Let’s Get on a Measureable Path to The Social Contract

“… there needs to be imagination”

We need a new indicator of economic success other than GDP.

We must change our thinking fundamentally: that GDP, or simply put, the aggregate growth of an economy is almost meaningless unless that growth is clearly defined in the context of democratic principles.

Let us measure GDP at home and abroad based on the path toward attainment of the social contract that achieves life, liberty, and the pursuit of happiness. Let us build solutions to the issues of health, education, housing, employment, and retirement measureable by outcomes that equate to nothing short of the achievement of the full capacity of every child, woman, and man.

To me the essence of organizing and social movement is that before there can be planning, strategizing, or even investment in change, there needs to be imagination, the ability to truly see a new place for people to create a peaceful and just society. Indeed such a place requires new public policies, but the creation of such policies that actually result in transformed lives for people to be able to achieve their dreams first requires clarity about what the dream actually is. I think consensus can be achieved about the dream. The means to get there is when we challenge ourselves with the facts.

Often people who want positive change complain that our nation lacks the constitutional commitments that exist in Europe and elsewhere that “guarantees” certain social and economic benefits to its citizens. We often complain that the struggle here in the U.S. is quite different. Perhaps.

I would suggest that such paradigms and constitutional mandates change over time…just look at the creation of the Eurozone and the current convulsions and threats to the economic security there. Sadly and predictably, all across Europe, even in what seem to be unlikely places such as Scandinavia are experiencing the rise of racist and fascist parties that are in large measure responses to Great Depression-era unemployment levels and dislocation. The social contract in Europe is under severe threat of falling apart. It will take much convulsion and reconciliation to arrive at up-to-date and workable solutions.

What about in the U.S.?

“Having won this race, all are complicit in both a major crime against humanity and against workers everywhere and here in the US.”

Let’s look at just how far off track we have gone:

In my view, a recent New York Times story in its way scratches the surface of these questions by detailing the misery this nation’s and others’ manufacturing, labor, and trade policies cause to so many.

On December 22, 2013, the New York Times provided a very important piece of research and journalism which explains what we already know: the race to the bottom of wages and working conditions in the clothing industry has been won by the manufacturers, distributors, and purchasers of clothing world-wide. Having won this race, all are complicit in both a major crime against humanity and against workers everywhere and here in the US.

Sadly, but unfortunately all too consistent with what is wrong with our nation in its essence, is that the U.S. government spends about $1.5 billion directly aiding this aspect of the race to the bottom through direct purchases of clothing from the lowest wage and inhuman working condition manufacturers in the world.

The race to the bottom in the clothing industry has been underway for more than a century.

There is no telling just how far the cynicism and fear among workers here and abroad will go. The nearly vertical direction of wealth flowing to the top 10%, 1%, .1%, and .01% both in the US and around the world by definition creates so much misery that the mind cannot really comprehend it. Yes, the race to the bottom has been going on for a long time. And the cynicism and fear in the hearts and minds of workers everywhere stokes the passions of dangerous ideology. Have we learned nothing from our past?

How much longer will we tolerate low wages and inhuman working conditions?

And how much longer will we tolerate the self-fulfilling prophecy that people “want” low-cost items because they cannot afford more? There is just too much data that we all know all too well that the race to the bottom is what capitalism has achieved. It is time for all stakeholders to discuss and plan for a much different set of outcomes.

This should not be a radical idea.

We must have a vision of how to attain high quality health outcomes for all while achieving manageable and affordable costs.

“I believe there is a grand experiment that we can undertake: change our thinking about GDP in the health care sector.”

There is a different path:

Health care in the US has also been a race to the bottom. 20% of our GDP, that amorphous super macro measure of growth hides the race to the bottom in US healthcare: 50 million uninsured, with health costs being the single highest cause of personal bankruptcy, and for all of our highest in the world spending, the World Health Organization ranks the US 37th in the world in health care outcomes for its people.

A vision known as The Triple Aim summarizes a new vision, a realizable state of consensus in which 1.) each individual, and 2.) the population in aggregate achieves health, and in so doing, 3.) the cost to achieve health is substantially reduced. There is a growing consensus among stakeholders in the healthcare sector of the economy that The Tripe Aim ought to be achieved. Obviously there are differences about how to get there…but the vision is demanding and actually quite specific in its intent. The Triple Aim demands that the 20% of GDP spent on health care be measured, improved, and substantially reduced.

We must have a vision of how to attain high quality health outcomes for all while achieving manageable and affordable costs. Our nearly $3 trillion annual spend in healthcare must be reduced if our economy and our people are to have money for other needs.

Through Medicare, Medicaid, the Federal Health Insurance programs, the Veteran’s Administration, and now the Affordable Care Act, we say as a people that care must be extended to all, care that is of the highest quality, highest safety, with gentle and caring patient experience. If actually achieved, care for all will become much less costly because health is maintained for everyone, not just for those who can afford care.

To accomplish this, we need systems thinking: the cost, safety, quality, and access to care requires a different delivery system of care and a different payment system that rewards outcomes as opposed to activity: outpatient and preventive care should be the emphasis, with clinics available near everyone; outpatient care must emphasize early childhood preventive care, including dental care and behavioral/mental health care. We need care that is based on popular education methods so that people learn to own their own health and understand their bodies.

There is a broad consensus that these transformations in health care would if implemented over time, save about $1 trillion of the $3 trillion annual spend. To achieve this outcome, we must start the investments in transformed health care thinking and delivery systems as soon as possible.

“Social dialogue must replace the politics and confrontation of self interest in all venues.”

All of these changes that must take place require a much different dialogue among practitioners, employers, employees, administrators, insurers, government, unions, and community stakeholders. Inherent in the changed dialogue is a commitment to put self-interest aside, and plan change in a collaborative fashion based on measureable improvement and value creation.

Social dialogue must replace the politics and confrontation of self interest in all venues.

Health care transformation should be part of a broader social movement, part of an imagined, but real vision of the hopes and dreams of our people.

If everyone is covered by insurance, the “risk pool” is broadened and spreads the cost across the largest population, the healthy and the not healthy. Since healthy people use the system less, the overall cost is reduced. Emphasis on prevention and patient education is the key to success: pre-natal care, teaching healthy eating/active living and pro-active management of chronic conditions like diabetes, heart ailments, asthma, and mental health saves money over the long haul. All of these changes require investment in new infrastructures outside of hospitals and other large institutions which create new opportunity and new forms of employment. Payments to providers must be based on achieving these goals.

“We have seen the race to the bottom…”

Like anything else, a system that works requires management and regulation: you cannot have utilities, transportation, or construction of buildings or housing without strict regulation and systems to ensure safety and service. Health care requires the same kind of planning. No more sacred cows!

Wholesale cuts in expenditures or services are not the answer. Clinicians and providers can only cut their own expenses so much, and these cuts will impact small group and individual practitioners and advantage large systems that can scale back costs through consolidation and volume. Such cuts will demoralize the workforce, which instead must be fully supported. It is the workforce that must be fully engaged to solve the problems of waste, error, efficiency, safety, and patient experience.

The Triple Aim envisions substantial reduction of the unsustainable amount of our nation spends and wastes on health care. Let the Triple Aim serve as a path to new thinking about a New New Deal: a fundamental alteration of priorities with a vision to create high wage employment, reduction of military spending, advance universal health care, alter the tax codes, make pension plans a right, universal early childhood development a right, with a parallel emphasis on “employment transition”; that is, long term planning for skilling up for the jobs we will forecast for the future.

We have seen the race to the bottom in the clothing sector and in manufacturing. We have seen the race to the bottom in health care. What these tragic experiences have in common has been a reluctant but wrong acceptance that we cannot have prosperity for all and products and services for all.

And through it all we keep measuring our economy with something we call GDP.

Without measures of improvement in our people, we will continue to mask democracy with incomplete and amorphous data. The Triple Aim is inherently measureable, and should serve as a path to how we think about and measure our economic activity.

This is hard, but it is much harder and dangerous to have a society in which the basics are missing for so many.