Waiting for C.E.O.’s to Go ‘Nuclear’
Op-ed
By Matt Miller
New York Times
May 18, 2005
The consuming Senate slugfest over judges (vital as they are) proves how Washington remains determined to fiddle while our biggest problem burns: a broken health care system that threatens working families and national competitiveness.
President Bush – who, with 51 percent of the vote, has set 100 percent of the agenda – has taken a pass. And the terms of the debate remain surreal. After all, Margaret Thatcher would have been driven from office if she’d proposed anything as radically conservative as Bill Clinton’s health plan, which would have left millions uncovered and had private doctors deliver the care.
Is there hope? Maybe. But only if America’s chief executives exercise their “nuclear option.”
Here’s the logic. Washington will offer zero leadership on health reform until 2009. The only way we’ll get serious then is if the campaign in 2008 centers on health. The only way that will happen is if groundwork is laid in advance. And the only way this groundwork will get traction is if America’s C.E.O.’s make it their mission.
Various groups (including one I’m paid to advise) have tried, without much luck, to energize this debate. C.E.O.’s are the one group with the incentive and the clout to take it on.
So what should the chief executives do? Even if we don’t have presidential leadership now, we desperately need the “presidential perspective.” By this I mean a view of our challenges that doesn’t reflect the narrow agenda of business or labor, or the medical-industrial complex. Instead, we need a “big picture” framework, a way to engage the press and the public in the right strategic goals.
Here’s my version of the script: A dozen marquee C.E.O.’s would convene a “Manhattan Project”-style effort on the future of health care. They’d propose a new goal: instead of health costs rising from today’s 15 percent of G.D.P. to 20 percent by around 2020, as is now projected, the nation should shave two to three percentage points of G.D.P. (or more) off projected growth in ways that improve quality, even as we extend coverage to the 45 million uninsured.
Our chief executives would explain that this is doable because today’s system costs too much and delivers too little.
(Quick review: We spend 15 percent of G.D.P. on health. Other rich nations spend 10 percent or less, but they manage to insure everyone – and have equal or better public health outcomes. And we have huge variations in practice patterns and medical spending that bear no relation to quality. Bottom line: radical inefficiency.)
Our C.E.O.’s would add that a new health strategy would get excess costs off businesses’ backs – costs that competitors don’t face in countries where governments pick up the tab. It would re-engineer the delivery of care so governments would have cash left for other purposes. And it would cope with the political reality that every dollar of health care “waste” is somebody’s dollar of income.
The group would issue a report in late 2007 with a full-blown agenda for the next president. Done right, the “Jones” Report (aspiring C.E.O. statesmen or stateswomen, picture your name here!) would become the touchstone for all health care talk in the campaign.
Now my rules for participation: First, only chief executives prepared to invest real time need apply. This shouldn’t be a bar; health costs now loom so large that C.E.O.’s are destined to focus on the problem. They can’t fix it alone, so they may as well fix it for everyone. (As a lure, we might enact a 100 percent short-term capital gains tax on their stocks during the life of the group to banish speculators and free the chiefs to think long-term.)
Next, eligible C.E.O.’s have to grasp that most rhetoric in the health debate – as exemplified by the Thatcher example above – is rubbish. Republican C.E.O.’s who think “big government” is always the problem may be at special psychic risk.
Critics may shout: Why should we want some lavishly paid bosses to take the lead? Well, for starters, as the Clinton debacle proved, if business doesn’t buy in, nothing that matters here can change. But beyond this, spiraling health costs have aligned corporate interests with workers’ for the first time in ages. My hunch is that inside many car and computer and bank and energy moguls, tomorrow’s political heroes are dying to get out.
Ordinarily a bold call for a commission is a way to punt, but given today’s leadership vacuum, it’s a way to start. I’m not saying that this will end with C.E.O.’s marching on Washington to demand “Margaret Thatcher-style universal health coverage.” But I wouldn’t rule it out either.
E-mail: mattmiller@nytimes.com; Matt Miller is the author of “The 2 Percent Solution: Fixing America’s Problems in Ways Liberals and Conservatives Can Love.” Maureen Dowd is on book leave.