House vote on the debt ceiling legislation - August 1, 2011

I watched the members of the U.S. House of Representatives vote on the debt ceiling legislation this evening and am reflecting now on the meaning of it. The scholarly explanation is that as a complex adaptive system our political system is presently stuck in a dysfunctional attractor. Assuming the U.S. Senate votes for the same language tomorrow and the President signs, I think they will have essentially kicked the can down the road a piece. I think our nation will soon lose its AAA credit rating and that all Americans will experience the equivalent of a substantial tax increase - not just the few who were saved from a return to their obligations during President Clinton's presidency. In my opinion, this bill will have more adverse financial consequences for "corporate jet owners" than a more responsible bill would have had. A more responsible bill would have prevented a probable loss in the nation's credit ratings that I think will hit every American -- not just those who are best able to buy their access to political power. I doubt that the stock markets of the world will be pleased by this legislation. My only moment of celebration this evening was the return of Representative Gabrielle Giffords. To me, she is more than a member of Congress. She is a living symbol of a great nation and of courage and survival.

Regarding the specific subject of this blog, a CNN announcer this evening made reference to future cuts affecting healthcare providers but not patients. Whatever affects providers is going to affect patients directly or indirectly.

Scope of a Miracle

It is good to see photographs of U.S. Rep. Gabrielle Giffords that became available to the public today. Few people know all the details of the kinds of care she received that made possible the near miracle of her survival and recovery. There are surely many physicians, surgeons, nurses and others who together made this possible. She is alive and recovering today because of the coordination of the efforts of many professionals. In other words, it was not only the skills of individuals who saved her life and promoted her recovery. It was the timely coordination of those efforts. In this case, the "system" of care worked. I want to believe it would have worked as well for any person who suffered her injury.

As I read some of the comments received by HHS regarding proposed rules for implementation of ACOs I see the strong expressions of good people who simply do not want government agencies to attempt to rationalize the healthcare delivery system. Some people are simply opposed to "socialized medicine" and/or define the proposed changes as a loss of freedoms won on battlefields around the world. Others are open to change but do not believe that the new law and the proposed rules will work. Rep. Giffords' recent experiences with the system could be cited either as evidence that what we already have can work; or to say that we can do better. I want to believe that we can do better for at least all American citizens, including the large numbers of people entering the Medicare program. I believe that the rationalization of medical processes can reduce costs and produce more consistent quality outcomes for all patients.

It is a safe guess to say that the implementation of the new law will produce unintended behaviors among providers. The system that produced the law is a political system. Democratic political systems cannot produce scientifically rational policy designs, as in the context of operations research which is rational in a more objective way. Politics is the art of what is politically possible. As we pray and hope for Rep. Giffords' continued recovery let us continue to hope that the new law which she supported in Congress with her vote backed by her courage can be implemented successfully. "Bureaucrats" have to run with what they are handed by others.

Representative Giffords' MSNBC Interview following Healthcare Vote