Short, Medium, Long Term

Last week (June 20-24, 2022) was a doozy in the U.S. Any other time the US House of Representatives’ January 6 hearings would have dominated the news cycle, but then you had a couple of Supreme Court rulings that rocked the country, the most “rocking” being the Roe v. Wade rollback that was released on Friday. Predictably, and understandably, that ruling led to protests across the country, and thousands, if not millions (billions?) of posts online.

I’m not a constitutional law expert, nor am I a women’s health expert, so I won’t offer any opinions on the merits of the ruling from a legal or medical standpoint. What I do know something about is working in the non-profit sector, with a particular focus on trade associations. That means I’ve spent a fair amount of time representing industries of one kind or another, and providing services to the member companies and their employees, in an effort to promote the growth of the people as individuals, the companies as businesses, and the industries as a body. That’s why, upon hearing the news from the Supreme Court my thinking went immediately to how I would approach the issue if I thought of those who provide women’s health/abortion services as an association (federation model) and women who could/would be patients as members of that association.
(Update: My daughter, who is much smarter than me, actually did a search and found just such an organization does exist. For those so inclined you can visit https://prochoice.org/ for more information).

First I’d do what every association does when confronted with a world-changing moment. That means we’d do an assessment of the situation and immediately begin defining what we need to do short term — think of these as tactical, “can’t wait” activities — then we figure out our medium- and long-term activities. It’s not that we only do the short-term activities from the start, it’s just that they take top priority at the time. Then we do an assessment of the resources needed to accomplish each activity, figure out which ones we can realistically tackle, focus on those and work our butts off to get the resources needed to accomplish them. Again, I’m no expert on the topic of abortion, but based on what I’ve been reading here’s what I see as some of the challenges and how they could be tackled. It’s not intended to be comprehensive – just a collection of thoughts I’ve had over the last few days.

Short Term (first 3-6 months)

Problem: Probably the most critical challenge is for women currently seeking service in states that have “trigger-laws” that immediately made abortions illegal upon the Supreme Court’s ruling, to get access to legal abortions. Some clinics in those states are already working to open operations in other states where it’s legal, but many women don’t have the resources required to travel to those states.
Solution: The association approach would be to fundraise to pay for travel for the women, and provide expertise and the required technology to affiliated local organizations to coordinate the travel of their “members” to clinics in legal states. This program would continue as long as abortion is illegal in any given state.
Problem: In states with trigger laws there could also be an initial fight in the courts about the legality of organizations aiding women seeking abortions in other states.
Solution: The association approach would be to provide on-demand legal services for local organizations or women who find themselves in a court fight. This could potentially be done in partnership with other organizations like the ACLU and Legal Aid.

Medium Term (next 5 years)

Problem: There are a huge number of passionate, energetic people ready to volunteer to fight for this cause. While there are numerous organizations out there that these folks are active through, there is a risk that they could go in multiple directions and not benefit from leveraging their collective resources.
Solution: Creating a federated organization that can pull these disparate groups together to leverage their resources, and organize them so that their work is optimized for maximum effect. It’s a delicate dance because you have to find a way to balance each organization’s unique identity and offerings, while getting them to line up behind a consistent message, political agenda, shared resources, etc. A good example of what I’m thinking is what Feeding America is to food banks, except that group doesn’t have the political challenge that a pro-choice group would have. You’d think this would be a short-term problem, but there’s no way something this complex gets done in a few months so I’d look at this as a medium-term issue.
Problem: States that ban abortions might also try to prevent women from having access to the “Morning After” pill or other therapeutic measures.
Solution: This is a legal and logistical problem. The legal issue could be addressed by an association’s legal operation; the logistical challenge of getting drugs into the hands of women in need could be addressed by teaming clinicians with Pharmacy Benefit Managers (PBMs) or even Mark Cuban’s new venture Cost Plus Drugs.
Problem: As far as I can tell there is not a strong legal framework that requires men to assume their share of the responsibility, financial and otherwise, for unintended pregnancies.
Solution 1: The association could create, and fundraise for, a cadre of lawyers to represent women in civil court, to require men to pay for pre-natal care, half (at least) of any of the mother’s related health care expenses, child support, etc. Those same lawyers can represent mother’s in any custody hearings. Again, this might be accomplished by partnering with ACLU, Legal Aid, etc.
Solution 1a: Before you beat me up about the atrocious history of men paying child support, another step the association should take is lobbying Congress and/or state legislatures to make sure these payments can be garnished from wages, that mother’s are first in line at any bankruptcy hearing, etc.

Long Term (foreseeable future)

Problem: With the Supreme Court’s ruling a woman’s access to abortions has become contingent on individual states’ laws. That means that women with limited resources living in states that ban abortions will not have equitable access to care that residents of other states, or women of more means in their own states, have.
Solution: This is a purely political challenge. The association will need to form and lead a long-term political operation that brings together stakeholders at all levels, local, state, and federal to effect the necessary changes to give women equal care no matter where they live. I’m not expert enough to say what the legal remedies are, but no matter what they are there will need to be a significant political shift to accomplish them. That will take long-term funding, coordination and will.

Obviously this outline is pretty simplistic, and unlike industry associations that have a relatively easy to define “membership”, the players in the pro-choice world are far more varied. Believe it or not, however, most industry associations have a fairly diverse constituency and often struggle to get members to agree to how to approach issues, what to prioritize with their political operations, where to concentrate their resources, etc. The same challenge will most definitely be faced by any pro-choice “association”, but the benefit that industry associations provide their members – political influence, shared knowledge base, leveraged legal representation, leveraged resources (particularly technology), a bigger messaging megaphone, volunteer recruitment and management – would be realized by women if a pro-choice association approach is taken.

Fixer-Upper Chapter 1: Housing Sits at the Intersection of Several Complex Systems

The first chapter of Fixer-Upper serves as a prelude to set up the rest of the book, but there are a few good takeaways. My favorite is the criteria Jenny Schuetz provides in “What does a well-functioning housing system look like?”:

  • Housing supply should be reasonably responsive to demand.
  • Within a metropolitan area some new housing should be added in the neighborhoods with highest demand, where people most want to live.
  • Markets should provide a diverse set of housing choices that match household budgets and preferences.
  • Regardless of income, all people can afford decent quality, stable housing in healthy communities.

Back to main Fixer Upper post.

Fixer-Upper Notes

In an effort to go beyond my normal “we have a housing crisis, not just an affordable housing crisis” rap, I read Fixer-Upper: How to Repair America’s Broken Housing Systems by Jenny Schuetz. I was interested in it because it looked like it would be prescriptive, not just descriptive in nature and I was not disappointed. The chapter headings pretty much tell the story:

  1. Housing Sits at the Intersection of Several Complex Systems
  2. Build More Homes Where People Want to Live
  3. Stop Building Homes in the Wrong Places
  4. Give Poor People Money
  5. Homeownership Should Be Only One Component of Household Wealth
  6. High-Quality Community Infrastructure is Expensive, but it Benefits Everyone
  7. Overcoming the Limits of Localism
  8. Build Political Coalitions around Better Policies

I’ll be doing a separate post on each chapter and as I do I’ll link to them from the list above. In the meantime you can see a presentation by Schuetz related to this over at Harvard’s Joint Center for Housing Studies’ website.

Unmeme 1

You know those memes you see on Facebook or other social media that asks you to do something and you know for a fact it’s just a way to gather data on you? Well, I decided to copy them on my old blog here and then give my own answer. I’m calling these Unmemes. Here’s the first:

Answer: Put the lid down

Simple, Powerful Messages

Last week I was on a panel with several other people to discuss some of the local housing challenges we’re facing in our part of the world right now. One of the other panelists, I’ll call him Mr. Smith, was someone who I’d worked with on housing related policies for the past 4+ years, and we’ve occasionally ended up on the opposite side of issues. We’ve never been in an argument, either one-on-one or in a group, but we have disagreed with each other on how to approach some issues that the groups we were involved with were addressing. So, while I don’t think Mr. Smith would think of me as his enemy, he probably thinks of me as his nemesis in certain situations.

Towards the end of the panel presentation we were talking about a new government-funded program that is being rolled out in response to the COVID-19 pandemic and that Mr. Smith’s department was responsible for creating and administering in one of our local cities. There are four local government’s that are crafting these types of programs and in my opinion Mr. Smith’s department had done as good a job as any in getting their program off the ground, and they’d done so in a very trying environment. I shared that opinion during the panel discussion, and honestly didn’t think much of it. It was my opinion, which may or may not be worth anything, but I’ve always felt that if someone does good work then you might as well say so.

The panel discussion happened at midday. Around four that afternoon I received an email from Mr. Smith that said, “Jon, Thank you for the kind words about the program. My staff and I really appreciate it. Have a good weekend and stay safe.”

That email made my week and it reminded me of the power of a simple “thank you”. It also reminded me that people always appreciate being appreciated especially when they do the kind of work that is invisible, or when it is visible, it is criticized. With that in mind please take a moment to recognize the folks who have made a positive contribution to our world – not only will it make their day, it will make yours too. And if someone does that for you, just remember to say “Thank you.”

*Quick note: I originally wrote this on my LinkedIn account. My apologies if I’ve bored you twice without notice.

Spirit of the Law? Hospitals Don’t Give a Fu%$

If you look under the “Categories” archive of this blog you’ll notice that over the years I’ve posted 52 times under “Health Care” and 71 times under “Healthcare.” Ignore the fact that I should have figured out a long time ago which one of those is correct; the point is that I care deeply about health care (healthcare?) and a primary reason for that is how much it has cost me and my family over the years.

I’ve spent my entire career working for very small companies or being self employed, and so I’ve never had access to what you’d call a “Cadillac” health insurance package. I’ve also been responsible for evaluating and choosing an insurance plan every year, whether for my own family when I was self-employed, or for my employer, for the last 25 years. To say that I’m sensitive to how much health care and health insurance cost would be the understatement of the century.

That’s why this story in the Wall Street Journal about hospitals using code to hide the pricing on their website. Here’s an excerpt:

Hospitals that have published their previously confidential prices to comply with a new federal rule have also blocked that information from web searches with special coding embedded on their websites, according to a Wall Street Journal examination.

The information must be disclosed under a federal rule aimed at making the $1 trillion sector more consumer friendly. But hundreds of hospitals embedded code in their websites that prevented Alphabet Inc.’s GOOG -1.24% Google and other search engines from displaying pages with the price lists, according to the Journal examination of more than 3,100 sites.

The code keeps pages from appearing in searches, such as those related to a hospital’s name and prices, computer-science experts said. The prices are often accessible other ways, such as through links that can require clicking through multiple layers of pages.

“It’s technically there, but good luck finding it,” said Chirag Shah, an associate professor at the University of Washington who studies human interactions with computers. “It’s one thing not to optimize your site for searchability, it’s another thing to tag it so it can’t be searched. It’s a clear indication of intentionality.”

Among websites where the Journal found the blocking code were those for some of the biggest U.S. healthcare systems and some of the largest hospitals in cities including New York and Philadelphia…Some regional systems also had such code on their websites, including Michigan’s Beaumont Health and Novant Health in Winston-Salem, N.C.

Lovely to see the system that has a hospital I can walk to, Novant, on the list.

Technically they’re complying with the rules, but in the same way that printing legal disclaimers in 2 point font would be. While that looks and smells bad, I think it would be a mistake to focus on the sliminess of this approach. In my mind it’s far more important to stay focused on how the continued efforts of the health care industrial complex to keep their pricing opaque, and their systems complex and antiquated, prevents any substantive system improvements from developing.

Years ago the insurance program we had was a Health Savings Account (HSA). The way it worked is that we set up an account kind of like an IRA with a bank. We contributed pre-tax dollars to it and it and then used those funds for any health care expenses. It was tied to a catastrophic insurance plan that featured a very high deductible and low premiums, so anything that wasn’t a major health event that would cost over $10,000 in a year we would pay out of pocket via the HSA. Sounds good in theory, but then you have to get an MRI and when you try to find out how much it will cost you find it next to impossible. As a result you pay $1,900 for a scan that took 30 minutes from parking the car to getting back in it, and find out later that you could have had the same procedure done a 10 minute drive away for much less.

That’s a true story, and in full transparency part of the problem was we were used to our old insurance system where we just went to wherever the doctor sent us without question because the insurance was gonna cover everything except our co-pay and deductible. It literally didn’t occur to us that we could ask, although we learned from this experience that we could.

I came away with a valuable insight after our year spent with the HSA and it was this: Our supposedly market-based health care system is lacking an important element – an informed and empowered consumer base. The complexity and opacity of our system virtually guarantees that it will be inefficient and provider-centric, which is great for the providers in the short term, but in the long term will make that bogeyman of “socialized medicine” look more and more appealing by comparison. If that happens they’ll have reaped what they sowed.

1NT: Roland the Farter

Good to know that at least one man in history has made a living via his flatulence:

Roland, court minstrel to 12th century English king Henry II, probably had many talents.

But history has recorded only one.

Referred to variously Rowland le Sarcere, Roland le Fartere, Roland le Petour, and Roland the Farter, Roland really had a single job in the court: Every Christmas, during the court’s riotous pageant, he performed a dance that ended with “one jump, one whistle, and one fart”, executed simultaneously.

For this, Roland was gifted a manor house in Hemingstone, Suffolk, and more than 100 acres of land.