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The inaugural theme, chosen by the Joint Congressional Committee on Inaugural Ceremonies, in consultation with the Senate Historian's Office, is "A New Birth of Freedom." After the seemingly endless and hopelessly partisan presidential campaign, it is especially ironic that the theme would come from the uber-Republican, Abraham Lincoln.
The line comes from the Gettysburg Address, Lincoln's 10-sentence, 272-word speech at the dedication of the Soldiers' National Cemetery in Gettysburg, Pa., in November 1863. While there is little doubt that President-Elect Obama's speech will be longer, it may or may not approach Lincoln's soaring rhetoric. Regardless, it will leave a lasting imprint in our nation's history.
Lincoln closed with words that should remain clear in our minds as we face the challenges to our country and our industry in the days and months to come: "... government of the people, by the people, for the people, shall not perish from the earth." The real power to effect meaningful change in our nation ultimately belongs to its citizens.
In forming his cabinet, Obama reportedly was mindful of Lincoln's assembling; what historian Doris Kearns Goodwin described as a "team of rivals." Some members of Lincoln's cabinet previously had expressed very public disdain for the new president. Yet Lincoln understood that strong argument from a wide variety of points of view would, ultimately, yield the best decisions.
In philosophy, an "argument" is not the same as a "fight." Indeed, the goal of an argument is not to diminish your opponent or to impress your constituency. It is to vigorously offer good reasons to support your conclusion -- reasons that everyone in the discussion can accept. You can't just say, "My opponent is wrong." You have to demonstrate, through the use of your reasoning, that he is wrong.
I hope, in Lincoln's "government of, by, and for the people," we in the health insurance profession will have an opportunity to argue for our vision of reshaping health care and insurance to deliver higher quality care at lower cost.
Today, the health care industry is a zero-sum game. For one component to "win," others must "lose." This not only contrasts with the remainder of the economy, but it underscores two more fundamental problems. First, a zero-sum environment never has produced higher quality and lower costs. Second, and more important, in this type of environment, the patient always loses.
As I think about the arguments to come, I remember a famous quote from one of the most interesting politicians in recent memory -- the late Sen. Daniel Patrick Moynihan of New York, who once cautioned that "Everyone is entitled to his own opinion, but not to his own facts."
This leads us back to one of the linchpins of the philosophical argument: the premise. In the broad sense, ideas that bolster your argument -- premises if you will -- are taken for granted. Logically, if the opposing side accepts the premise of your argument, they should also accept your conclusion. Sometimes the premises set forth to persuade you to accept a conclusion are obvious, but often they are not.
Conversational indicators known as "premise-flags" often precede a premise. One of the most common premise flags is "given that." For example, "Given that there are 47 million uninsured Americans, the government needs to step in to provide health care for this population." If you are on the other side of any philosophical argument, you should do two things. First, recognize your opponent's premises; and second, remember that you have no obligation to accept those premises, in whole or part.
For example, you might counter: "Given that 11 million of those uninsured are currently eligible for Medicaid/SCHIP but are not enrolled, your premise is not valid." You might also point out that "Because" (another premise flag) another 9.7 million of those 47 million are not citizens of the United States, they should not be included in your calculations."
Another useful premise flag is the ever-popular "since." Here's an example: "Since 4.7 million in the group you refer to are college and university students, and another 9.1 million people in the group have incomes in excess of $75,000 a year, the real number we are discussing should be closer to 15 million, not 47 million."
All these numbers, by the way, come from the public record. You might close your argument this way: "Given that the real number of uninsured, while troubling, is much lower than my opponent has suggested, the type of vast governmental solution he envisions is unrealistic and ultimately will not work."
Those of us who have been media trained understand that to refute the premises of others, you must arm yourself with the facts and be ready to make a reasoned argument supported by those facts. Remember Moynihan's admonition -- no one gets to make up the facts. With apologies to Dylan Thomas, I should also note that some will use the facts the way a drunk uses a lamppost -- more for support than for illumination. Your challenge is to use the facts for illumination. Personalized facts won't win the day.
As I write this, just weeks after the election, already a dozen blueprints for reform are floating out there. Some have little or no detail -- merely white papers of a sort. Others are long on details but impossible to comprehend or to implement. Some of the reformers believed the news media had so badly misconstrued their ideas, that they felt compelled to write op-ed pieces to set the record straight.
Then there are the ideas of the "d?j? moo" variety; you get the feeling that you've heard this bull before. Sen. Hillary Clinton (soon to be our secretary of state), using a carrot and not a stick this time, thought we should offer incentives to get doctors to choose certain specialties and practice in certain geographic areas. This is a page ripped from the 1,000-plus pages of the American Health Security Act of 1993, otherwise known as "Clinton Care," which never even came to a vote in Congress.
In any reasoned argument about what role the government should have in our business, we also need to be on the lookout for the glaring contradiction. Unlike the premise-flags, these are not always easy to discern. Here's an example: the same federal government that is going to help everyone get health care has recently allowed the states to set premiums and higher co-pays for Medicaid beneficiaries.
The nation's governors had wanted this discretion for a long time, and a bill signed into law by President Bush three years ago gave it to them. According to Sara Rosenbaum, quoted in the Nov. 27 New York Times, "It's a tremendous break with the past in terms of what low-income people are expected to pay for their health care." It is more than that, though. The states now have the power to deny care or coverage to those enrollees who don't pay their premiums or co-pays for services rendered. Some health care advocates are concerned that these new costs might cause this population to delay or defer needed care.
There are arguments at the federal level -- among Democrats no less -- to tax health benefits. The Boston Globe (Dec. 1) reported that "Some key Democrats are talking about limiting the benefit for workers so that those with higher incomes or more generous health benefits might pay taxes on some portion of the income they use to pay for their health premiums." ("More generous" than what, I ask.)
Sen. Max Baucus (D-Mont.) has suggested capping tax breaks for health insurance premiums on both of those bases, income and benefits. Yikes! Doesn't it seem like only yesterday that Senators Obama and Biden warned that John McCain would "Tax your health benefits for the first time ever"? To quote Julius Caesar, "Et tu, Brute?"
Many forces are at play. If you want to help keep some form of private enterprise in the system, you need to learn the tools and understand the arguments. No one is asking you to become a professional debater, but you'll help yourself to remember that just because someone asserts a premise, it is not necessarily true. It may be one of those "facts" Sen. Moynihan cautioned us about.
As you follow the inauguration festivities, keep in mind that "A New Birth of Freedom" is only a conclusion, while our immediate concerns are the premises in argument. Let me close with another quote from Lincoln that could serve us well not simply as a premise but as a whole philosophy: "I am a firm believer in the people. If given the truth, they can be depended upon to meet any national crisis. The great point is to bring them the real facts."
Readers may write to David Saltzman at Carolina Care Plan, Inc., 201 Executive Center Drive, Columbia, SC 29210. David is a past president of NAHU and has been a health, disability, life, and employee benefits consultant and broker for more than 25 years. He is the director of the large group segment for Carolina Care Plan.
