The Muppets Take Mercury | Bohemian Rhapsody

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.

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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.

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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 Christian 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