The Art of Governing: Healthcare
From the Desk of Vincent Truglia
February 26, 2010
As my readers know, I have no specific preference for the overall structure of healthcare reform, with a few important caveats. When I worked on the Global Commission on Aging, I became familiar with systems around the world. All of them have problems of one sort or another. What is important to me is do the people have access to reliable healthcare, given the country’s level of development? Poor countries obviously can’t provide the same access that advanced industrial countries can. Access doesn’t mean that every new fangled medical procedure should be paid for by a government created, managed or regulated system. It also shouldn’t mean that every non-essential procedure requires general access. If you want something not covered by the general system, go to physicians and pay for it yourself. Also, no doctor should be allowed to remain outside the new system. Creating two classes of healthcare is disastrous to the body politic in the long-run.
One of the best reforms that could be done is to allow licensed pharmacists to prescribe medications without a doctor’s prescription. This is a common practice around the world, and many of these countries have longer life expectancies than the US. You don’t need to burden an overwhelmed medical system with simple colds, rashes, immunizations, etc. A simple example of this is how much easier, efficient and cheaper it was/is to allow pharmacies to give flu shots. A central shared data base of medications and immunizations among pharmacists is all that is needed to avoid problems. Another benefit is that every year when children are registered in school or camp a parent/guardian could go to any pharmacist and get a print-out of their child’s immunizations instead of requiring another trip to the doctor. Also, over medication, particularly of the elderly, who often have multiple doctors, can be avoided.
Another reform would be to allow nurse practitioners to open their own offices. They could easily handle many medical problems at a fraction of the cost of a doctor. They could then refer more complicated cases to the appropriate physician.
To help physicians, the government should provide low cost malpractice insurance for doctors (and nurse practitioners). Just as the government provides flood insurance, malpractice insurance should become a government program. Right now, one of the biggest expenses doctors have is excessive insurance premiums. Eliminate the problem. Also, that may help reduce frivolous cases. People may be a bit more reluctant to bring cases against a government-run program where the power to investigate is stronger.
As usual, it takes me a bit of time to get to my real point. Governing requires making decisions and following through, no matter what the near-term political consequences. The long-term effects are more important. Moving the Capital from New York to Washington, D.C. certainly wasn’t popular with Northern States, but thank goodness it was done. Imagine if New York was both the financial and political center of the country. It would be ungovernable and the Government subject to too much public pressure.
Great leaders do what they think is right, not what the latest poll says. Winston Churchill, the Prime Minister who won the war for Britain, was ousted after the war. Does that matter? Do most of us even know or care about his successor? Lincoln knew his election would cause states to leave the Union. Did he drop out of the race? Truman made many decisions which were controversial at the time. He desegregated the military and he recognized the State of Israel, both done without any Congressional approval. I could go on, but I think I have made my point.
What leaders should not do is to play politics when their fundamental beliefs are at stake. In the US we saw this happen for much of the latter part of the 19th Century when we had a series of presidents who just avoided making tough reformist decisions. Do we even remember their names? Except for President Grant, who we remember for his efforts during the Civil War, not his scandalous Presidency, the rest remain in the fog of history. The first truly great president to sweep the air clean was Theodore Roosevelt, who spent most of his life reforming both Government and the economy. He we remember.
The last president I will discuss is President Carter, a man who dithered as the US appeared to be crumbling. He is an example of a non-leader, although as I have written on other occasions, he has been one of the best ex-Presidents we have ever had.
What does all this imply for healthcare? It means that President Obama should argue for his core issues about which he should not compromise. Compromise should only occur on the margin. He has no excuse. He is the President and his party controls both houses of Congress. If we don’t like the results, voters can speak in the future and change the programs. Enough said.


It is not news to anyone that Greece is struggling with a fiscal crisis of major proportions. Unfortunately this is not the first time this has happened. In fact, Greece had to receive special assistance from the European Union (EU) in the early 1990’s, along with Italy, because its domestic debt was turning into an international problem. The interesting thing is that Greece got the assistance it needed even though the Prime Minister of Greece at the time was openly insulting Margaret Thatcher the then British Prime Minister. It didn’t seem to matter. Political realism was more important than personal slights.
We have the latest GDP estimates for 4Q09. They were quite good to say the least, even far better than this optimist expected. The economy grew at an annual rate of 5.7%, far above the long-term trend rate. As you know, I always like to look behind the numbers to see where the growth came from. Doing that presents an interesting story, consistent with my earlier views as to why the last recession was going to end last year and not drag on.
For my long-term readers, you know that when I first met Bernanke as a Federal Reserve Governor I found him the least impressive of all the Federal Reserve Governors I had ever met. He seemed to lack the market savvy necessary to do the job right. I was told he was an academic expert on the Depression, which at the time seemed like unimportant academic history.
As a former member of the Global Commission on Aging, in that forum the one thing everyone seemed to agree on was that pensions were only a piece of the long-term demographic problem. The crux of the problem for most countries would be healthcare.
This is obviously one of the main topics of the day given the nature of the economy, especially given the disagreement over bank lending and compensation; are lending/compensation becoming too aggressive or too small. One thing I can assure you of is that the Fed needs to keep money flowing until unemployment starts falling fast. Otherwise, we could wind up with a rather slow and anemic recovery.
Some friends already know that I was fortunate to get degrees in both economics and international affairs. For my international affairs education I was lucky to get into Georgetown’s School of Foreign Service. It was the first university program dedicated to such a degree. It has been copied successfully by a number of other universities since that time. I was also fortunate enough to have studied with some of the greatest minds in the field. Besides Prof. Mikus, a true friend and mentor, one of my favorite professors was Jeanne Kirkpatrick, who was not only a brilliant professor, but one of the best story/joke tellers I have ever met. It was certainly no surprise to me when she was named U.S. Ambassador to the UN.
There has been a lot of talk recently about Brazil, Russia, India and China (BRIC for short) and the G-7. Some argue BRIC will overtake the G-7 by the end of the next decade. There is a reason I added an “et al” to the title. What we are really talking about is if the advanced industrial countries as a whole will be overtaken by the emerging market countries.

