Wednesday, January 20, 2010

Holding Out for Top Dollar

It was Joseph Kennedy, father of Jack, Bobby and Ted, who said, "Only a fool holds out for top dollar." At some point, you have to do the deal even if it falls short of the best possible outcome.
A few years ago, I was working on a business plan for a client I came to regret working with. He turned out to be a disorganized micro-manager, and insisted on endless improvements, even in the face of looming deadlines. At one point I had to tell him that the marginal improvements he thought were so important would mean little if he missed the deadline. Eventually I stopped working for him, and he is still trying to get his business off the ground.
I wish I could have given this advice to the disorganized micro-managers in Congress who somehow couldn't get health care reform done. Deadlines kept being pushed back, from August to November to January, and now we don't know if we'll get anything at all.
It seems that everyone was holding out for top dollar: the centrists, the unions, the insurers, big pharma. All stood to gain, and all kept pushing for a bit more as if health care was a zero sum game. Now it looks like we could be left with less than zero.
I'm not arguing for incrementalism. Eliminating pre-existing conditions and insuring an additional 30 million Americans can hardly be called incremental improvements. But everyone kept wanting to make it just a little bit better, without agreeing as to what that means. And now we face the real prospect of getting 100 percent of nothing. Those who argued we should just go back to the drawing board may well get their way, along with those who fought the idea of reform itself through endless obstruction and outright lies about "death panels" and the like.
If health care reform dies, those hard nosed negotiators holding out for top dollar can look forward to getting their way eight or sixteen years from now.
Could things get worse? Yes, the Democrats in Congress could fail to pass anything. Could things get better? Yes, if the Democrats get a bill passed and campaign in the fall on having delivered actual benefits for voters.


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