Episode 23

Rebecca Cures Healthcare

Less than a week after her inauguration in January 2017, Rebecca and ARP leadership are ready to begin tackling healthcare. Obamacare has proven extremely divisive, expensive, and ineffective, relative to the claims of its proponents. Its opponents are doing everything they can to keep it from working. Healthcare is an issue that involves nearly every American as a passionate stakeholder with ideas, opinions, horror stories, information and disinformation ranging across the spectrum.

Rebecca holds her first official press conference to announce the initiative and the process:

R: Good evening. The purpose of this press conference is to announce the start of our first major national decision-making initiative. As all of you know, the issue of healthcare has been a divisive and painful one for many years. We need to come up with an approach that we all believe is fair, efficient, and effective. As you also know, I’m not going to announce any policy tonight. You, all of you, the American people, are going to determine our policy. What I will do now is explain how I and the ARP will facilitate the process to make sure that every voice is heard and that we choose a policy that is nearly universally accepted as the best we can do. So let me get right down to it.

   First, we’re going to ask everyone who believes they know how to structure and manage our national healthcare system to write a proposal and send it to me at the following address: proposal@healthcare.gov. The proposal should be no more than five pages long. It must be sent in as an electronic file, and it must be received by the end of February. I realize that no one can present a detailed health system in five pages, but at this point, we’re not looking for details. We’re looking for ideas presented as a general outline or summary. We just want the essence of your plan.

   I suspect we will receive thousands, maybe tens of thousands, maybe millions of proposals. When we receive your proposals, we’ll feed them into a program that will analyze them for characteristic elements. Our computers will, in minutes, read all your proposals and divide them into a few basic categories. When we’ve generated the basic categories, we’ll present them publicly on our website and ask for comment. At that time, everyone who presented a proposal will have a chance to tell us if you think something important from your proposal has been dropped or ignored. If you did not present a proposal, this will be your second chance to do so. When we receive your feedback, we will again generate a few basic proposals and present them again. We will continue this process until we believe we have identified all the salient elements that are in contention or competing in some way. We will be identifying the key points of difference.

   At that point, we’ll write up several alternative proposals that synthesize the ideas we’ve identified. We’ll then present these proposals publicly and begin identifying the people who sent in the key ideas or proposals. We will do our best to come up with the smallest group that, if they agree, can persuade the rest of the population. Those people will be called in as representatives of their respective  ideas. 

    Once we have our basic proposals and the representatives who will defend them, we will hold a public discussion. This discussion will not be a debate. The representatives will be expected to follow certain discussion guidelines designed to address the key differences among the proposals and promote understanding of the best possible solutions to the problems those differences highlight. In other words, the representatives will not be seeking to win a victory for their own proposal. Rather, they will be expected to seek in good faith the solution that will be the greatest good for the greatest number, that is, the solution that will be best for our country.

    Every minute of this discussion will be televised, and it will continue until we have come to consensus regarding the one or two proposals that need to be explored in greater detail. At this point, we’ll launch a similar process regarding the details of the consensus proposal or proposals. When it has become clear that a certain plan is nearing consensus, we’ll draw up that plan in full detail and present it publicly for comment. We will take your feedback, revise the plan accordingly, and continue until we have a plan that we believe will be supported by the vast majority of the American people.

   I know this seems like a cumbersome way to make a decision, but this is what conflict resolution looks like. If we want to make a decision we can all be proud of and happy with, we need to invest the time and effort required to explore the alternatives and make an informed choice. For decades we have seen plans proposed, implemented, and hamstrung because so many are dissatisfied or distrustful, or because the interests of too many stakeholders are discounted. This process will help us find and utilize the best ideas available. I hope you will give this new approach a chance, I hope everyone will feel free to submit a proposal, and I hope you will all be working in good faith to find the best possible solution. Do you have any questions?

Reporter 1: How long do you think this process will take?

R: I really have no idea. It’s a vital, high-voltage issue, so it could take months. I would be very surprised if it takes more than a year.

Reporter 2: You ran on a platform of transparency and incorruptibility, but the insurance industry is extremely rich and powerful. How do we know your process cannot be corrupted by the money and power they have at their disposal?

R: In the process I’ve just described, where is the vulnerability to corrupting influences?

Reporter 2: Well, you’re going to boil down all the proposals to just a few. You could control the outcome by narrowing the competing proposals to those that favor the industry. Or, conversely, you could select proposals that leave the industry out.

R: I see. Yes, I agree that’s a theoretical possibility, but I hereby give you my word that such manipulation will not happen, and let me point out that if we were to do something like that, we would instantly lose all the support we have painstakingly earned by being fair, open and honest mediators. The whole process will be televised. In fact, we will make all the proposals available online, so you and the America people would immediately see through our scheme, and we would be completely discredited. Won’t happen.

Reporter 2: A follow up, if I may.

R: Sure, please.

Reporter 2: What you are saying is that the insurance industry will have little to no advantage in this process. In other words, they will be unable to lobby you or your cabinet or any ARP legislators. Their ideas will be presented along with any idea from any Tom, Dick or Harry out in TV land. Two questions. Do you think this is reasonable? And, do you think you will get away with it?

R: First, the modern insurance system started in the mid-1700s. That means insurance companies have had  more than three hundred years to solve this problem. That should give them an enormous advantage in writing their initial proposals. Second, in all their years of healthcare dominance, insurance companies have become increasingly despised by the general public. This is not because of incompetence or evil intent, it’s because they’re institutionally forced to compete with each other for profit, and that profit necessarily comes out of the pockets of the people. I would be very surprised if the process we are now embarking on allows that competition to continue. Of course, I’m not taking a position, but I’ve seen the polls and know that year after year the majority has supported some sort of nationalized healthcare system. Third, we’ll be receiving proposals from insurance companies, but we’ll also be receiving them from economists, politicians, doctors, nurses, and ordinary people, some smart, some not so smart. Solving a problem of this magnitude can benefit from the realism of those who have been inside the industry but also from the creativity of those outside the system. So yes, I believe our approach is reasonable.

   In answer to your second question, yes, we’ll get away with this because this process is clearly an effort to do what’s best for our country. It will be difficult for the insurance companies to let go of their power and the wealth they’ve controlled, but most people in the insurance industry sincerely want to solve this problem, and I assure you that this process will not be over until we have a way of meeting the needs of everyone involved, including those whose companies and jobs will be affected by what we do.

Reporter 3: Is your process not susceptible to the participants? What if the industry participants, for example, or just some crazy people deliberately sabotage your process and do everything in their power to prevent any consensus from emerging? They could continue presenting their ideas and demanding changes just to prevent any action, regardless of what the majority think or want. How will you handle this?

R: First, most people sense the need for and inevitability of change and will be working in good faith toward an excellent and universally acceptable solution. But remember, all the proceedings will be public. The discussions will all be televised. If any party is being disruptive or unreasonable, it will soon become obvious to all who are watching. If we suspect that someone is not discussing in good faith, we will confront them and talk openly about what we see as their unreasonable behavior. They will be forced to defend everything they say and do in front of an audience that will grow rapidly once a confrontation like this begins. If the party is an attention-seeker, we will all soon see that. We will not allow a crazy person to derail this process.

   If we suspect someone is working undercover for an insurance company, we will use all the resources the government has available to find that out, and we will reveal whatever we find. Hiring and deploying such a person would be a fatal mistake for any insurance company because we will defend our process tooth and nail. Any insurance company found to be deliberately subverting the decision process will be boycotted and out of business before the process is complete. I do hope that neither you, nor any potential stakeholder underestimates the power of the new superpower. If the people decide to take a company down, that company will go down. So obviously, honesty and sincerity will prove to be the best policy. Are there any more questions? If not, I declare the healthcare process underway. If any of you watching today or anyone who wants to submit a proposal has any questions, feel free to contact proposals@healthcare.gov. Please get your proposals in by midnight Eastern Standard Time, February 28.


Thus begins the process through which the US finally arrives at a healthcare system that is the envy of and a model for the rest of the world.

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