some thoughts on the difference between managing and leading in preparation for this: You don't have to be Jack Welch and you don't have to be responsible for the well-being of a giant corporation to make your mark as a leader.

The last two decades gave rise to all manner of initiatives and systems for managing our way to greater margins through cost savings. But no one has demonstrated how we can manage to cut our way to sustainable growth.

Continue reading at InsideWork...

Manage v Lead Part I

They should display Jack Welch’s words on the side of a building in brilliant General Electric bulbs:

“I don’t run GE,” he said, "I lead GE."

And so he did. Love ‘em or not, Welch led GE through a period of extraordinary performance. Was it a perfect run? Of course not. His tenure was marked by great risks and magnificent blunders that reaped great financial rewards and created a powerful learning organization.

Welch identified his ingredients for success in an October 2001 talk at the University of Chicago Graduate School of Business. They are, he said, “four E’s wrapped in a P.”

Energy — For Welch, energy means, “…going like a house afire.”

Energizing — Leaders “Energize people to take a chance so they succeed and build self-confidence.”

Edge — Edge means “…the ability to say ‘yes’ and ‘no’ and not maybe.”

Execute — one word: “deliver.”

Success is four E’s wrapped in a P and that P stands for Passion — “Caring more than the next person…” Welch said, “…passion for what you’re doing. It’s all that stuff in you that goes for it and you give everything you’ve got to make it happen.”

These, Welch told his B School audience, are marks of leadership, as distinct from, say, management.

Keep reading at InsideWork...

US House of Representatives Passes Historic Health Care Reform Bill

From the President of the United States; 07 November, 2009:

Tonight, in an historic vote, the House of Representatives passed a bill that would finally make real the promise of quality, affordable health care for the American people.

The Affordable Health Care for America Act is a piece of legislation that will provide stability and security for Americans who have insurance; quality affordable options for those who don’t; and bring down the cost of health care for families, businesses, and the government while strengthening the financial health of Medicare. And it is legislation that is fully paid for and will reduce our long-term federal deficit.

Thanks to the hard work of the House, we are just two steps away from achieving health insurance reform in America. Now the United States Senate must follow suit and pass its version of the legislation. I am absolutely confident it will, and I look forward to signing comprehensive health insurance reform into law by the end of the year.

Letter to Congressman Bilbray | Step Up on Health Care Sir

Dear Congressman,

I urge you to distance yourself from Congresswoman Bachmann and the others who made an empty-headed spectacle of themselves on the steps of the Capitol yesterday.

The Business Roundtable, the Institute of Medicine, the AARP and the AMA are all calling for robust health care reform now and I join my voices with theirs.

You have a singular opportunity to distinguish yourself as one who stands with your constituents in this most critical domestic policy issue. Step up sir.

Sincerely,

Jim Hancock

George Barna on Jesus' Health Care Plan | A Response

As the US Congress approaches health care reform in earnest, I think it's important to hear from each other in measured tones.

In that spirit, my friend Dan sent me a link to this editorial, Jesus’ Health Care Plan, by George Barna.

I think Mr. Barna makes a category error here.

His numbers convince him that most Americans have accepted a poverty frame for the health care debate, so he addresses the question within that frame.

There is no problem with what he says, as far as it goes. The problem is that he doesn't go the right direction.

In 2004 the Institute of Medicine of the United States National Academies published the final report from a series of mandated, evidence based studies. The report is called Insuring America's Health: Principles and Recommendations.

You can read it for yourself, but I’ll highlight a few findings:

• About four out of five uninsured people in the U.S. are citizens.
• Just over 55% of uninsured Americans are in households with at least one family member who is fully employed. Nearly 14% are in households with two full-time workers.
• The cost of employment-based insurance increased by 260 percent between 1977 and 1998, and the employee’s share increased by 350 percent — while median household incomes only increased by 17 percent (all in constant 1998 dollars).
• About 58% of uninsured adults in the reporting period had changed or lost jobs in the previous year (this is all before the recent job collapse).
• The cost to the U.S. economy in lost productivity from uninsured Americans ran as high as $130 billion a year (nearly twice as much as it might have cost to insure those Americans outright).

In September, the Business Roundtable concluded a study of US health care in a report called Health Care Reform: The Perils of Inaction and the Promise of Effective Action.

For the purposes of this exchange, their findings are summarized well enough in a series of passages from the report:

The Status Quo Is a Prescription for Failure
As months of Congressional and now public debate have proved, discussion of coverage provisions and financing of health care reform is complex and controversial. The debate over health care reform is increasingly being framed as a choice between the current system and the uncertainty of what reform may bring. But the comparison should be between the uncertainty of what reform may bring and the near certainty of what inaction will bring. Doing nothing is simply no longer an option. If current trends continue, the future looks dire for the U.S. health care system and for employer-sponsored coverage that is its foundation. Without change, Hewitt projects that employer-based health care costs will increase 166% by 2019, resulting in a cost burden of $28,530 per employee. This price tag approaches three times the 2009 per-employee cost of $10,743. America’s businesses cannot win in the marketplace when bidding against global companies shouldering significantly lower health care cost burdens.

Without fundamental changes to the system that continues to push costs upward, there is no reason to expect any different trend line over the next 10 years. If that happens, costs in 2019 will be 166% higher than they are in 2009. As summarized in exhibit 2,13 the average cost to American business will be over $28,000 per employee ($28,530).

If current trends continue, the future looks dire for the U.S. health care system and employer-sponsored coverage that is its foundation. If nothing changes, by 2019, total health care spending will reach $4.4 trillion and will consume over 20% of the U.S. gross domestic product. Employer spending and associated employee contributions will significantly outstrip increases in cash wages, causing a decline in consumer purchasing power that will hinder economic growth.

Large numbers of both uninsured and underinsured Americans have filed for personal bankruptcy. One recent study reported more than one-quarter of all personal bankruptcy filings in 2001 were caused by a specific illness or injury.24 Others estimate this number to be around 30%.25, 26 Increasing the number of Americans who have health insurance, as well as ensuring that all plans provide protection from catastrophic expense, should reduce the out-of-pocket burden on individuals. In our consumer-based economy, money spent on health care becomes money not spent on other goods and services. Combined with the drag on wage growth caused by the high cost of employer-provided health insurance, ever-increasing health care costs have far-reaching effects outside the health care sector.

These two reports, one commissioned by government, one by business, both based on evidence-based research and analysis, reach compatible conclusions.

From the IOM report:

1. Health care coverage should be universal.
2. Health care coverage should be continuous.
3. Health care coverage should be affordable to individuals and families.
4. The health insurance strategy should be affordable and sustainable for society.
5. Health insurance should enhance health and well-being by promoting access to high-quality care that is effective, efficient, safe, timely, patient-centered, and equitable.

The Committee calls on the federal government to take action to achieve universal health insurance and to establish an explicit schedule to reach this goal by 2010.

Imagine what the country would be like if everyone had coverage—people would be financially able to have a health problem checked in a timely manner, to obtain preventive and primary care, and to receive necessary, appropriate and effective health services. Families would have security in knowing that they had some protection against medical bills undermining their financial stability. Key community providers and health care institutions could provide care to those who need it without jeopardizing their financial stability.

This picture can become reality, with the right mix of leadership and political will. Unchecked, the costly consequences of the status quo are too large to sustain. It is time for our nation to extend coverage to everyone.

From the Business Roundtable report:

If more people were covered under the existing delivery system, overall spending would increase. The Kaiser Family Foundation estimates that total health care spending for full-year and partial-year uninsureds would add $122.6 billion to the annual cost of health care in the United States if this population became insured.16 Additional health care spending is quite likely to be a short-term result of expanded coverage as the medically underserved receive more and better care. However, there is additional evidence that the economic benefits of this increased spending in terms of improved health status, longevity, and productivity would result in a positive return on this investment. Perhaps the greatest challenge—and reward—will be to modify the underlying delivery system so that it is moved along a path of greater efficiency, quality, and lower cost trends in the future.

A reformed health insurance marketplace that eliminates preexisting condition exclusions and ensures guaranteed access to coverage would reduce or eliminate individuals’ fears that health conditions would block them from obtaining health coverage based on where they work. This would ultimately result in a more level playing field for talent between small employers and large employers.21 One out of every four employed Americans works for a company with fewer than 20 employees, and 82% of Americans are employed by companies with fewer than 500 employees.22 Businesses with fewer than 500 employees account for over 50% of private non-farm GDP and play a large role in supplying inputs and innovation to the American economy.23 Barriers to affordable health insurance hinder the growth of small, entrepreneurial business; we need to remove these barriers to stimulate small business development.

Without market pressure on unit cost and with little incentive to control utilization, the traditional supply and demand equation doesn’t work in health care.

We have established that there is a business and societal advantage to giving more people access to health insurance coverage even in a health care system plagued by obvious flaws. The positive impact can be magnified if expansion of coverage is accompanied by fundamental reform of the health care market and delivery system that underlie the insurance benefit.

The problems and the successes in the U.S. health care system developed over decades, and it would
be naïve and unrealistic to expect that a $2.4 trillion health care system can be radically overhauled very quickly. It will take time. The challenge to key stakeholders in this debate is to positively influence a solution that will first address the current inequities in the system. However, as we reap the positive benefits, it is even more important to put structures and incentives in place which, over time, will produce significant and sustainable reductions in the future cost of health care. We are at a tipping point where continued escalation of health care costs will break not only the Medicare and Medicaid systems that protect our elderly and indigent, but also the companies that the majority of Americans rely on to provide valuable health insurance protection for themselves and their families. Reform in coverage must be accompanied by changes in the underlying markets and delivery system to generate higher-quality and more efficient health care for every American.

These studies have a great deal more to say than I’ve excerpted here and it’s good reading as such things go.

What they don’t do to any significant degree is moralize the problem as George Barna does. The issues at hand do not scale as moral questions any more than interstate commerce or international banking or sickness and injury have moral standing in and of themselves. They scale as macroeconomic questions. And that’s how the delivery of appropriate health services in the US scales.

I think Mr. Barna does not answer the question he asked. Who would dispute his call to followers of Jesus to follow Jesus in caring for the poor and the sick? But that’s a Duh-rated observation. This is not, as he suggests, about “Views of Poverty.” At the least, this is something more akin to shalom and at most it is about how a nation is to conduct its internal affairs. On this subject Moses was clear that Israel was not to allow its citizens to fall into poverty when she had the capacity to prevent it. If these are questions of morality, then it’s a morality that informs their economic practices at a very practical level (as the Business Roundtable report reminds us, “In our consumer-based economy, money spent on health care becomes money not spent on other goods and services.” I agree with the inference from Mr. Barna that Jesus’ health plan isn’t about teaching the sick and the poor a blanket lesson about industry, frugality and self-discipline—especially if we don’t know how this individual or that one became sick or poor.

But when he invokes the Golden Rule and the Great Commandment he reduces them to the size of the individual or household or church or denomination. He loses me there. What if the question were framed, “If I’m to love my neighbor as myself and do to others as I would like them to do to me, would I want others to let me succumb to bankruptcy because of a multimillion dollar medical event if, collectively, we had the means to ensure that doesn’t happen to any citizen?”

And when he describes Jesus’ health care strategy as "whoever, whatever, whenever, wherever;" does that include exerting the political will to reform the system of US health care delivery and payments so it scales meet the legitimate health needs of 300MM citizens?

I don’t think Mr. Barna’s devotional on Luke addresses the questions we're asking right now (unless the questions his audience is asking are decades behind the rest of the nation). AARP and AMA this week endorsed a robust health care reform bill with a public option. I think Christians leaders who represent people who may at some point fall prey to illness or injury—or who care about others who fall prey to illness or injury—ought to do the same and tell their members of Congress about it.


Doctor Jesus (Guatemala) photo by Xeni

Medical Bankruptcies | a follow-up

A couple of months ago I wrote about the steady increase of medical bankruptcies in the US:

• 8 percent in 1981

• nearly half of all bankruptcies in 2001

• a staggering 62 percent of US bankruptcies attributed to medical crises in 2007

But 62 percent of what? How many 2007 US bankruptcies were medical bankruptcies?

Answer: 497,140. US bankruptcies were up 40 percent year over year in 2007 and almost half a million of them were precipitated by medical crises.

US bankruptcies jumped another 32 percent in 2008 topping one million. Every business day in 2008 there were more than 3,000 bankruptcy filings, with things getting worse as the year wore on.

If the 62% number from the American Journal of Medicine study held up from 2007 to 2008 (I don't have data that speaks to that one way or the other, but if that number is within the range of accuracy), that pushes the number of medical bankruptcies last year above half a million of our friends, family and neighbors.

My friends in Canada and Europe shake their heads in disbelief that we permit such economic and human devastation. I join them.

Really? | Christian Bookstore

[h/t Jay Howver]

Protect Insurance Companies PSA

Protect Insurance Companies PSA from Will Ferrell

The President's Plan for Health Reform in 4 Minutes

Here's are the highlights as a downloadable pdf. There's more at the White House website.

Garrison Keillor | Writer, 67, has stroke, lives to write about it

As summer drew to a close Garrison Keillor of Lake Wobegon, Minnesota survived a stroke in St. Paul and lived to write about it. Here's part of what Mr. Keillor wrote in his first column back at Salon.com.

The women who draw blood samples at Mayo do it gently with a whole litany of small talk to ease the little blip of puncture, and "here it comes" and the needle goes in, and "Sorry about that," and I feel some human tenderness there, as if she thought, "I could be the last woman to hold that dude's hand." A brief sweet moment of common humanity.

And that is a gift to the man who has been struck by a stroke: our common humanity. It's powerful in a hospital. Instead of a nice linen jacket and cool jeans and black T, you are shuffling around in a shabby cotton gown like Granma in "Grapes of Wrath," and you pee into a plastic container under the supervision of a young woman who makes sure you don't get dizzy and bang your noggin.

Two weeks ago, you were waltzing around feeling young and attractive, and now you are the object of Get Well cards and recipient of bouquets of carnations. Rich or poor, young or old, we all face the injustice of life -- it ends too soon, and statistical probability is no comfort. We are all in the same boat, you and me and ex-Gov. Palin and Rep. Joe Wilson, and wealth and social status do not prevail against disease and injury. And now we must reform our health insurance system so that it reflects our common humanity. It is not decent that people avoid seeking help for want of insurance. It is not decent that people go broke trying to get well. You know it and I know it. Time to fix it.

photo by L-T-L

Health Care Reform | Two Old Friends Chat Each Other Up

A note from an old friend begins...

Hey Jim, since you've gone political on us, a few questions. First, where is your proof for all these claims? Second, where is Obama's "plan" so I can read it? He's never put it in writing. It remains a moving target. Third, all these points are high claims, most of which are being disputed by reputable people and groups, even within Obama's camp (ie. the CBO). I'm sorry, but most of us don't want the government to mess with the world's best heath care. :)


And I respond...

hey; nice to hear from you. I haven't used any numbers that aren't documented in the links from the blog posts in this series on health reform. I'll be happy to dial that in for you if you have trouble finding something.

I ought to have linked this morning's post—sorry; i thought it was more widely available than perhaps it is. You can find the list of essentials here.

The Congressional Budget Office is not in President Obama's camp any more than the Institute of Medicine that produced the 2004 guiding principles was in President Bush's camp. The CBO is chartered specifically to provide economic data to Congress.

My understanding of the CBO health care numbers that seem, as far as I can tell, to be thrown around fairly haphazardly, is that they were requested and delivered in response to first drafts of the health care bill while it was still in committee—multiple committees if I have the story right.

So it's like the first blue sky draft of most any kind of budget: Everyone on the committee puts in everything he or she would like to have and, if it's a good brainstorm, nobody says "we can't afford that" because nobody knows what it costs yet and there are no bad ideas in a first draft.

It's the job of CBO to count costs, not make policy. They put a good faith estimate on what's placed before them and, in many cases—probably most—the sticker price for the gold-plated, handmade, spare not expense first draft of the plan is a splash of cold water in everybody's face. I imagine you've read some film scripts that reflect that process.

Harmonizing a bill that's actually deliverable is what the committees have to do before they put it on the floor of the House or Senate to be further amended and sent yet again to the CBO for cost analysis.

The CBO letter to Congressman Rangel on July 17, 2009 roughly projects the House bill (H.R. 3200) as proposed would produce a reduction of the deficit of about $44BN from 2010-2014 and an increase to the deficit of about $65BN from 2015-2019. These numbers are nothing like the ones thrown around in Knucklehead Nation which I think, generously, must have come from the CBO estimates on the first draft.

So, already, the bill the House is considering is more measured than most of us have been led to believe, and it will be even more realistic before they're done with it.

All this craziness about ObamaCare from the Knuckleheads has been sound and fury signifying nothing but their knuckleheadedness because, as you note, other than what he posted during the campaign (which I don't think many people actually read) he hasn't put a plan in play until now—he is not, after all a legislator and seems to respect the separation of powers to a degree that makes his predecessor look like the socialist dictator his detractors claim the president is.

Putting his plan up now, as chief executive and leader of his party seems about right to me, but I think he's mostly right about this stuff so take that for what it's worth.

...and with this I close: By the end of 2008, the percentage of Americans covered by government-sponsored health insurance plans rose to 29%. Increasingly, I think the "most of us don't want this" refrain depends on getting the right people in the room (or studio) and wording the questions very carefully. In the last decade—much of which was decidedly Republican depending on how you look at it—private health care subscribers grew by one tenth of a percent while public health care subscribers grew by nearly 30%. Assuming a lot of that growth is Boomers, we're not going to see a decline in that shift any time soon.

OK, I'll try to tackle these one at a time. My point in citing the CBO (part of the gov't.) is that it is contrary to Obama's preposterous claim that it won't cost us (the taxpayers) a nickel or add a dime to the deficit.

The Knuckleheads you talk about are, in many cases, disputing Obama's claims and can substantiate their arguments as good or better than Pres. O can. But we're just talking generalities here...

And yes, I'll stand with my comment that the President really has no "Plan". Its not written anywhere and never has been. His speeches have put it in play but its like nailing jello to the wall. Let's see the "Plan" and then lets debate the merits, the solutions and the costs. Wouldn't that be fair?

And the House Plan is so great that every member of Congress is making sure that they are exempt from it!

Well, you didn't cite the CBO, you mentioned it, vaguely and not in a particularly accurate manner. I'll be happy to have you take me to school on what the CBO has said that's more recent or factual or conclusive than the July 17, 2009 letter to Congressman Rangel I linked to above that relates to H.R.3200 as proposed, the only actual health care bill under consideration as far as I know until a) the House does its magic and b) the Senate puts a bill on the table.

No offense intended here, but if you have a case to put forward, please do so. "There are Knuckleheads who disagree" is not a case I can engage.

I couldn't agree more, with your contention that we need to see the president's plan and debate the merits, solutions and costs. That's entirely fair. At the end of the day, of course, the law that's enacted will be legislation harmonized between the House and Senate versions. I think the president is obliged to speak into that process but he's not a lawmaker anymore. American democracy is a beautiful thing...especially when everyone works together.

You're the second person who's mentioned that exemption thing today and I have to admit I'm not familiar with it. I haven't found it in H.R. 3200 (which, not to beat a dead horse, is the only bill under active consideration at present). Can you direct me to something definitive on the subject?

The exemption for Congress has been around since at least the early 90's, as far as I can tell. Here's a couple of links:

here and here.


Jim, thanks for batting this back and forth with me. But I don't want to get lost in the controversies. Can we agree on a few basic points? Would you agree:

1. that we have the best healthcare in the world?
2. that, unfortunately, healthcare insurance seems to cost way too much?
3. that it would really be nice if everyone could afford to have excellent health insurance?

I think that is the basic problem - affordability.

You wrote: "The exemption for Congress has been around since at least the early 90's, as far as I can tell..."

I suppose I hadn’t heard anything about it because it’s a red herring and hasn’t been part of the serious discussion of health care reform.

Here’s a research-based examination of the question from the St. Petersburg Times' Pulitzer Prize-winning Politifact.com.

and

"1. that we have the best healthcare in the world?"

You’d think, wouldn’t you? But the outcomes don’t support that assumption. The most recent evidence based study I know of—published by The Commonwealth Fund in May 2007—compared health care over time in Australia, Canada, Germany, New Zealand, the United Kingdom, and the United States. US health care ranked sixth. You can download the report here.

and

"2. that, unfortunately, healthcare insurance seems to cost way too much?"

I wouldn’t say it’s unfortunate, I would say it’s contrary to American ideals.

and

"3. that it would really be nice if everyone could afford to have excellent health insurance?"

Yes. And I would add that I think it’s really not nice to stand in the way of that.

photo by Zavosh

we're number 37!

After days and days of earnest posting, this from Paul Hipp
(with a h/t to Heidi Wagner Turner!).