Integral Healthcare Reform? Not even close.

I live in the UK and my wife works for the NHS. Whilst some of my friends view America as some sort of barbaric (but rich) place that's "obviously" wrong for not providing free health care, my wife says that yeah, that would be nice, but it isn't as if our NHS is working either. 

Beyond this simple observation (the USA's system isn't working, and neither is the UK's) the issue seems to become horrendously complex and I for one just give up having an opinion on it. But I'm going to try to read the papers you've linked -- an integrally informed view is just the first place I want to begin, even if I don't understand it, for I do understand that the world is complex far beyond my understanding anyway.

Hi Rob. This explication reads excellently; I think you captured the complexity and current dilemmas.

I liked this long-term optimistic thought/speculation/hope that doesn't easily spring to my mind: "There will be a time when per-capita GDP (i.e., real material wealth per person) will be high enough that we don’t bother thinking about the nominal cost of healthcare, but that’s exactly the sticking point of the current debate: we are a long way off from that point and, if anything, healthcare inflation over the next few decades will keep us stuck where we are today: thinking a lot about healthcare as a drastically-expensive good."

If I didn't have to run to work this very minute, I might try to make a case, maybe try to rationalize as an evolutionary path the way that this recent legislative-administrative situation has klutzed along and its potentially very heated and counterproductive aftermath. It's more of an impulse on my part, probably of inner organization that I want to to do this. An inner work-through. I feel that several psycho-cultural possibilities are still in play that might allow this scene to settle down and later become better understood and addressed. Not the best way, certainly, but maybe through the messy path, still moving generally towards truth and the light, as water courses head for the sea. Or not. Working through this would probably help me. There are facets of me that are optimistic and others that are deeply pessimistic, etc.

Later, I may get to read those two articles, but I am guessing that I have a general sense of the possible positions already - and probably excellently elaborated as you suggest.

I wish this wasn't so rushed so I could think about what I am typing here more.

Thanks for this good presentation.

Robb,

Just some feedback. I absolutely love commentaries like this one. I learn more in the 15 to30 minutes (and hours of reference branch reading) that I spend reading this than many hours of my own personal study. I think what makes it valuable is that it comes from a leader like yourself, Ken Wilber or a few others. I don't have to spend time analyzing whether the content is integrally informed. You've developed that trust with me already, so I can just dive into learning mode. Choosing a currently hot topic makes it easy to contrast and compare different perspectives since they are all over the media.

I realize you're the CEO of the most evolving company on the planet and your time is very precious. If you and the others could swing a weekly commentary I would feel very privileged (not entitled :), but I do think it would add tremendous value to the site and drive traffic.

--

Steve Redmond

Robb: Interesting post. I was impressed by you use of integral language and attempt to capture the complexity of the healthcare issue. However I was left feeling a little flat at the end of your post. It seems we have a complex problem that no one has an ability to understand yet alone fix. How do we develope the skillful means to speak up and down the rainbow(Red to teal, teal to red)? Jim

 Integral is great at showing how different world views have value and need to be honored and nurtured if we are going to have solutions that do not create more problems than they solve. So we get expressions, like Kevin Bowman’s on Integral Economics and now Robb’s post, that pertain to surfaces of culture but seriously lack the deep social truth in the LR historically. The healthcare reform like all issues that have a LR component revolve around money and economics. There is the surface intention that we are told and debate and Integral has a include and transcend view but there is the deep intention that we barely get to see. Like the creation of the FED reserve had a surface intention of preventing bank collapses but a deep intention of taking control of a country by controlling the availabilty of funding for society and government. Same with this healthcare reform. We have the surface intention of making healthcare available to all but a deep intention of making personal information and tax information available to control the people. So my issue with Integral on economics, politics, climate change, science, is that it just integrates the surfaces with these issues and is historically ignorant of the power elites deep intentions. We do not live in the systems we think we do in the LR. We would need historically informed people on economics and monetary systems to address this, and Kevin Bowman doesn’t even come close. So our conflict is on the surface, is everything that Integral brings up, but the deep cause of conflict and suffering is between the people of the world and the power elite( The power elite is not the government, or fortune 100, or very wealthy people worth billions, but people worth trillions, like Morgans, Rockeffellers, Warburgs etc.)

A little video that is not Integral but shows the historical pattern Here

My Comments are in Bold in Robb’s following post.

I’ve been asked to blog about my reaction to the healthcare reform package.  This could get messy.  It’s an extremely complicated topic and there are very few truly thoughtful (or integral perspectives) anywhere that I’ve seen the past 12 months.  Even the commentators who claim integral credentials really miss the mark, in my opinion, diving too quickly into their preferred values-framework without giving deep and considered credence to the very strong arguments that exist on both sides (and no, I don’t mean Ds and Rs).

So I’m going to keep my comments shorter than I normally would because this post could be a 100 page issue paper if I wasn’t careful.  And in this post I'm not going to focus on my specific critiques of the healthcare system itself (if there's interest I could post on that topic); instead I'll focus on integral observations of the reform debate and on giving you two resources that if you want to be educated on these topics you should read.

First though, two observations need to be made at the outset:

1.    Most people are just not informed enough to have a sophisticated opinion on the healthcare issue.  (Similar to Kevin Bowman's presentation here on Integral Life of naive conservative and naive liberal economic views.) Sophisticated: meaning Integral? Kevin Bowman’s work on economics fails completely with banking history and knowing the empirical reality of where the tire meets the road, so to say.  This is not a criticism, but a characteristic resulting from the complexity of the system itself. Yes complex but not beyond our ability to understand. Many large-scale issues that have Teal levels of systems complexity are too complex for the average voter or policy maker to understand and navigate.  This is a problem everywhere and one of the reasons I continue to argue that integral leadership will be humanity’s most precious resource in the 21st century.Yes Integral leadership is key but Integral will be effectivly naive if it does not know our history, which so far it doesn’t. And, for the record, I don’t claim to have the full knowledge necessary to dissect the healthcare issue.

2.    An integral view requires that we account for the fact that there is not one healthcare system.  And there is not one right way to do reform.  And there is not one ethical stance towards how to provide healthcare. Or one right view on whether healthcare is a right or a privilege.  The integral view demonstrates that every perspective can be situated within the world-space and values-domain giving rise to that perspective.  That doesn’t make them all equal – they are vastly different! – but it does mean that 1) all interventions are context-bound by the ethical and pragmatic limitations one chooses to impose and one has to set those boundaries before you can decide what the most effective form of healthcare system would be given that context and 2) an integral reform praxis would look at the psychological, cultural and systemic data at different levels of worldview enactment in deciding what the best way to proceed would be.  My criticism of Obama’s approach is that he is an opportunist, not an integralist: he doesn’t care enough about the philosophical divide that will wrack the United States for years to come because of the divisive foundation this reform was laid upon and manner in which it was passed.  I’m not angry about this because I understand the limitations of the political culture, but it will produce more social shadow and suffering because of it.Social Shadow? Yes and what is that Shadow? The shadows of individuals in society or the shadow of a small group of people pulling the strings on banking, governments, corporations, military industrial complex, drug companies, agricultural companies,education etc.The latter Integral profiscients have not researched or recognized enough to be competent with current events. Most scholars included.

So where to start?

Much of what I could say about healthcare comes down to two fundamental axes of consideration: What is ethical? What is pragmatic?  And unlike many commentators I’ve read on this issue, my homework starts with the people who are doing real and sophisticated research in these areas.  So here are two gems, both peer-reviewed academic presentations, that present very convincing and well-informed arguments on both sides of the debate, both in ethical and pragmatic social policy terms.Pragmatic would include the power structures we are already imbedded in. Control and power! Who has the control and power? Scholars, polititions, voters, professionals, etc. Nope. Hows about the power elite. We can express ourselves all we want. Make subtle distintions all we wan’t, but until we can see how power has been yielded throughout history and see how it is currently being yielded, and not just on the surfaces, we can start to have a pragmatic plan to bring a potential bright future into actuality.

Ethical foundations of a single-payer system and a free-market system

Pragmatic considerations of a single-payer system and a free-market system

The reason I include these is that in my opinion if you’re not seeking this kind of reasoned argument on both sides than you’re missing out.  You might also be a partisan.  Which is fine as far as it goes, but it also means you’re probably more a part of the problem than you are the solution.  Here’s the test, elegantly pointed out by Ken Wilber: when you read a view that differs from your own, does it bother you or inform you?  When society reaches the point where a majority of people can honestly claim the latter, we’ll be ready.  Until then: there is no chance that an integral political solution to healthcare reform will emerge anytime soon. The world’s not ready. So it goes, as Vonnegut writes. The integral trap of until regular people are developed enough then it will not change very much. But most people do not have the free time and money to explore their development if our monetary and economic situation is as its is. And how is it. Not a modern, or postmodern system, but an elite tribal system by the elites for the elites. How does Kevin Bowman handle the fact that the FED Reserve, IMF, ISSC, World Bank are PRIVATElY OWNED BANKS.

So the first thing we can observe is that unless policy makers are having a reasoned debate as thorough, considerate and empirically-grounded as what we see in our best scholars,( You WISH) we're going to get deeply fractured outcomes.  Which means that the messy war of exclusive worldviews will march on, fighting each other with everything they’ve got, each claiming to have the will of God on their side (though different gods, mind you). 

And in their own ways, both are right.  We do find ourselves in an evolutionary period where we’re halfway between healthcare as a privilege (200 years ago) and a right (200 years from now).  The debate we’re in is a developmental one, an evolutionary one.  And don’t think that you can jump the gun on evolution: healthcare has not graduated to the developmental status of food, where we as citizens don’t think twice about providing food stamps for our poorest citizens while also relishing the most expensive items at a fancy restaurant for ourselves. There will be a time when per-capita GDP (i.e., real material wealth per person) will be high enough that we don’t bother thinking about the nominal cost of healthcare, but that’s exactly the sticking point of the current debate: we are a long way off from that point and, if anything, healthcare inflation over the next few decades will keep us stuck where we are today: thinking a lot about healthcare as a drastically-expensive good.  

No honest analyst on either side of this debate honestly believes this legislation will bend the cost-curve down: population is going up generally; the aging population is rising; up to 30% of doctors may retire in the face of this legislation (according to some polls); there is no price mechanism to discourage moral hazard (or rational behavior); it doesn’t change medmal; it doesn’t deeply incentivize different behaviors; it will not be deficit-reducing (there is already legislation pending to wipe out about one-third of the savings being used to pay for the bill, savings stemming from a reduction in Medicare payments); the ills of the current system (high administrative burden, reduced innovation and competition etc.) are more embedded by this legislation, not less.  And on and on.Again who’s in power? legislation? Democracy? Please, none of these turn at to be true, where the tire meets the road. Are we the people in Control? Are the politicians? Nope

So at the heart of this discussion is a disagreement about how we make healthcare a good that works so well we basically take it for granted.  Free-market supporters argue that healthcare is not fundamentally different than other life-preserving goods and therefore we should treat it as such: the market after all does have a superior track record of increasing quality and decreasing cost in almost any good it touches (and no, healthcare today is not even close to this kind of market).  Single-payer supporters argue that healthcare today is so broken that what we need is to model reform after countries where we can see single-payer systems working effectively so as to increase access.  And in case anyone missed the headlines, this legislation doesn’t really do either.  It actually perpetuates the problematic hybrid of both a highly regulated quasi-free market with a single-payer system that currently accounts for about half of all healthcare spending in the U.S.  It’s sort of the anti-Pangloss, the worst of all possible worlds (again, context is key here though: because this legislation is effectively a form of wealth transfer from the young to the old, for certain people this reform will be great, and for others it will be harmful.  Which is right? Both, as far as it goes, and the relative goodness of favoring either side will depend on one’s moral outlook and economic rationale).  Wealth transfer is exactly what the elites specialize in. It is the foundation of a fractional reserve banking system where the government pays interest to the FED reserve bank.

This is important, so let me try to state the perspectival-fighting at the heart of this reform in another way: the great contribution of the postmodernists was to show that all views have validity from within their own frame of reference (and some went to the extreme and concluded that therefore there’s no firm truth anywhere).  So to prove you’ve digested this postmodern insight (stemming from early vision-logic cognitive complexity) let us suppose that every claim, whether positive or negative, that can be made about the healthcare bill by any person is a truthful claim by them (a subjective validity claim).  But what makes statements about healthcare reform more or less true (an objective or interobjective validity claim) or more or less just (an intersubjective validity claim)?  That’s where context counts for everything, because integralists came along with their middle vision-logic cognition and said that everything is not completely relative, and while context does shift infinitely (a postmodern insight), we can (and have to!) pin down the context in question to arbitrate the relative truth and justness of various views, particularly given a developmental framework that allows us to see that some views are more adequate than others for a given objective.  But defining the specific timeline and terms for that result have to be established before one can have any hope of creating an elegant reform.

So the net result is this: in any healthcare reform that is not integrally-designed – that is, it is designed by an exclusive worldview that wants to hegemonically impose its ethical-pragmatic will on all others, such as the one we just got –  will produce outsized delight for some people and outsized suffering for others.  What the integral intervention would have sought to do is establish the terms of context by which all the validity claims could be most adequately arbitrated for society: this would require some developmental balance and also a sense of the time frames for success.  Not everyone would be happy, but the goal is always to reduce the most amount of suffering.

Which is why…

1.    The right integral healthcare reform in my view is to take all the money they’re throwing at the U.S. uninsured problem and spend it instead on clean water and sanitation projects throughout the world, which would easily and far more cost-effectively improve the health and well-being of 20 times more people (about 880 million people) than the uninsured in the United States. And, ( Like the goodwill Robb, but at a loss as to how this helps the root cause of our issues, looks like patchwork to me)

2.    At the end of the day, I can make a strong argument for the inanity of the current reform approach and for a free market system (with a social safety net) as a more ethical and cost-effective long-term option. But at some level I don’t actually care as a philosophical point: either a free-market or single-payer system would work and do (see Canada on the one hand or Singapore on the other).  But the middle-of-the-road approach we're stuck in will be very ugly: a lesson that liberals will ignore, a profit opportunity that capitalists will relish, a battleground that conservatives will agitate, and a fiscal nightmare for my children.  And because I can take each of these perspectives and see what’s valid and interesting in each, I am heartened to know that evolution always wins. I hope.

In the final analysis, short of the mortality-inducing access restraints of the current system that legitimately need reform, many of the gripes we're setting out to "reform" - whether the pain of higher taxes on the one hand or the pain of a medical bankruptcy on the other - let's get real: these are high-quality problems characteristic of a luxurious first-world society.

Robb

Robb,

I've worked in the healthcare system for years.  Typically, my experience has been with emergent care in urban environments.   With aging parents, my own "pre-existing condition" and a couple of kids to boot, I've grown weary of yelling at the small screen and shaking my head after reading headline after headline, page after page.  But you have said it.  Simply and integrally.  The complexities remain, but you've framed the essential and identified much of what shrouds the core issues.  Thank you.

Once again, those who proclaim their actions are for the common good have proven to be no more than opportunists in search of the next spotlight to showcase ideolgy in need of justification.  Debate has been labeled, denigrated in the din of national politics.  This healthcare debate really hasn't been about healthcare at all.  And many people, perhaps most of the voting public, regardless of party membership, regardless of where on the political spectrum they fall, simply don't understand. 

All of us who strive to bring Integral forward, however we may in our daily existence, should ask ourselves candid, sobering questions regarding this issue.  Whether one agrees with modest or major reform, we see open, respectful, SINCERE debate dwindling.  The nation retreats to what is comfortable:  labeling the opposition to undermine any opportunity to hear opinion, to weigh options. 

Perhaps the crux of it all is determining whether proposed reform really honors life. Dismissing the extremes of any sample population, whether very young or very old, moderately healthy or seriously ill, to appease the immortal sense of the mid-life center is never wise.  Thanks for fueling a necessary and enriching discussion.  We thank the "greatest generation" for fighting to keep mythic and ethnocentric perspective in check early in the last century.  Perhaps its the current generation's task to lay the next lever of society's foundation by championing Integral now.

Robb,

Thank you for your thoughtful analysis of our current mix of thought on health care.  I appreciate the way in which you put the current legislation within the context of a much larger evolutionary thread and found myself thinking of other ways in which health care will look different in the future.  There seems to me to be such a very high demand for health care that is so indicative of our culture's present mix of dualistic values, as well as the allure of an unbalanced life that leads to the premature need for surgical, pharmaceutical, and mechanical intervention.  Many of us are living in cultures that encourage excess and the obsessive pursuit of fleeting pleasures. I think it is important to point out that as more individuals give themselves over to non-dual understanding, and adopt more balanced approaches to living, building cultures that support these approaches, the demand for health care will decrease in increments, thus aiding in bringing about "the nominal cost of health care."

Thank you again for your insight. 

-Aleks