Monday, December 9, 2013
Published in http://hnn.us/article/154172
Those wanting an expanded governmental role in healthcare and those opposing it are fighting the wrong battle in the wrong way.
The debate over national healthcare policy has lasted over a century – intensifying during the Clinton Administration. It has always been about coverage, liability, and finance, never about care protocols and patients. http://kaiserfamilyfoundation.files.wordpress.com/2013/01/7871.pdf If making health affordable is everyone’s stated goal then why not focus on the actual care, health, and wellness of Americans?
America remains the best place on Earth to have an acute illness or shock-trauma injury. Our nation’s emergency rooms and first responder protocols are unequaled. Princess Diana may have lived had her car accident happened in New York City instead of Paris. America’s diagnostic methods and equipment are unequaled. That is why patients from all over the globe seek answers to complex symptoms by visiting the Mayo Clinic, the Cleveland Clinic, Johns Hopkins, Sloan Kettering and countless other world class facilities.
The other side of American healthcare is its failings in chronic care, expense, and a system that is controlled by the medical profession, pharmaceutical companies, and insurance industry. This triad of entrenched interests has prevented the widespread use of substances and therapies deemed effective and traditional in most of the world.
Thankfully, an increasing number of healthcare professionals are embracing global best practices, virtual technology, and patient-centric methods. These innovations are improving the health of patients while driving down costs. This is the arena where policy-makers should check their partisanship at the door. Seeking ways to improve healthcare, not health financing, will ultimately make health affordable to us all.
I have personal experience with the convergence of these worlds. Since 2007, I have been the primary caregiver to several family members with serious chronic conditions. These conditions have been punctuated by emergency care and major surgeries. Making decisions and managing treatment across this spectrum has been a real education.
This education has helped me identify four major areas of opportunity for healthcare improvement. These four areas will improve our health and healthcare, while addressing the affordability of private and public health services.
First, not all ailments require doctors and prescription medications. Government and industry policies drive people away from cheaper and more effective natural remedies. Herbal remedies have been successfully used since the first humans. For example, Apple Cider Vinegar has completely solved acid reflex for two of my family members. However, natural substances are not covered as a medical expense either by insurance or tax deductions. Instead, acid reflex sufferers must pay for over-the-counter treatments (which are also not covered by insurance or tax deductions), or must obtain expensive prescriptions after paying to see a doctor or a specialist. Being a natural treatment, the vinegar regime also avoids side effects and drug interactions. http://www.healthcentral.com/diet-exercise/c/299905/155581/potential?ic=506048 Why not go “back to the future” and find ways to support these more affordable and effective treatments?
Second, nurse practitioners form one of the new front lines of care http://www.aanp.org/. The overwhelming majority of my family’s office visits are with a nurse practitioner interacting with the patient and the lab technicians. Occasionally, a doctor will review the information and discuss treatment options with the patient. Supporting the evolution to Nurse Practitioners through education, professional certification, protocol modifications, and pricing would bring down costs and expand health opportunities both for professionals and patients.
Third, community caregiving is another new frontline of achieving and sustaining wellness. In 2009-2011, I was part of the planning team for developing a community-based care system for the Atlanta area. We found a disturbing pattern - patients, especially Medicare/Medicaid patients, arrive in hospital emergency rooms when their chronic conditions, such as Diabetes, congestive heart failure, and Chronic Obstructive Pulmonary Disease (COPD), become acute. These patients are treated at the most expensive point of care (emergency room). Once they are released, many do not have the support (family, friends, neighbors) or the capacity (some form of dementia) to follow a treatment regime that would prevent the next emergency room visit. These revolving door patients drive-up costs and end-up in a cycle of deterioration.
Our solution was to develop a community-based healthcare network. Such networks are known as “Accountable Care Organizations” (ACOs) http://innovation.cms.gov/initiatives/aco/. They break-out of traditional hospital and doctor office environments to forge partnerships with the community – churches, social workers, local government, neighbor associations, and nonprofits. A needy patient with chronic conditions is assessed holistically. This includes risk factors (i.e. smoking, alcoholism, drugs) and environmental factors (family & home environment). A care plan is developed and assigned to a multi-faceted care team (comprising community resources) and a care manager. Doctors and nurses are part of the team. The majority of health actions take place among family and community - driven by Electronic Medical Records, aided by remote sensors and virtual care, and guided by the managed care team.
The result of this holistic approach is improved care, sustainable health, and reduced costs. It is the one way Medicare and Medicaid costs can be substantially reduced while enhancing quality of life. There are initiatives to promote this methodology within the Center for Medicare and Medicaid Services (CMS), but it is occurring too slow and is too isolated.
ACOs are making a difference, but no major politician has embraced the concept and neither party has promoted them as a way to reduce Entitlement costs.
Fourth, families have always been a pivotal component in healthcare. Whether it is a parent staying home to care for sick children, or adult children caring for ailing parents, family caregiving is vital, but also emotionally and financially draining.
According to the National Alliance of Caregiving, 70 million Americans provide unpaid assistance and support to older people and adults with disabilities. Forty percent of these caregivers provide care for 2-5 years, while approximately 29 percent provide care for 5-10 years. Unpaid caregiving by family and friends has an estimated national economic value (in 2004) of $306 billion annually—exceeding combined costs for nursing home care ($103.2 billion) and home health care ($36.1 billion). This value is increasing as the population ages. http://www.caregiving.org/data/CaregivingUSAllAgesExecSum.pdf
I know how much time is spent with ailing family members. Current IRS regulations provide for listing parents as dependents based only upon financial support.
http://www.irs.gov/pub/irs-pdf/p501.pdf However, there are no tax credits or deductions for those who have the Medical Power of Attorney and devote countless hours to direct care or acting as the patient’s advocate for managing their care. Politicians at both the state and federal levels should provide relief for this indispensable and growing volunteer service sector.
These four areas of opportunity will not address every health issue or entirely diffuse the fiscal bombs strapped to medical entitlements, but they are a good nonpartisan start. It is time for politicians to focus on the wellbeing of patients, not themselves.
[Scot Faulkner was Chief Administrative Officer for the U.S. House of Representatives. He served on the ACO team for the Southeast Atlanta Health Care System [SAHCS] and as an advisor on professional standards to the American College of Dentists. He has been the Medical Power of Attorney and primary caregiver for his spouse and parents since 2007. http://citizenoversight.blogspot.com/ ]
Tuesday, November 26, 2013
Sunday, November 17, 2013
Every President confronts moments of truth that expose their inner weaknesses or strengths. The disastrous roll-out of the Affordable Care Act (ACA) has ripped apart Obama’s curtain of competence.
The bane of any powerful person is becoming insulated from reality. Sycophants and courtiers have swirled around leaders since the first hunter-gatherer campfires. The question about President Obama is whether he is the victim of this truism or its architect.
Obamacare’s implosion has generated parallels to other Presidential tipping points. The Tet Offensive exposed LBJ’s credibility gap on Vietnam and sank his Presidency. The Iranian Hostage crisis became a daily reminder of Carter’s ineptitude. His Desert One disaster opened a trap door of public revulsion, from which he never recovered. These faces of failure form a depressing portrait gallery of American Presidents, leading up to the most recent comparison of Bush’s Katrina debacle with Obama’s Obamacare.
In one aspect President Obama is a lucky man. There are no vivid visuals for his humiliating management meltdown. Thankfully for Obama, except for screen images of locked and crashed websites, there are no searing images of his disaster, like Katrina refugees in the Superdome and the flood waters swirling around New Orleans. That being said, the ACA is definitely Obama’s Hurricane Katrina. Everything that could go wrong - has. Everything that went wrong could have been avoided.
Beyond imagery, there are stark similarities between the ACA and Katrina. Both were predicted. Both were failures of leadership. Both revolve around a callous disregard for suffering. Both have Presidents who were at best clueless and at worst complicit. Both disasters are defining moments occurring eerily around the same time in their respective tenures. Neither handled the subsequent damage control very well. Bush watched his fellow Republicans sail into oblivion in the 2006 off-year elections. The fate of Obama’s Democrats has yet to be determined.
What makes these two disasters worthy of comparison is that their epic failures transcend ideology. While supporters parse and spin and opponents gleefully exploit the moment, the vast majority of Americans gasp in disgust at another failed Presidency.
Success or failure of a President revolves around competency and credibility. Events like Katrina, ACA, Tet, and Desert One do not, in isolation, destroy a President’s reputation. Rather, they crystallize a cumulative sense of unease that has been building over time. Public perception of a President’s competency and credibility are irretrievably altered once these events occur.
Katrina was a natural phenomenon, but a very predictable one. Four days before it hit New Orleans every forecast model showed this historic devastating storm heading straight for Louisiana. By Saturday morning, 36 hours from landfall, the radar images showed Katrina as a category 5 storm, filling the Gulf of Mexico with a highly defined “eye”. While Walmart and other private companies immediately initiated their disaster protocols, the Bush Administration dithered until two days after the levees broke. It was not until the next weekend that Navy and Coast Guard ships put to sea and another four days before they reached the scene. The federal government was also amazingly deferential to incompetent local officials regarding their lax preventive actions and first responses.
Katrina was the last straw for most Americans. Republican politicians and pundits swooned over Bush while turning blind eyes to his Administration’s lengthening record of incompetence. This ranged from bungling the rebuilding of Afghanistan, to invading Iraq on at best “cherry picked” intelligence, to multi-billion dollar sole-source deals for cronies, to collective Republican complicity in rampant spending and earmarks. In 2005, Katrina broke the levees both in reality and politically. The anti-Republican deluge only ended when Obama and the Democrats overplayed their hand and paid the electoral price in 2010.
The implementation of the ACA, or Obamacare, has crystallized concerns over Obama and his Presidency. Nearly everyone uses online commercial websites. The Christmas shopping season is already underway, meaning that Americans are using trouble free, consumer friendly websites 24-7. New versions of existing commerce sites and new ventures launch daily, with only an occasional hiccup (most notably Netflix’s July 2011 pricing debacle). It is totally inconceivable that Obama did not reach out to any of the millions of web designers and digital commerce experts to advise, oversee, design, implement, or test his central legislative achievement. Why didn’t Obama tap those who revolutionized his online campaigns in 2008 and 2012?
Also, most adults have served on project teams either professionally or with volunteer groups. They know the basics of planning, resourcing, measuring progress, adjusting plans & schedules, and the fundamentals of dry-runs, rehearsals, prototyping, and beta testing. It is therefore mindboggling that Obama did none of these on behalf of his signature policy initiative.
These systemic failures on such basic levels expose the inconvenient truth that state senators do not make good Presidents. This is especially true when they serve less than two years in higher office before running for President full-time.
Ultimately, Obama’s management failure is far worse than Bush’s Katrina. Katrina started as a natural phenomenon and time was finite. Obamacare was wholly manmade with arbitrary deadlines. Katrina’s human toll is well documented. ACA’s impact on people’s wellbeing is still to be tallied.
One failure does not define or sink a Presidency. The failures of recent Presidents Johnson, Nixon, Ford, Carter, Bush 41 & 43, Clinton, and now Obama were cumulative - ranging over time and many different issues.
Thursday, November 7, 2013
Irene MacDonald Faulkner
February 8, 1925 – November 6, 2013
My mom passed peacefully in her sleep around 9:00 p.m. EST on November 6.
Irene had struggled with Alzheimer’s disease since 2007. In-home Hospice care began on October 28 and was a key element in making her final moments comfortable. Amanda and Ki were instrumental in providing 24-7 frontline care during her final weeks.
My Mom not only fundamentally shaped my life, but the lives of all she touched. She was a Den Mother for my Cub Scout Pack in Durham, New Hampshire and the nurse at Camp Flaming Pine for my Boy Scout Troop in Minnesota. More recently, she helped raise Amanda Hunter Newsom. Earlier, she raised her three youngest brothers, Ashel, Ed, and Dick MacDonald after her own mother passed in 1948. As a Nurse-Supervisor at the Eastern Maine General Hospital she oversaw the care of patients during World War II.
Irene lived a rich and diverse life. She grew up on a large farm in Eddington, outside of Bangor, Maine. Her family sold eggs and dairy products to families during the Depression. She hunted (mostly upland game birds), fished, skied, and skated. While living in New Hampshire she scouted out high-bush blue berry patches for making preserves and maintained large vegetable gardens at her various homes. Irene was a creative and gracious hostess – decorating barns for parties in New Hampshire, leading local festivals in Lee, New Hampshire, presiding over family reunions in Maine, and organizing political and community events in Minnesota, New Hampshire, Virginia, and West Virginia.
My mom was a life-long Republican. She was a local organizer for Barry Goldwater during his 1964 New Hampshire Primary campaign. The “This House Sold on Goldwater” yard sign that was on our front lawn proudly hangs in my home office. Irene worked diligently for Rep. Tom Hagedorn, and County Supervisor “Bud” Robb, in Minnesota. In Virginia, she was a Republican leader in Fairfax County helping numerous Republican candidates, including Rep. Frank Wolf, and State Delegate Gwen Cody. In 1982 she was awarded Volunteer of the Year by the Virginia Republican Party. From 1981-1993 she worked as a volunteer in the White House Correspondence Office. She oversaw the issuing of the President’s personal congratulatory messages and assisted in managing the White House Christmas Open Houses and Easter Egg Rolls.
Irene was inseparable to Ki, my father, for 67 years. They remained together through her passing last night. She lives on in the memories we all share, but also in the countless ways she taught us humility, instilled intellectual curiosity and a passion for reading, and fostered community spirit. We are very blessed she was a mother to us all.
Sunday, October 20, 2013
The Republican Party is coming apart at the seams.
The fratricidal chaos that reigned during the government shut down is the culmination of years of factional strife, internal contradictions, and huge egos.
The Republicans' elephant symbol should be replaced with a more accurate rendering of its current woes: Sybil.
“Sybil” was the main character in a 1973 best selling book about multiple personality disorder. Sybil manifested sixteen personalities, each dissociated from her central personality. That is today’s Republican Party and conservative movement in a nut shell.
Each Republican manifestation is based upon a separate reality. Within each reality there are leaders, acolytes, and rabid supporters. Those residing within each reality dwell in an echo chamber of self-affirmation that constantly asserts they are the only ones capable of saving America and their movement from the forces of darkness. Each reality opposes the others assuming any alternative reality to their own at best diminishes their ability to prevail, and at worst, poses a clear and present danger to their existence and that of our nation.
Political parties are coalitions of like minded interests, coalesced around a core of fundamental beliefs, clustered together in order to benefit from an overarching organization focused on electoral success. The Republican Party of 2013 is none of these.
The Republican ship no longer has a rudder – a credible universally acceptable leader. Worse, this Republican ship no longer has a keel – a philosophical grounding that prevents it from being capsized by even the smallest ripple on the political seas.
Today’s Republican Party is being torn asunder by contradictory forces at war with each other and with the broader populace. Libertarians who want virtually no government are at war with Fundamentalist TheoCons who want a huge government to patrol neighborhoods enforcing biblical imperatives relating to sex and belief. Isolationists who want to pull back from the world and construct a literal as well as figurative wall around America are at war with NeoCons who are in denial about America’s failures in Afghanistan and Iraq while seeking other places to intervene. Fiscal hawks who have spent decades seeking ways to rein-in Washington’s spending binge are at war with the Tea Party who want to shut the government down no matter what the results. Wall Street and Main Street Republicans, who hate regulation but work within the system to lessen its effects, are fighting Tea Party activists, who echo “Occupy Wall Street” conspiracies about crony capitalism.
What happens next? Is the GOP of 2013 becoming the Whig Party of the 1850s? Will the Tea Party fizzle out or prevail over a crumbling Republican establishment? While doctrinaire liberals are dancing a Conga Line hoping for an end of Reaganism that will usher in a new era of rampant government growth and spending, other Americans are legitimately worried about not having a viable opposition voice.
More rational voices within the conservative and Republican movements need to unite around core principles that are relevant and compelling for the 21st Century. Start with the rule of law, holding government accountable at all levels, demanding transparency in all public processes, and consistent adherence to ethics and integrity by all officials and public sector functions. Upon this foundation, add that government should be the solution of last resort, after personal actions and collective efforts of the private sector and local community fail to address challenges and societal ills. When a government role is warranted, it must be designed and implemented to successfully meet tangible and measurable objectives using public resources in the most cost effective ways possible.
Within this framework Republicans should rationally engage in a civil discourse on where the Party’s center of gravity should reside on strategic issues. Embedded in this discourse should be a new toleration of differences among reasonable people. No one agrees 100 percent with another person, not even spouses and siblings - so why demand purity and mindless adherence?
The strategic issues that will frame a new Republic Party and potentially form a winning coalition movement include, but may not be limited to:
 The role of government. There will always be a public sector in America. Republicans traditionally buy into the 300+ year old concept of a social contract whereby individuals freely give up some freedoms and delegate some decisions to live and prosper in an ordered world. This is as basic as stopping at a stop sign, paying for trash collection, agreeing to litigate disputes in courts of law, and electing representatives to address policy issues. How much government, where it should reside (local, state, federal), the role of public input and accountability, the appropriate structure for public action (regulation, tax policy, public program), and its costs are areas where reasonable disagreements will occur and where there is no one right answer to apply to every locale or issue.
 The role of America in the world. America is part of an increasingly complex and linked global community. Since World War II, America has been its leader – economically, politically, and militarily. Since the collapse of the Soviet Empire and the rise of the information age, the world has evolved into many centers of economic and civic vitality. Some countries, like the BRICS (Brazil, Russia, India, China, South Africa), are willing to challenge America’s hegemony. In some industries and some regions, America is no longer the leader or even competitive. Internally, these variables harm economic opportunity and job creation. Externally, it is about free and fair trade as well as about who becomes the first responder to tyranny or disaster should America reduce its global reach. These are reasonable areas for discussion. America needs a competitive strategy for the 21st Century and it needs realistic “rules of thumb” that guide split second decisions when terrorism or other unforeseen events suddenly disrupt our existence.
 Healthcare. It is truly unfortunate that the debate over healthcare started in the partisan sphere. Providing health services to a work force that is increasingly without employer provided benefits is important, but the discussion should have first centered on standards of care and caregiving. Americans are aging. This means that health issues are shifting from shock/trauma acute care to long term care of chronic conditions (like diabetes, congestive heart failure, and Alzheimer’s). How to support the role of families in care giving? How to allow for using successful treatments that are traditional in many parts of the world, but viewed as alternative or nontraditional in an American healthcare system dominated by pharmaceutical and insurance companies? How to promote technology-enabled remote care and wellness to supplement or supplant office and hospital visits? Baby boomers are confronting these issues every day as their parents live into their 80s and 90s. Facilitating a sincere nonpartisan dialogue on this multitude of heartfelt issues would be a most positive addition to public policy.
In addition to Republicans returning to sane and productive input on strategic policy issues, they must begin holding their leaders, and leader wannabes, to established standards of leadership. Everyone has an ego, especially leaders, but true leaders rise above and think beyond themselves. Can anyone imagine Ronald Reagan doing a reality television show? Can anyone imagine Barry Goldwater making every speech and media appearance about himself? Would William F. Buckley have ignored facts to win a rhetorical point? Republicans lack anyone even remotely approaching these giants of modern conservatism – and that is the problem. It is time for Republicans to shun cults of personality and demand leaders who think first about what is best for America, and promote the 300+ year philosophical foundations of conservatism, over their personal fundraising and campaigning.
The Republicans’ multiple personality disorder will not be cured overnight. These suggestions form a good course of treatment. The first step must be for the warring factions to realize what they are doing to themselves, their movement, and their country.
Wednesday, October 16, 2013
Congress and the White House are stumbling toward a temporary deal to reopen the Federal Government and raise the national debt.
This temporary fix does not solve any of the fundamental problems with government spending, fiscal management, or health policy. All it does is pull everyone back from the brink and give them limited time to find common ground.
Washington’s spiral into chaos and crisis began years ago. It accelerated after the 2010 elections. The debris field includes not just both political parties. The faith Americans and the rest of the world have in the functionality of the Federal Government is severely damaged. It is going to take more than a “grand bargain” on the budget to repair that damage.
During the descent into madness, all combatants displayed their willingness to destroy the fundamental fabric of America’s civic culture in order to win rhetorical points during ever smaller news cycles. Politicians and pundits acted as though America was a parliamentary democracy, where a legislative defeat would bring down the government, force the resignation of public officials, and trigger new elections.
Our Founding Fathers intentionally designed America’s rules of engagement to avoid the “all or nothing” confrontations that shape British legislation. Fixed terms of office were supposed to force opponents to work together and govern instead of remain in a constant campaign. The U.S. Constitution’s brilliance and resilience stems from practicality, not idealism. That said, it is going to take an historic effort on everyone’s part to repair the damage and restore trust in our institutions of government.
Unfortunately, many involved in these recent political battles seem to want to permanently undermine these institutions of government. "We are looking for an Egyptian moment here! Enough tyranny...” trumpeted an organizer for the truckers’ protest that ended up being more bluster than reality. Other political voices are advocating continued unrest and chaos. Some now champion nullification (ignoring the rules) or a constitutional convention to completely change the rules.
During 226 years living in a Constitutional Republic, Americans have weathered terrible, corrupt, and incompetent Presidents, tolerated dysfunctional and “do nothing” Congresses, and have had to retry and overturn ill-conceived Supreme Court rulings. No matter how bad things got, Americans and their civic culture persevered without risking collapse (save for our Civil War).
It is therefore dismaying that things got so far out of hand during this recent confrontation. The level of righteous ignorance about government functions and processes, the uncivil and abusive accusations about opposing agendas, and the shrill demagogy have created a hole in the fabric of our system that will take time and creativity to repair. Record low levels of support and trust in our elected leaders and record high levels of dissatisfaction must be addressed.
One possible way to rebuild rational discourse and productive engagement is to experiment with crowd sourcing and facilitated discussion. Go to http://onlinetownhalls.com/start/90 to join in an online conservation to test out a new community engagement tool.
Online Townhalls is used by professional and business groups to aggregate opinion and facilitate consensus. In 2012, the Organization of American States (OAS) and the U.S. State Department used Online Townhalls to engage citizens in 35 nations using four languages to support the Summit of the Americas.
Here is a 7-minute video that explains how to use Online Townhalls.
Another way to learn about Online Townhalls is to follow a sample conversation based on the famous movie “Twelve Angry Men”. This tracks the jury’s consideration of trial evidence. http://onlinetownhalls.com/read/6
One online tool is only a very small step toward re-establishing sanity and decorum in our public processes. Just like after a wind storm, you start the recovery process by picking up the first downed branches. While chainsaws and a tree removal service may become part of the clean-up process, you have to start somewhere.
The recovery from our most recent political storm will take more than a few months. It will probably take years. We all must start somewhere. Your ideas are welcome! We must all pitch in. Perhaps trying out http://onlinetownhalls.com/start/90 is a good first step.
Monday, October 7, 2013
Republicans need a remedial communications course. They have flunked every test during the budget/shut down battle.
Republicans have also failed political strategy 101. They are fighting the wrong battle, in the wrong way, at the wrong time. A key element to any political struggle is advocating viable alternative actions and/or policies to those you oppose. Kicking the table over is not a policy.
The most embarrassing aspect of the government shutdown is how it is undoing Republican assertions. This shutdown was supposed to stop Obamacare in its tracks, when, in fact, Obamacare is being implemented. Signing-up on health exchanges opened the very day the government shut down to stop Obamacare. Worse, media coverage of the shut down drowned-out news stories on the wobbly start to Obamacare. Media 101 – you never step on your own headline. Obamacare’s glitches would have helped build the Republican case for strategic action toward a complete overhaul or repeal. That story is now lost to the ages.
The embarrassments continue hourly. Republicans rail against Public Broadcasting - voting to defund it every year. The government is shut down and PBS and National Public Radio are providing full programming. Such disconnects between rhetoric and reality makes the GOP look clueless on how government is actually funded. That is not the best place from which to launch a fiscal fight over the debt.
Republicans are also displaying their utter powerlessness to impact the Executive Branch. President Obama can pick and choose what to shut down with impunity. He knows it will be months before the House Oversight Committee or the Government Accountability Office (GAO) will second guess his actions. So what if they find he was arbitrary and capricious? There will be no consequences, political or legal. So America gets to watch as National Parks are shut down (a list of the more over the top closings may be found at: http://www.breitbart.com/Big-Government/2013/10/05/list-obama-closures-for-shutdown), while pro-Obama political rallies are allowed on the “closed” National Mall (immigration reform). Government websites that serve Americans are offline (even Pandacam), but the primary government website that serves the government – www.USAJobs.gov is still scooping up applications for currently unfunded federal jobs.
The current budget battle began in the summer of 2011. Republicans have always been on shaky ground because of their own 14-year binge of spending and earmarking (1997-2011). They have never done anything to counter their fundamental lapse in Republican fiscal orthodoxy. Shouting within the conservative media echo chamber is not winning the broader argument with all of America.
One major Republican mistake was making reasonable fiscal management a partisan issue. In the 1970’s, Rep. John Ashbrook, one of the most conservative members of Congress, and Senator William Proxmire, one of the Senate’s most liberal members, coordinated their exposing of government waste. Ashbrook spoofed “goofy grants” while Proxmire issued monthly “Golden Fleece” awards. They both understood that “waste is waste” no matter which Party is responsible. Today only a handful of politicians and pundits transcend partisanship for true spending oversight and accountability, notably Senator Tom Coburn and journalist John Stossel. Unfortunately, neither receives the attention they deserve.
Many so-called conservative pundits and think tanks remained silently complicit during the Republican spending binge and the gross mismanagement of the executive branch under George W. Bush. The moment a Democratic President and Congress picked up where Bush and his GOP Congressional allies left off it was like Rip van Winkle awakening from a long slumber and wondering how things got so bad.
The Tea Party is filled with Rip van Winkles. They poured into Congressional town hall meetings in August 2009 screeching about a health program that was originally the Republican’s multi-payer alternative to Hillarycare’s single-payer system. Multi-payer healthcare was trumpeted by the Heritage Foundation and implemented by Governor Mitt Romney in Massachusetts. It was the preferred GOP way forward – until Obama’s name was attached to it. Even now, the “Affordable Care Act” polls better than “Obamacare” even though they are different names for the same program. One’s arguments lose all credibility and integrity when it is all about who proposes something, not what is being proposed.
So what can Republicans do?
First, they can get off their treadmill to oblivion. As proposed in [http://citizenoversight.blogspot.com/2013/09/kamikaze-congress.html], Speaker Boehner can allow a clean Continuing Resolution to be voted on in the House. He can hold his Republicans off the Floor and not have them vote on it. This means the Democrats “own” the CR and Obamacare funding. The focus shifts back to the flawed launch of the Affordable Care Act and making a reasonable case for reform or repeal.
Second, shift the focus to raising the debt ceiling. Cede the fact that the debt ceiling is driven by previous spending actions. America has to pay the bills it rang up. That said, there are ways to add reasonable and rational provisions to rein-in spending.
Three ideas come to mind.
- Control the fourth quarter spending binge. Put a 25% of fiscal year spending cap on the 4th quarter of each fiscal year. [http://citizenoversight.blogspot.com/2013/08/budget-bacchanal.html]
- Mandate a budget sweep of unspent and unobligated accounts. [http://citizenoversight.blogspot.com/2013/07/congressional-coinstar.html] Over $687 billion sits unused in accounts across the government. Put it to use.
- Start managing the federal workforce. [http://citizenoversight.blogspot.com/2013/02/fear-loathing-in-washington-dc.html ] As referenced earlier in the column, federal jobs are still being advertized and applications being collected. How many of these jobs are considered “non-essential”? Instead of furloughs, do hiring freezes, and job eliminations via the 60,000 retirements each year. Over $350 billion would be saved from these actions.
No thinking human being will be able to counter these prudent nonpartisan steps toward fiscal sanity. The only exception is Rep. Nancy Pelosi, who recently declared the cupboard bare of places to cut spending.
These simple and immediate acts would help Republicans reclaim the high ground of sound fiscal management, transcending partisanship. Whether you love a program or hate it, you should not want even one penny misspent. Accountability, transparency, and efficiency attract adherents across the entire political spectrum.
Finding and eradicating waste is just the first step. After recovering their footing, Republicans could revisit the Simpson Bowles debt reduction plan and Senator Coburn’s annual “Waste Book”. Some of these items are more partisan, but these vetted ideas can guide the foray into deeper political waters. Those who lead such a realistic and rational effort will find followers among the 230 million registered voters, not just the Tea Party and Fox News. Republicans – the choice is yours.