I'll be the first to acknowledge this framework is a working document and invites challenge. As additional research uncovered new issues to explore and incorporate, inevitable conflicts would arise with prior vetted sections. All attempts were made to resolve these conflicts, but at a certain point I had to make the decision to wrap it up and put it out there. I don't want the perfect to be the enemy of the good.
Section 12 was written last. Upon reflection, the issues discussed in this section may be the most significant of this framework — the real-world obstacles that reform advocates will face trying to persuade the American population that Universal Reform is a good thing. Here are excerpts from Section 12 that shine a light on the hard truths that all reform advocates must come to grips with.
The Political Reality
I'm not oblivious to the political reality of sweeping healthcare reform. There are numerous special interests whose mission is to maintain the status quo and each has, at its core, legitimate arguments. They all generally agree that the current system costs too much and that patient access failures are causing real harm. They also all agree that it's always someone else's fault, and their interests will save the day.
Our response to political objections should not be rhetorical, but structural. The tri-partisan Commission answers the federal overreach concern. The private maintenance tier answers the single-payer market concern. The tokenized privacy architecture answers the surveillance concern. The guaranteed issue mandate answers the discrimination concern. The catastrophic pool answers the bankruptcy concern. In each case, the framework's architecture must take center stage as the debate — not empty talking points layered on top of it.
The 1% Strategy Problem
A well-intentioned reform community has emerged around the concept of incremental improvement — the idea that if comprehensive reform is politically impossible, targeted marginal improvements are better than nothing. This strategy carries a structural vulnerability its advocates rarely acknowledge: every marginal improvement reduces urgency for comprehensive reform, gives the opposition a talking point that the current system is self-correcting, and fragments the coalition required for comprehensive reform.
The forces benefiting from the current system's dysfunction are sophisticated enough to encourage competing incremental proposals — knowing that fragmented reform energy is far less threatening than a coherent comprehensive alternative. When ten competing 1% solutions are debating which delivers more value, no one is building the necessary coalition to deliver the 100% solution.
The Expert Coalition Problem
The reform community's structural weakness is not a lack of intelligence or good faith. It is a coordination problem that is structurally predictable and historically consistent. High-analytical-capacity individuals are exceptionally good at identifying flaws in each other's work and exceptionally poor at subordinating their individual judgment to a collective position. Quite frankly, we are not team players. Never have been — never will be.
The opposition does not have this problem. The forces defending the status quo are coordinated, well-funded, and relentless. They have learned that the most effective strategy is not to defeat comprehensive proposals on the merits — it is to ensure that comprehensive proposals never develop sufficient coherence or traction to engage on the merits. The opposition is made up of team players.
The best analogy I have is that we are building expansion football teams to compete in the NFL. We have drafted, or acquired, the best quarterbacks, receivers, edge rushers and cornerbacks. They are all Primadonnas, but man when our offense gets on the field no one can beat us.
The opposition is also building an expansion team. They invest nothing in these skill positions, but rather focus on the interior lines. The biggest, meanest and nastiest offensive and defensive lines imaginable.
Because we are so confident, and all of our focus has been on the skill positions, we've drafted JV linemen from Division II schools to protect our star players. We're built for offense. They're built for defense. If you know anything about football you will recognize that our team has absolutely no chance to win even a single game. We'll get crushed before we even reach mid-field.
It's time the reform movement gets its act together and starts building an offensive line.