In 2005, having already made two fortunes—as a Microsoft executive and then as CEO of Drugstore .com— Peter Neupert returned to Microsoft to create software for health-care providers. His division, the Health Solutions Group, now has 800 employees and sells to hospitals nationwide. Neupert’s basic premise, oversimplified, is that one key to improving health care involves installing modern software that can make the system more efficient and ultimately enable patients to get better service at a lower cost. The need for this kind of change is obvious to anyone who, like myself, is hitting the age when we need to see doctors more often and/or is the parent of young kids. Keeping track of our health information is a complicated kludge just begging to be digitized. Why is it so easy for me to manage a 7,000 song music collection, yet so hard for me to keep track of my kids’ vaccinations? We now do almost everything online: banking, travel planning, shopping. But when we go to the doctor we still do things pretty much the way we did them a half century ago. Too much still gets done on paper. Even when your medical information is stored digitally, the data often can’t be shared among providers.
The reality is that patients want to have a say in what happens to them when they’re sick and, more often than not, they don’t want heroic and often hugely costly measures to save them. In the new study, researchers found that more than 90 percent of the adults who had living wills requested either limited care or “comfort care” at the end of life. Only 1.9 percent (a total of ten patients out of 3,746) asked for “all care possible.” Aggressive medicine does not equal happy patients. Doctors must acknowledge this and have honest and informative conversations with their patients. In another study, published in 2008, researchers found that end-of-life discussions resulted in less aggressive care-including ventilation and resuscitation-and earlier hospice enrollment, which equaled better quality of life for patients.
If Congress is mostly Democrats, why is there an anti-abortion-rights majority in the House? Because Republicans treat abortion as a litmus test, while Democrats don’t.
As I see it, there are three principal requirements for the job. The first is experience in management, business, and organization: maybe someone who’s worked as a management consultant, an entrepreneur, and an executive in both the public and private sectors. The second is the ability and capacity to commit: someone who isn’t likely to have any pressing obligations for the next several years, and who has enough cash that he or she doesn’t need a large private-sector salary. Third is relevant experience in implementing a large-scale health-care reform program, ideally one that involved using an individual mandate and the private insurance system to attain near-universal health insurance.
In other words, this sounds like a job for Mitt Romney.
The first strategy may be safer, but I doubt it’s smarter. Before Obamacare became the law of the land, the “Newt Gingrich Circa 1994” approach—voters won’t reelect a governing party that can’t pass anything—made perfect sense.But now that the Democrats have passed something (i.e., the largest piece of social legislation in half a century), that argument is irrelevant. Sure, you can throw temper tantrums, refuse to work after 2 p.m., sue the government, or, like Mitt Romney, try to spearhead a (somewhat quixotic) nationwide effort to “repeal and replace” the new law. The 23 percent of Americans who currently identify as Republicans will probably be pleased. But in the seven months between now and Election Day, as other issues take center stage, new benefits kick in, and passions cool (one poll shows 49 percent now calling health reform “a good thing,” compared with 40 percent who say the opposite), it will become increasingly difficult to appeal to the other three quarters of the electorate—which encompasses the 23 percent of voters who cast ballots for John McCain in 2008, but now call themselves independents—by fixating on Obamacare and blocking everything else the Dems propose. Especially when those proposals are things that most voters really want Washington to get cracking on, like financial reform, teacher accountability, and job creation. At the end of the day, you can’t win elections with only 23 percent of the electorate on your side—no matter how fired up that 23 percent is.
It would be very difficult to tote up all the times pundits pronounced the health care bill dead, and the prospects for the Obama administration dire—especially after the election of Scott Brown in January. Intrade, the political futures market, which functions as a conventional-wisdom-processing machine, also got health care wrong. Check out this chart for the contract on health care reform being passed by June 2010. The contract is worth 100 if it is passed, zero if it is not. After Brown’s election, it slumped to as low as 20. As recently as March 17, it was below 40. Even as late as Friday, it was trading in the mid-80s. These trading data show that “investors” in this market were skeptical of the Obama administration’s ability to pass significant health care legislation, right up until the end.
Is there a larger lesson here? (Aside from the obvious one, which is political futures markets usually aren’t very good at predicting what actually will happen in the future?) I think so. And it’s this: Don’t short Obama. In fact, that’s been the lesson of Obama’s entire career so far.