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Jeffrey Pfeffer
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Jeffrey Pfeffer

Jeffrey Pfeffer is the Thomas D. Dee II Professor of Organizational Behavior at the Graduate School of Business, Stanford University, and author of the Sept. 2010 book, POWER: Why Some People Have it and Others Don’t.

Losing Control of the Debate

The Obama administration has made numerous mistakes in its push for health care--including giving veto power to an opposition whose objective is, not surprisingly, to hurt the administration. But its biggest mistake has been to let opponents define the terms of the debate--cost (can the U.S. afford universal health care?), rationing, the loss of employer-sponsored care, and government takeover, among other dimensions.

There were, and are, alternative ways to define what the health care debate is about, including getting some facts straight. One framing might be why the U.S. is the only advanced industrialized country that fails to provide health care as a fundamental human right to its citizens. As the country quibbles over costs, it already spends much more than any other country on a per capita basis and has health care results that don't place it in the top 30 in terms of performance. The current system is failing--a fact that one would be hard to see in much of the discussion.

Another angle might be the fact that the government already funds nearly 50 percent of health care costs (through Medicare and Medicaid) and the private sector has been running away from providing health care benefits for years--with only about half of the U.S. now getting health insurance through their employment--facts that further the argument that the current system is neither sustainable nor stable. And as for rationing--there already is rationing, by health insurers who deny care and services as a way of increasing their profits--something that has been documented by numerous investigations, lawsuits, and documentaries.

A fundamental principle is that control over the language and measures used to define an issue helps determine who will win the debate. The current health care debate seems to take as a given an accountant's view of health as being about cost and budgets. In case people failed to notice, the Iraq War was not about cost, but about "national security." Health care is about human life and its quality. The fact that the U.S. lags on measures of health outcomes while spending the most money--and the reasons for this--should be the focus of the discussion. By ceding the terms of the discussion to the opponents, the Obama administration, in a doomed effort at accommodation, risks losing not only this battle, but a broader war about what criteria the U.S. should employ in making decisions about human well-being.

By Jeffrey Pfeffer

 |  July 27, 2009; 12:30 PM ET
Category:  Accomplishing Goals Save & Share:  Send E-mail   Facebook   Twitter   Digg   Yahoo Buzz   Del.icio.us   StumbleUpon   Technorati  
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I've been following the health care debate and am thrilled to see the American people turn against Obama's big plans.

Way to go America!

Posted by: westcotran | July 31, 2009 2:10 AM
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Obama duped the American voters.The media refused to examine his paltry experiences and qualifications, his socialistic proclivites,and his scholastic records(or lack of). We were naive to believe that he would govern from the center. The country is surely doomed.

Posted by: tsapp77 | July 30, 2009 7:35 PM
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This is Nuts tell the Obama Nationalist an socialistic dictaitors to keep there greedy hands off The health care.if anything and stand up an be leaders of these doctors and Abortion the oath of a Doctor is frist do no harm what is the point to have that vow if you are not going to stand on it..I really liked the Lady on Rush limbaugh that came on the air and was a health insurance person and what she was talking about...she made more sence then anything I have heard yet..Great Job Miss...Go Rush if he really wants to do some thing worth a Crap force these libs to use the foundation more in our courts...

Like Indiana Still on the books is the oold Law that says after a person gets out of jail they are get a Gold pice and a Horse..the fact to this as I understand the US Constitution was set any time the Goverment Takes they are justly compensate..it was a check and balance system to again keep Tyrantical Leader Like Obama's team from being over baring judges from have to much control. and passing and inforceing unjust law's...

alot of these judges are not up holding the Fedural Guied lines and need to be sued Like I am working..enough is enough with these Kings rulers..Sanctum mcgallium US Title 42 USC Section 1983 Judicary Constutional Contemp...degerdation of duty.

I do not blame law officers I am blaming the law makers acting like Kings

Obama teams need to do the same thing with those that try to push Unconstutitional Gun law's like this last State Lines thing..

Term limits, Freedom of Speech, Voluntary Taxes, and Self defense. keeps Goverment Smaller and Honest...

Posted by: WindSong | July 30, 2009 5:05 PM
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There should not even be a Health Care Debate at this time. The President and all of our representatives should be putting in 100% in stimulating the economy.

Enough already with those Town Halls designed to influence the masses.

Elected officials need to be otherwise engaged in getting a real stimulus going. And I don't mean silly Governemnt "make-work" jobs.

This country is working against the best interests of its people.

It is the Economy, stupid!

Posted by: primegrop | July 30, 2009 4:29 PM
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Barry has a difficult time selling the Pelosi Socialist Bloated Plan because he is not concerned about health care per se. He is more interested in the Government Control over the population it will afford him. That is his priority. Simply, he is a fraud.

Posted by: ChangeWhat | July 30, 2009 3:51 PM
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Please someone who has analyzed the language of the bill, clarify some of the details of the proposed health care bill.Does the bill cover noncitizens and their families as reported? Will taxpayers' money be used to fund abortions? If medicare is cut significantly, what happens to seniors?

Posted by: tsapp77 | July 30, 2009 3:40 PM
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On Gates & Sgt. Crowley OBAMA...gets ALL questions from his hand-picked liberal press. He saw one "College Professor gets arrested in his own home by a WHITE cop"..WOW... OBAMA has a chance to push Police Brutality on Black People..WOW.. so he took the question and pre-paired his answer..WOW He just picked on the wrong cop.. Sgt. James Crowley is a model policeman... OBAMA s@@t in his hat... The national news media will never say the truth...

Posted by: ztraveler | July 30, 2009 3:29 PM
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I fundamentally disagree with the cry for "public healthcare/education" rubbish.
European countries, technologically advanced ones, are essentially failed models of social experiment.

USA is a capitalist country. If you have money you should do it yourself - that's the attitude. President Obama is not evil; he is just out of sync with this thinking.

The flip side is that if healthcare and education are "socialized" we shall see more illegal immigrants entering in hordes into USA and breaking down the two systems. (California's financial woes are a grim reminder for the rest of us.) Thus, stopping or selective immigration - implying immigration restricted to only high-skilled personnel, will be an issue. Skilled and hence deserving folks who should be immigrated to USA shall be tied up while illegal immigrants shall swim the seas and come here. I cannot see why my tax dollars will be used to fund education and healthcare for some illegal immigrant or a potential terrorist.

Agreeing that Bush-Cheney combine had spent trillion dollars and miscalculated the Iraq war, I just cannot see why such a flawed decision from the previous administration be replaced by another flawed proposition from the President himself, when he himself has no clue. Just making pleasant statements that everybody should have healthcare and education is a total rubbish from the US perspective. If that noble view was so politically crucial, then why stop at that ? Why not send American emissaries to each and every impoverished, strife-torn corner of the world and dole out our tax dollars ? What more noble deed can a President do than being charitable with US tax dollars and revenues ? This would make US citizens look more virtuous, and probably improve the "war-mongering/anti-Islam" image that USA has been stuck with post-Iraq.

Got clues, Mr. President ?

Posted by: DebChatterjee | July 30, 2009 2:26 PM
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Interesting comparison, Health Care Reform and the Iraq War.

The Iraq Was was about 'national security' ?? You simply have to be kidding. And the people who defined it as 'national security' won the debate? Not really, they blew over a Trillion dollars and made national, and global, fools of themselves.

Current Health Care reform is centrally about spiraling costs going out of control, and the Administration has been very clear about why cost is item one on the agenda. Also, the current system is such a literal mess, from so many angles, any reforms the Adminstration obtains will be an improvement over the present system. The opponents here aren't really defining the debate, they are merely making the same suggestion as they did about the recession: "do nothing, the system will eventually fix itself . . ."

That's hardly "defining the debate".

Posted by: kenhyde | July 30, 2009 11:41 AM
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People like to talk about personal responsibility.

How about corporate responsibility?

How about national responsibility?

Was it responsible to switch from grass fed to grain fed cattle?

Which poor black, white, or hispanic mother made that decision?

Answer: not a single one.

It was profitable - sure but its led to the obesity that is costing us billions of dollars in health care.

So lets not fool ourselves this debate is about money, 100's of billions of dollars flowing into the coffers of corporations that have insulated themselves from the negative consequences of the aggrandizement of wealth at the expense of the common good.

Why do we need a health insurance industry?

Well because President Nixon thought we did.

Was he right? Apparently not when Wendell Potter former VP for Cigna confesses that they are skimming 20% of health care dollars for themselves.

That's a lot of money for denying Mary Sue an x-ray because she has a pre-existing condition.

Posted by: agapn9 | July 30, 2009 11:20 AM
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The problem is not Senator Feinstein. The problem is we do not know what is in the bill (bills) so how can we have a considered opinion.

What it feels like is that all taxpayers and those who are pleased with their health care (80% we are told) are skeptical. Seniors fear the loss of Medicare on which many depend.

We have seen Obama's rush, rush, rush in the past and that has not worked out very well. Something this important should not be rushed. Obama knows when the congress goes home and listens to their constituents, this bill is going to be even harder to pass. All politics all the time.

I think that we the people are asking for open communication and it is not happening.

Posted by: Kansas28 | July 30, 2009 1:49 AM
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Finally! A commentary that addresses many of the key issues! Very well written and I wholly agree.

Where are these Democrats we elected? As a Hillary Voter I am absolutely disgusted with the disloyalty and fractious nonsense these "Blue Dog" 'democrats' are engaging in. These men are gutless political hacks more intent with saving their own skins at the expense of their Party and the National good. LBJ would have teken each one out by the ear and brought the whole of them to heel.

I am so dismayed to see Obama's inability to control these disloyal Democrats in Congress and push the Public Plan, a real Public Plan, through, unadulterated as it now seems is happening. Why the insistence on bipartisanship above all else? The Dems only need 51 votes, not 60! Why is Obama bending over backwards to placate those intent on eviscerating his plans!

I hate to say it, but Hillary had much bigger balls. She wouldn't have caved like this. It's disgraceful to watch this. At the expense of our people.

All Americans should have a right to healthcare, just as they have a right to a public education!

Propping up and ensuring the survival of inefficient, for-profit insurers seems to be the biggest concern of the GOP and the Blue Dogs. Would they have equally been so concerned for the buggy-whip manufacturers and the makers of gramophones? They are a shame on our nation.

Posted by: hyperlexis | July 30, 2009 1:26 AM
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I agree with virtually everything you say about health care.

But I disagree that the president is "doomed" or has failed.

This process is far from over.

President Obama began by saying he wanted this to be an inclusive process because I think he truly believes that if you make a rational argument, most honest people will listen--and understand.

Unfortunately, many in Congress are not honest. And some just can't follow a rational argument (or don't want to.)

But I think that the president's efforts reassured many Americans that this is not just a wild-eyed liberal president who is intent on imposing his ideas on the nation.
He wanted dialogue.

Now, however, we're in stage two of the process.

Here, the president is appealing, not to Congress, but to Americans. The Obama organization is asking Americans to donate $1 each day until we have true reform.
(They will bill your credit card $30 each month. Presumably you can ask them to stop at any time)

A clever idea, much like the ideas that brought in so many small contributions during the campaign. The Blue Dogs have the lobbyists and their campaign contributions. The Obama group is looking for contributions from the people--the money is not as important as the fact that
this wiil engage people, and make them pay attention to what Baucus et. al. are doing.

We always knew the fight for reform would be bloody.

I am still hopeful that, in the
end, the Senate Finance plan will not dominate the discussion, and that we'll wind up with something much closer to the HELP plan and the House plan.

I believe that it will all be hammered out at the very end--with Peter Orszag and Zeke Emanuel(who both understand what needs to be done to provide better care at a lower cost) and Rahm Emanuel (who understands what needs to be said to politicians who are standing in the way of progress) in the room

Posted by: Maggie Mahar | July 29, 2009 5:07 PM
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Sadly, no one is listening to those of us who actually PROVIDE health care in this country (and trust me, the American Medical Assocation and the American Nurses' Association do NOT speak for their respective professions) We have become a nation of malingerers who are killing ourselves with a fork and knife. Horrible diseases and accidents occur, and for those we have the best medical care on the planet, regardless of ablility to pay. However, most health care dollars are spent on futile treatment for those in the last year of life, and on management of chronic problems related to obesity, addictions, sedentary lifestyle, and smoking. A healthy diet and exercise program would eliminate billions of dollars of wasted care, but it involves a concept Obama and his cronies wouldn't recognize if it bit them...personal responsibility.

Posted by: PattieRN | July 29, 2009 3:41 PM
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The problem is the Blue dogs, some democratic senator like Feinstein, Bacus and company who are in the pockets of the pharma industry. If Obama's so called democratic colleagues are not batting for him most of the time and turned into closet critics, as an astute politician he has to make lemonade out of lemon. If Obama has 70% of the congressional votes on both sides of the house, he could easily couch the debate in similar vein as the professor correctly pointed out. Unfortunately, he does not have that luxury.

Posted by: ere591 | July 29, 2009 2:36 PM
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Excuse me but this has got to be one of those Extreme Right blogs that talks stupidly and Haitt get rid of Froomlin for this old man who probably live in that house on C Street

Posted by: danson1 | July 29, 2009 2:06 PM
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Lets have the best education for all and it will cost what it will.

Posted by: Dermitt | July 29, 2009 1:33 PM
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Well said, HILL_MARTY. Obama is clearly in a job "above his pay grade".

Posted by: rg019571 | July 29, 2009 12:09 PM
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...so your conclusion, Dr Pfeffer, is what? That a weak president is doing a poor job? I think Obama has done a good job of framing the issues. Essentially, he has offered the country a choice: Socialism, high tax rates, bloated Government, poor health care, and stagnation, or something else. The people, through their elected representatives, are choosing something else.

Posted by: hill_marty | July 29, 2009 11:35 AM
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