Monday, December 30, 2013

A Good News Summary

This is simply the best! Cheerful, energetic presentation of lots of things that are going right!

Sunday, December 29, 2013

Some Predictions for 2014

It's that time of year, the time to make some predictions for the year coming up. So here are my predictions for 2014:
  1. Obamacare - 3/31/14 enrollment: 5MM private, 7.5MM Medicaid. Under 35s' signup: 30% or more. 2015 premium increase average: less than 5%. Effect of 7/1/14 Employer Mandate startup: modest/under 500,000 workers estimated to be dropped in 2015. Total people with employer-sponsored insurance - 2014 vs. 2013: no change, or slight increase. 9/1/14 Obamacare approval: 50%
  2. Debt Ceiling - GOP calls for negotiations. Obama refuses. GOP backs down, before we enter "full crisis mode".
  3. Immigration - Boehner allows a vote on the Senate bill, after primary deadlines passed. Bill passes and is signed into law by Labor Day.
  4. NSA Surveillance - President agrees to substantive changes to surveillance policy.
  5. Healthcare Costs - No excess cost growth (growth in excess of GDP per capita) for fifth year in a row. CBO further trims long term healthcare forecasts, but not quite enough to stabilize long term debt/GDP picture. Becomes clear that the ACA has significantly impacted healthcare costs, and if the trend continues, the US does not have a debt, or an entitlement problem.
  6. Global Warming - No legislation, but significant EPA action tightening up CO2 emission standards for existing and new utility plants.
  7. Economy - Strong growth - 3% or more for GDP. 10/1/14 unemployment: 6.5%. Inflation and interest rates stay low. Best developed economy's performance, matched only by Japan. Europe stays almost flat. China slows down to 5% growth. Austerity economics starts losing supporters.
  8. Iran - Agreement is reached to control and inspect Iran's nuclear program, upending the calculus for Middle East power dynamics.
  9. Syria - Peace agreement is reached, with Iran's help. Assad forced to step down. International peacekeepers put in place to oversea an unstable peace agreement.
  10. Obama Job Approval on 9/1/14 - 50%
  11. Senate Midterms - Dems hold the Senate.
  12. House Midterms - Dems pick up 5 seats.
A successful winter and spring for Obamacare is what underpins my political forecasts. Think the Iran deal will happen because both sides want an agreement. The Syria deal will happen, because Iran will help. The Sleeper: a possible Israeli-Palestinian peace deal.

A Profile in Courage

(from Nancy LeTourneau - "2013 Most Memorable Moments")

The above picture is of Antoinette Tuff who talked down a solo gunman with an AK-47 in a Georgia school this last August. I can't embed the video Nancy links to in her blog, so here's the link to the video. If you have the time, listen to it - an extraordinary profile in courage.

What do you hear? Here's what I hear:
  • Antoinette tells us she was terrified, though you can't sense this in the calm, strong-voiced way she tells her story.
  • She "anchors herself" in her sense of God, using the words of her preacher as guide. In other words, she directs her attention and energy to something strong and transcendent, leaving little room in her consciousness for fear or felt helplessness.
  • She also grounds herself in Love - for the 800 "babies" in the school.
  • The gunman is not the "enemy"; he is a sad and wounded soul. She shares her own story of despair and then recovery, telling him repeatedly that this same hope can be his too. Her words are not from some Emergency Procedures Manual. Nor are they a lecture. They come from her place of pain, felt very recently, so they ring true to the gunman. They are her words, but because they are "real", they are also his.
  • In this connection, they recognize each other as brother and sister.
Are you capable of such courage? Yes, if you -
  • are fully responsible for your emotions and where you choose to place your attention
  • love others and honor yourself
  • can embrace your own pain and also see it in others
  • can stop thinking and be present
Another "self-test", this one in poetic form, is the call to authenticity embedded in the following poem:


It doesn’t interest me if there is one God
or many gods.
I want to know if you belong or feel
If you know despair or can see it in others.
I want to know
if you are prepared to live in the world
with is harsh need
to change you. If you can look back
with firm eyes
saying this is where I stand. I want to know
if you know
how to melt into that fierce heat of living
falling toward
the center of your longing. I want to know
if you are willing
to live, day by day, with the consequence of love
and the bitter
unwanted passion of your sure defeat.

I have been told, in that fierce embrace, even
the gods speak of God.

By David Whyte

From Fire in the Earth

If you can live "in that fierce embrace", with true authenticity, you will always have the courage you need.

Tuesday, December 24, 2013

Perspectives on the Birth

(Rembrandt, Adoration of the Shepherds)

On Saturday, Ross Douthat (a writer with whom I rarely agree) put up a splendid column in the New York Times titled "Ideas from a Manger". I will quote from it at length:

PAUSE for a moment, in the last leg of your holiday shopping, to glance at one of the manger scenes you pass along the way. Cast your eyes across the shepherds and animals, the infant and the kings. Then try to see the scene this way: not just as a pious set-piece, but as a complete world picture — intimate, miniature and comprehensive.

Because that’s what the Christmas story really is — an entire worldview in a compact narrative, a depiction of how human beings relate to the universe and to one another. It’s about the vertical link between God and man — the angels, the star, the creator stooping to enter his creation. But it’s also about the horizontal relationships of society, because it locates transcendence in the ordinary, the commonplace, the low.

Many Americans still take everything: They accept the New Testament as factual, believe God came in the flesh, and endorse the creeds that explain how and why that happened. And then alongside traditional Christians, there are observant Jews and Muslims who believe the same God revealed himself directly in some other historical and binding form.

But this biblical world picture is increasingly losing market share to what you might call the spiritual world picture, which keeps the theological outlines suggested by the manger scene — the divine is active in human affairs, every person is precious in God’s sight — but doesn’t sweat the details.

Then, finally, there’s the secular world picture, relatively rare among the general public but dominant within the intelligentsia. This worldview keeps the horizontal message of the Christmas story but eliminates the vertical entirely. The stars and angels disappear: There is no God, no miracles, no incarnation. But the egalitarian message — the common person as the center of creation’s drama — remains intact, and with it the doctrines of liberty, fraternity and human rights.

Sunday, December 22, 2013

ACA is Reaching Solid Ground


Accelerating progress. If you go to, you can click back to prior forecasts, so you can get a sense of the acceleration factor. With 43.4% of the time between October 1 and March 31 elapsed, some states (with their own Exchanges and reporting systems) are just behind, right on, or ahead of pace for private insurance enrollments:
  • California - 397K enrollments, 29% of 1.3MM target
  • Colorado - 25K enrollments, 25% of target
  • Connecticut - 23K enrollments, 71% of target
  • Kentucky - 25K enrollments, 11% of target
  • Minnesota - 30K enrollments, 44% of target
  • New York - 117K enrollments, 54% of target
  • Vermont - 23K enrollments, 41% of target
  • Washington - 93K enrollments, 27% of target
My forecast has been: 5MM private, 7.5MM Medicaid. If the current pace continues, I could be low on both.

So what enrollment numbers would be generally acceptable to a broad range of the media? My guess is that any number below the 7MM private enrollment CBO forecast will be flagged as a miss by many in the media; though it's possible a "big win" in the Medicaid number would offset the miss narrative for all but the most conservative media. 9MM was the original Medicaid target, but that included all states: the 25 states not accepting the Medicaid expansion accounted for about half that forecast. So if Medicaid hits 8MM, which it might, that might offset a private forecast miss. Minimum private enrollment needed to record ACA a success in most major media? My guess: 5MM. And I think we'll hit that.

And how about the possibility of a premium "death spiral", caused by too few "young invincibles" signing up? This is the core conservative argument as to why Obamacare will "collapse of its own weight": the ACA, according to this argument, is based on a faulty model - the mandate penalties are too low to compel performance by the young, so they will not sign up and the program will eventually break down. The "death spiral" argument is, I am certain, groundless:
  • Larry Levitt et al., from the Kaiser Foundation, recently published a paper showing that very significant drops in the rate of under-35 signups, below the 40% target, would affect premiums only modestly.
  • Almost all analysts have missed the point (covered in Levitt's paper) that the risk pool combines Exchange signups with those continuing to buy non-group coverage off the Exchange, as long as those policies are ACA-compliant. All ACA-compliant policies sold on or off the Exchange form a single risk pool. In other words, every canceled policy that is converted to an ACA policy counts in the risk pool. I called Levitt last Friday to discuss this. He said that the off-Exchange, ACA-compliant policies could be 2MM early in 2014 and 4MM by year end. Since these folks most likely were reasonably recent entrants into the non group insurance market, and since they have been carefully screened to weed out health risks in the original application process, this 2-4MM group most likely represents a clear strengthening of the overall risk pool. 
  • There isn't much demographic data yet, but it looks like California and Kentucky are getting under-35 year old turnout that is reflective of this group's share of the state population as a whole.
And finally, what about the employer-sponsored insurance market? Any chance of a wholesale dumping of people into the Exchanges to avoid ACA-related problems? The Right is pushing this meme big time, saying we will see this as we approach the July 1 date when the delayed employer mandate kicks in. My response: Quite simply, it won't happen. Providing quality benefits is too important to employers to just give it up.

The ACA is reaching solid ground. It will not be derailed. Will the strengths of the program emerge before the November, 2014 elections? They might, and they might not. To some extent it will depend on how effectively Democratic candidates present the evidence. By 2016, I am confident the benefits of this bill will be understood and this will contribute to what I am certain will be a Republican shellacking.

Thursday, December 19, 2013

Why So Many Cannot See Obama

(Obama and Clinton just post-Benghazi)
Why can't people see this man? Nancy LeTourneau, aka Smartypants, has just completed a three-part blog series very ably addressing this question (Part I,  Part II, and Part III). She looks at three "lenses" that cloud the perception of many:
  • The Patriarchal Lens - The Daddy versus the Mommy Party. Independent, get-it-done, aggressive male versus communal, nurturing, working-in-support position female. Authority and hierarchy versus shared leadership and communion-in-circle-space. Dominator versus partnership as leadership models. Using this lens you can "see" Obama when he kills Bin Laden or clobbers Republicans by refusing to negotiate in a Government Shutdown; but most of the time he is simply "invisible". "Leading from behind" is utter nonsense to this lens or viewpoint. Multivariate but still linear Chess works for this lens; the more fluid, slow, emergent, intuitive game of Go is nearly impossible to master. Nuance and complexity must be eliminated. Paradoxes must be "solved" or fixed, never engaged as Teacher.
  • The Racial Lens - Few of us are able to acknowledge our Racial Lens; and because we can't, we endlessly generalize about the strengths and weaknesses of another ethnic group or race. We may even think we really like Blacks, or Asians, or Latinos, but as long as the ethnic character of the individual is what we see first, then we look through a Racial Lens. It's not a Person we see first; it's a Black....person. If we can admit to ourselves that we do wear, albeit unconsciously, a Racial Lens, we can then notice what generalizations spring unproven from this lens. The two Nancy points to are competence and luck. Obama is always demonstrating incompetence, or he's about to. And when a success is achieved, it's luck. There are a few people who credit the Syrian CW success with foresight and strategy (WaPo's David Ignatius), but only a few. And watch closely as the ACA proves to be a huge success over the next three years, and the evidence becomes incontestable that the Healthcare delivery system has undergone a transformation, due to the ACA; that the cost curve has been bent, and we no longer have an entitlement or debt problem in this country. The GOP will have enormous trouble seeing this because it would require both Obama and the Government to be judged as "competent", and the scale of the system change is simply too large to call it "luck".
  • The Cultural Lens - Traditional media are in the process of splintering and transforming. Truth has lost its luster in the mass media. Ratings, polls and profits rule. Our media has become as polarized as our politics - each contributing to the developing extremism of the other. There are no wise men any more; no true arbiters; no revered institution seen to be "objective", above the fray. Even science has lost its credibility. Everything is up for questioning. All we can possibly tell for sure is who won and who lost; and even that is subject to question. The story with the strongest link bait - the explosive, possibly prurient innuendo that calls us back, like addicts, to the conversation - is the story that carries the day. This is a strange new world, where street fighters and celebrities are the ones talked about and admired; where our attention span has shrunk to nearly zero; and where the sensationalism has dulled our senses and we yearn for larger and bloodier spectacles. If we put this lens on, we will never pick up or see this man Obama, the long game player, the "no drama Obama", who leads from behind, is relentlessly decent and kind, and never strikes out in anger.

Wednesday, December 18, 2013

The Medicaid Tragedy

The following charts are all taken from a Kaiser Family Foundation report on The Coverage Gap, outlining state-by-state (all 25 are GOP-controlled states) how 4.8 million at or below the Federal Poverty Level ($11,490 for a single person) will be denied healthcare coverage that residents of other states will be getting, starting in 2014. This all makes me a bit angry and a bit ill.

In reading the KFF report, I found out some things about Medicaid I hadn't known:
  • Did you know that adults without children have not (up until the ACA) been able to get Medicaid?
  • Did you know that in the 25 red states the cutoff point for getting Medicaid is one half what it is in the mostly blue states? In other words, if you earn more than 48% of the FPL, you are cut off?
Take a look. The Medicaid-expanding states will provide Medicaid for everyone, including adults without children, up to 138% of FPL. In the 25 red states, nothing. Medicaid will remain available only for parents and only up to 47% of FPL. A bloody tragedy, to my mind.

In the pre-ACA system, all states had gaps (shown by the people in grey and areas without a solid colored umbrella). Poor adults without children were not covered. In red states, you were thrown off Medicaid if your earnings went above a certain number. The ACA fixed all that: everyone under 138% FPL was covered. And the Feds would carry the full load for three years, with the states picking up 10% in 2020. Red states not accepting the Medicaid expansion are leaving large numbers of their citizens uncovered, where folks in other states, at similar income levels, will be getting full coverage under Medicaid.

Look at Texas: over 1 million people who qualify for coverage under the terms of the ACA will be out in the cold, while the poor in neighboring states will be covered. A travesty, which I hope will not be allowed to stand for long.

The chart below shows the small percentage of poor that get coverage in the non-expansion-accepting red states. Wisconsin has put through legislation that replaces Medicaid with a state program, thus providing coverage to all the poor.

The waste of this makes me weep. And the downright meanness.

A Large Gender Gap

(from Gerald Seib at The Wall Street Journal)

Gerald Seib put these numbers up in his column this morning at the WSJ. He dug into the cross tabs from the most recent WSJ/NBC poll. True, this is just a one shot/one moment in time look, but the differences between the men and women is remarkable.

Much better marks for Obama among women. Pro-gun control. Pro-minimum wage increase. Eager for Dems to retake control of the House. More supportive of the ACA. Angry at Republicans for the shutdown. Wow! 

What might move men in a positive direction?
  • Strong enrollment for Obamacare by March 31 - 5 million private insurance and 6-8 million Medicaid (Likely)
  • GOP hostage-taking on the coming debt ceiling raise (Unlikely)
  • Immigration reform (Possible, but not yet likely)
  • Accelerating growth in GDP and employment (Likely)
  • An agreement with Iran (Possible, but not yet likely)
It's possible they all could happen. If so, the GOP will lose the House.

Tuesday, December 17, 2013

Andrew Sullivan at His Best


Ron Fournier is out with another sweeping hit on President Obama at The National Journal titled "This is the End of the Presidency", where he compares Obama's evolving second term to Bush II's. I will let Andrew Sullivan at The Dish do the rebuttal for me. Listen to Sullivan at his hard-hitting best:
All these critical, central facts for the last five years do not fit anywhere in Fournier’s analysis. And the truth is: nothing this president has done compares even faintly with the damage wrought by his predecessor. Bush exploded the deficit in a time of growth; Obama has cut it dramatically in a time of near-depression. Bush gave us two disastrous wars; Obama has largely ended both, and set in process diplomatic initiatives in Syria, Iran and Israel-Palestine that, if successful, can defuse potential new ones. Obama has tackled a huge domestic problem – the accessibility and cost of healthcare – which Bush allowed to fester and on which the current GOP has no policies except a return to the disastrous status quo ante. Bush initiated the first ever American-run program of torture of prisoners. Obama ended it. Bush presided over the worst breach of national security since Pearl Harbor. Obama killed Osama bin Laden and decimated his forces on the ground in Afghanistan and Pakistan. Bush presided over the total collapse of the free market system in the US; Obama has painstakingly rebuilt it.

I am making some progress in not contracting angrily around these lopsided attacks, but I have a long way yet to go, and I am helped mightily by the writings of seriously articulate warriors like Sullivan.

Monday, December 16, 2013

This is Why We Care

This is an amazing story told by Billy Baker, a reporter at the Boston Globe, in his multiple tweet story at Be sure to click into page 2, because at the end of that thread you will learn that George, the younger of the two food-stamp Vietnamese brothers, was, at 5pm today, accepted, early decision, into Yale.

This is why we care. This is why America is still the land of possibility.

This story is gorgeous, unbelievable, absolutely believable, and real.

Know that helping folks grow, supporting them in finding the power and genius that is within all of us, each with his or her own special forming and signature - this is what matters. This is where Joy is sourced!

Sunday, December 15, 2013

Deep Currents, Surface Storms - Immigration

I am starting to get excited. When the Ryan-Murray budget compromise went through the House with a commanding bipartisan majority, I knew this could be an opening for Immigration reform, but most of me thought this might be just a one time thing, and that the Hard Right would quickly  reclaim control of the House agenda. Now I'm not so sure. Smartypants kind of woke me up to the new possibilities, starting with this clip from Speaker Boehner's small but powerful rant:

Smartypants thinks something has shifted. She came back to it today. She thinks the GOP generally thinks it's in the Party's interest to pass Immigration reform, and because of the "shift", Speaker Boehner will allow a vote, despite Tea Party objections.

I think (and very much hope) she's right.

But what caused the shift? Why did Boehner stick with the Tea Party during the shutdown and not now? Shifts happen beneath the surface. What current caused the change? Here's my guess:
  • Obama didn't back down in the shutdown. The GOP strategy was based on the felt certainty that he would cave, and Republicans would get something "juicy" for their efforts - a delay in the individual mandate was the prime target.
  • Obama's "long game" had him flexible in negotiations, until the $4 trillion deficit reduction target was hit (which it was with the sequester); required that he hold firm on the debt ceiling (or, as it turned out, on Obamacare), and watch the GOP juggernaut crack in two when Defense hawks wanted to move off the sequester, and Leadership knew only a mini-deal would work, because they could not shut down - the President wouldn't budge in a shutdown.
GOP leadership has taken a shutdown off the table due to how effectively Obama has played his hand. Without a shutdown threat, there is nothing in the Hard Right's agenda that they have any real chance of advancing. So we either do things on a bipartisan basis, or we do nothing. I predict that Boehner will not go back to ceremonial votes, where all the GOP vote for something (like repealing Obamacare) and none of the Democrats do. He might on minor, symbolic stuff. But on big, visible, important stuff, I predict he won't.

So if he feels it's important to the GOP that they allow a vote on Immigration, he will. And it will pass on a bipartisan basis.

And the positive ripple effects through this country will be HUGE!

Saturday, December 14, 2013

Deep Currents, Surface Storms - International

(Obama's Cairo Speech, January, 2009)

We have looked at some key characteristics of the integral leader:
  • Sees the Deep Currents (what is trying to emerge) and experiences, but is not distracted by the Surface Storms (the often chaotic, what-is-happening-right-now, who's up-who's down level of action).
  • Leads from Behind most of the time. Sets the vision and a few key organizational goals or "attractors" that invite both high-performing teams and entire complex systems to self-organize in support of causing the vision to emerge.
  • Listens deeply, to what people and events are wanting to say.
  • Knows how to put aside his/her personal lenses in order to look clearly at what is arising.
Today I want to add one more quality of the integral leader - the ability to plant "seeds of possibility" and the patience to wait for what may emerge.

That's what Obama did in Cairo, in January 2009: he planted "seeds of possibility" that are beginning to grow and bear fruit. Let me give some highlights, which will include other "seed planting" fruit growing; in other words, Obama planted seeds in many places, not only in Cairo:

  • The Arab Spring would surely have happened at some point anyway, but I am certain our President's words that day in Cairo gave a great many people a sense of "Something is changing; now is the time to grow and transform." The result is not (at least not yet) the tolerant democratic governance we would have hoped; but wasn't it likely that the initial revolutionary surge would first bring in a different (i.e., Islamist) form of authoritarian structure, before democracy could grow?
  • The emerging conversation with Iran surely took its very early energy from the principles outlined in this speech: the US does not want to control any Muslim countries; I/we have deep respect for Islam; we/the US has sometimes made mistakes; and we want to work with all of you to build a new, safer, more peaceful, more exciting future. This was offered as a new beginning. And then there was Obama's fiercely criticized restraint during Iran's Green Movement after the "stolen elections". Had Obama intervened in any real way, I am sure we would not be in serious talks right now. Remember, from Iran's perspective, we had invaded Iraq to their West and Afghanistan to their North; we had declared them part of the Axis of Evil; we had a Presidential candidate singing "Bomb, bomb, bomb Iran." Why in the world wouldn't they be on guard? So the seeds were planted in early 2009; but it was Obama's patience and consistency that have allowed these seeds to emerge from the earth and begin to grow into the light. It's a long way from a done deal; but the seeds were planted and the gardener is patient.
  • How about the partnership with Russia to eliminate Syria's chemical weapons? Do you think Russia would have stepped forward to work with us, if the seeds had not been well planted years before with the new START treaty? Even though our relations with Russia have often been bumpy, Putin believed in Obama's commitment to reducing the world's supply of WMD, through the START treaty and through our patient building of the Iran sanctions program. And he knew that this President, unlike George W. Bush, was not trigger happy: he had withdrawn US troops from Iraq and was in the process of doing so from Afghanistan. People think the Syria move was a huge blunder and the CW deal was an accident. They're wrong. Deweaponizing Syria's CW with Russia's help was always the first choice. And do you really think Iran would be at the table now if we had bombed Syria?
  • And how about the seeds planted in starting discussions on the TransPacificPartnership and the more recent Trans-Atlantic Trade and Investment Partnership negotiations. It looks like Congress will grant the President fast-track negotiating powers, which means these agreements should be completed by mid-2014. Liberals hate these deals (can cost jobs, grants special powers to large corporations, sometimes weakens worker protections); but these deals will go through. Japan is now fully engaged in the TPP discussions; and I predict that before 2014 is out, China will want in. One of the key elements of these big trade agreements is that they provide multiple venues for resolving disputes. I suspect that the new TPP may give a structure and a space for peacefully resolving some of the East Pacific territorial disputes. Both the TTP and the TTIP are important deals, helping to bind the world together into a more connected system; but, in my view, the TTP has the ability to play an outsized role in bringing China more fully "into the fold".
In some ways, Obama's work in the international domain doesn't fit quite as neatly into the Deep Currents, Surface Storms metaphor and analysis. But key elements are there. And for certain, the media is essentially blind to the deep currents beyond our borders. They are endlessly distracted by our distractions. I will close this piece by saying I feel the world is becoming a safer place: the big, powerful countries are less and less likely to go to war with each other; and weapons of mass destruction have a reasonable to good chance of being curbed in the coming year.

One more note from the past and pointer towards a possible future: have you noticed that the Global War on Terror is over - we have specific adversaries but no existential threat; and what would you say if Israel and the Palestinians made peace before 2016?

Hopeful - that's the stance I am taking in the world. And much of the source of it for me is the extraordinary integral leadership our President is offering us. Bravo, Sir. And our gratitude.

Friday, December 13, 2013

Making Progress


I'll stick with my December 2 forecast:

  • Private - 5.0 million
  • Medicaid - 7.5 million
Can't wait until April, when we will know these numbers. We'll also have a better feel for the numbers of folks who feel they ended up losers. For example, if 5.0 million policies get cancelled, how many of that number, at the end of the day, feel they were, in some way, ripped off? I'm guessing only 20%, still a lot of people, but way less than 12.5 million.

Also want to know how many under 35s' will have signed up for private insurance, and whether folks are saying the pool appears balanced. I'm pretty confident it will be.

By April, millions upon millions of Americans will know Obamacare is here to stay! The Right won't acknowledge it. But the next job for Progressives will not be to bad mouth the Right; rather it will be the important job of making the big case for the cost curve being bent, and how this solidifies the country's fiscal sustainability.

Deep Currents, Surface Storms - Budget

The Budget Wars are over! Which side won?

Can you see how the win/lose frame keeps us tied to the surface, stuck in the storms and unable to discern the deeper currents?

One way to approach this problem is to engage both dimensions, both levels of the question:
  • The  surface question is "Who won?" Most would say the President and the Democrats eked out a slight margin of victory, though many would disagree. Here's Paul Krugman in today's New York Times lamenting the failure to extend unemployment compensation. Here's Andrew Stiles in this morning's NRO with his article "Score One for Boehner".
  • The deep currents question,  as always, is "What's really going on? What's trying to emerge?" The answers at this level will not reveal themselves if you are committed to wearing a particular set of lenses, generally of a partisan nature.
So let me try to work on the deep current question - What's emerging? What patterns can we see, if we clear the lenses of perception? Here's what I think is happening at a deep currents level:
  • Budget cutting is over.  Budgets are not going to go any lower than the August, 2011, Budget Control Act sequester levels. That's the level we have just moved up from. In the BCA negotiations, Obama insisted that the sequester should affect Defense and Non-Defense equally, and that entitlements should not be touched. Obama knew GOP hawks would eventually cry "Uncle" due to the serious Defense cuts, especially in year two of the sequester, beginning in 2014. They did exactly that and the result is the Ryan-Murray deal, raising Defense and Non-Defense Discretionary $67 billion over the next two years. The BCA is probably the last budget cutting act we'll see for a long time: it set the principle that Defense and Non-Defense must be treated equally, and GOP hawks will not allow further Defense cut backs.
  • No more shutdowns. The GOP was badly clobbered on the shutdown. They were convinced Obama would fold. He didn't. They had to cave and got nothing for their efforts. They will not go here again for a long time. This forces them to change their negotiating tactics, putting compromise back into the discussions. This infuriates the Tea Party wing of the party.
  • Entitlements will not be cut without new tax revenue. And therefore they won't be cut. This is the very big deal that Obama's failed negotiations with Boehner, followed by the August, 2011 BCA,  accomplished. The President demonstrated a willingness to cut entitlements in exchange for new tax revenues from closing loopholes. Hard liberals called this the "Grand Betrayal", as opposed to the "Grand Bargain". But Boehner walked away from the deal. Now (as in the current Ryan-Murray deal) it is accepted that entitlement cuts must be matched by new tax revenues. Obama really was willing to trim entitlements, but it looks like the GOP has lost their chance, at least while a Democrat is President and as long as they are completely opposed to raising taxes.
  • A "common sense caucus" in the House is now visible. The vote in the House last night on the Ryan-Murray bill was 332-94, with 169 Republicans joining 163 Democrats to pass the bill. Hard conservatives mustered only 62 votes in opposition, joined by 32 liberal Democrats, who were upset that Unemployment Insurance was not extended. Could this mark a sea-change? Has the GOP phalanx, which appeared  solid until now, been broken? Will a real, continuing civil war play itself out within the GOP, with all of our eyes upon it? Might something like this allow Immigration to pass? Red State's Erick Erickson, a hard conservative and fierce "Amnesty" opponent, is certainly afraid it might. I'm not forecasting yet; but I personally feel a new sense of optimism and possibility around Immigration reform.
How did this happen? How did Conservatives allow themselves to be backed into the corner they are in, with the Party possibly split, Budget cuts off the table, entitlement cuts not possible without new taxes, and the Speaker possibly getting ready to bring up Immigration reform? How in the world did all this transpire?

Thursday, December 12, 2013

Deep Currents, Surface Storms - Healthcare (3)

So what does an Integral Leader do exquisitely well that allows him/her to distinguish the surface storm from the deeper current or purpose? He listens. It's hard to describe this deep listening that is the foundation of the integral leader's personal power. You the reader need to reach into your personal experience for a time, a moment when you felt totally seen, totally heard - as if the person listening to you was offering you a safe, even sacred space in which to be heard.

If you can remember a time you were listened to that way, can you also find a moment in your past when you listened to someone else that way? What was present for you? What thoughts or feelings were active? And if your experience was authentic deep listening, then you probably felt an interior quiet, an absence of thought, and a presence of deep caring, even love.

This is what is present in the picture above: the President is listening deeply to Aung San Suu Kyi. And remember that she is an integral leader as well; so she knows deep listening when she experiences it; and she gives it right back. Teachers of this deep listening practice will tell you that "We listen each other into speech." Ego, anxiety, even plans simply disappear. If we can trust, we simply relax, enter the flow, and are inevitably surprised by what we say.

What does this have to do with Deep Currents, Surface Storms, or Leading from Behind, or Healthcare? Let me try to explain.

What happens in deep listening is the leader puts her ego off to the side. We don't try to command the ego to go away; we just quietly ask it to stand a bit over to the side. It's present and available, if needed; but it's not running the show. The ego is the part of ourselves that attaches to things - positions, ideas, possessions, people, emotions, anything. And whatever we are attached to, that we can no longer see clearly. To see the deeper currents, to pick up on what is trying to emerge, you have to let go of your attachment to any particular outcome, to your being right, to "your side winning". In deep listening we let go of attachments and let what wants to arise, arise. If we are not attached, if we have cleared our lenses of perception, then we can see what is really present. This is how the integral leader can consistently see the deep currents, can decipher what is really happening underneath all the strum und drang. And the storms don't bother him; he maintains a quiet center. It's the ego that seeks and is constantly caught in the surface storms and distractions.

The same qualities of non-attachment allows the integral leader to lead happily from behind. Non-attachment does not mean indifference, apathy, or separation. You will care deeply about your commitment, but you don't grasp it. You have a preference for an outcome, but you will be content with what arises.

So what does the integral leader do when he wants to see a universal healthcare plan come into the world, one that will alter one-sixth of the world's largest economy?
  • First, he articulates the vision in clear and tangible ways. "Put a man on the moon by the end of the decade." JFK to the American people, declaring a vision in a way that makes it real, and what's left for the people to do is to "fill in the gaps".
  • Second, she listens deeply and continuously for what her friends, her enemies, and the world is trying to say. And then she moves the conversation forward from the grand, singular vision, to a few guidelines, principles and metrics - Universal coverage; $1 trillion in cost; Budget neutral; Bend the cost curve.
  • When agreement is reached by the team, step back; lead from behind. Let the team (in this case, staff and legislators) "fill in the gaps", do the day to day work, write the legislation, negotiate its mark ups and the language compromises until final passage. The integral leader's job is to guard the space, protect the team, and to always ensure that the guiding principles are adhered to.
The team so organized and listened into existence becomes a high performing team - extraordinary in its creativity, its resilience, and its perseverance. Teams like this ultimately resurrect several times during a dream-building project. After a while, team members are certain that they can literally walk on water. And the dream emerges. Anyone of you who has worked on a high performing team, one which could walk through walls and on the water, and could come back to life more than once, after having been declared dead - you know what I'm talking about. And in my experience an integral leader is the one most likely to be able to nurture and help manifest such a team.

As to the long term healthcare cost curve bending down, the fact that this is happening, is due to numerous provisions in the ACA, and it follows a similar dynamic. The way to affect and change a complex system is through adjustments to its identity, relationships, and information distribution. The ACA directly and indirectly gave the healthcare industry a new mission: move away from fee for service; pay for quality not quantity; find a way to reward providers helping patients stay healthy and not use the system; convert the entire system to Electronic Medical Records. In other words, initiate a healthcare delivery productivity revolution, so costs can come down long term. The bill has suggestions on how to do this, but it does not mandate a particular path. The idea was to provide a testing mechanism and a way to effectively scale up from good tests, and call on the creativity of the industry to find ways to organize themselves so as to meet the guiding principles and deliver long term cost restraint.

Nobody knows in advance how to do this thing. So set up goals, key objectives, and some new incentives, and let the system take off and begin to self organize in a creative movement towards the stated "attractors" or objectives. Don't overmanage. Set the vision, and some specific processes, metrics and incentives, and step back. And it's working.

This is how an integral leader leads. She can do this because ego is not the driver. It's the vision. And the people the vision is intended to serve. And the emerging high-powered team that is doing the initial work.

All of this starts with a leader who can listen others into speech.

Wednesday, December 11, 2013

Deep Currents, Surface Storms - Healthcare (2)

(CBO Monthly Budget Report)

The above chart presents some great news: combined Medicare/Medicaid spending for the first two months of F2014 (October-November) is down 2% from F2013 levels. This continues the trend pointed to in this chart from the Council of Economic Advisers' recent report on how the ACA is helping to moderate healthcare costs.

Medicare and Medicaid costs are flatlining. As the chart above shows, costs per capita are flat for Medicare and down for Medicaid since 2010, when the ACA was launched. In point of fact, on a gross basis (overall year to year spending comparisons), they are flat as well, meaning that the cost slowdown thus far has been able to absorb the demographic increase in enrollees, due to the retiring of the Baby Boomers, without increasing spending. The October-November F2014 numbers above show this trend is continuing.

Monday, December 9, 2013

Deep Currents, Surface Storms - Healthcare

Until very recently, it seemed that Storms is all we could see or hear in the Healthcare fight. Skies are clearing a bit now, with the website working, but the forecast seems to say - Expect More Storms.

What's going on at a deeper level, the level of the Deep Currents? To get into that domain, let me pose some questions. Try to answer them for yourself, and then I will give you my answers, which are obviously not yet provably true. They are my Deep Current Forecasts - what is really going to happen in 6 months to a years time:
  • By October 1, 2014, how many enrollees will we have (private, Medicaid)?
  • What's the forecast for private and Medicaid enrollees at the end of 2015?
  • What percent of the private enrollees will be under '35? Will this be enough for experts to label the risk pool stable?
  • How much will 2015 Exchange premiums increase over 2014 levels?
  • What does market research (if conducted) show is the percentage of folks (whose 2013 policies were cancelled) that think they ended up with a bad deal?
  • Has employer-sponsored insurance in 2014 (total employees covered) moved up, down, or stayed the same, relative to 2013 levels?
  • What's the forecast for employer-sponsored insurance in 2015?
  • What percent of people covered under Obamacare are experiencing access or other quality problems (access to specific doctors or hospitals) and conclude the healthcare system has deteriorated?
  • Do a majority of people label Obamacare a success, a failure, or say it's too soon to tell?
  • Did healthcare cost growth remain moderate in 2014? What's the forward forecast?

Sunday, December 8, 2013

Deep Currents, Surface Storms


Deep Currents, Surface Storms. This is a big topic that I will be returning to in coming days and weeks. I will just introduce it today in broad brush fashion.

Politics and punditry operate at the surface. Storms, like summer squalls on a mountain lake, swoop in, blow fiercely, then are gone. We often cannot see or tell what is going on beneath the surface; we cannot discern the direction or even the existence of the deep currents. We intuit they are there, and also suspect they may be the most important things to watch; but the cotton candy and drama constantly pull us away. They distract us, sometimes absolutely.

An integral leader, which Obama is, does not get distracted. He or she knows what is happening on the surface, in front of our eyes, and also what are the directions of the deeper currents. They know, or at least suspect, what is trying to emerge. They work with values and vision and identity, knowing that complex systems always tend to self-organize, moving in the direction of their vision, their yearning, their identity. Chaos science calls these strange attractors - a kind of 3 dimensional pattern, or basin in the universe that a chaotic system will limit or coordinate its movements, in order to honor the pattern. The new sciences tell us that chaotic, complex systems are very difficult to manage; but they can be influenced, steered, possibly, through three key system variables: identity, information, and relationships. Work with these effectively, and the most complex system can begin to self-organize, moving towards its agreed upon identity, its chosen North Star.

This is how Obama works. Some call it his Long Game. I call it that, plus I say he is working with the  Deep Currents, mostly ignoring the Surface Storms.

Over the next few weeks, I want to look in six key areas to see how the President has worked initially to influence the self-identity of the emerging conversation and policy, and then has mostly pulled back to let the system self-organize, reentering the emerging conversation when needed:

  • Healthcare - 
  • Budgets: Deficits and Debt -
  • Syria and Iran -
  • Immigration -
  • Financial Regulation -
  • Democrats vs. GOP -
You might want to say that this will be a multi-part essay on Leading from Behind, which is the way an Integral Leader leads, at least most of the time. And you would not be wrong.

Do You Know Your Own Light?

(from @ucobudo)

Don't you 
know yet?

It's your light 
that lights the world.


This idea is very hard for those of us raised in the West. The sin/sinner idea is hard to shake. But Jesus did say:

"If thine eye be single, thy whole body shall be full of light."
Matthew 6 (22)

and He said:

"Ye are the light of the world. A city that is set on a hill cannot be hid."
Matthew 5 (14)

Am I that tree in full flower under the stars?

A Masters' Class in Both/And

I continually make the argument that Obama is an integral leader. This is a new concept for many of you, and I have decided not to write a long concept paper backgrounding and explaining this idea; rather when a particular situation, event or story seems to me to bring out integral leadership qualities, I try to point them out and include a brief explanation.

In the above video, Obama is answering very good questions, asked by a very smart facilitator, in front of a very smart audience: Haim Saban is the questioner; the setting is the Saban Center for Middle East Policy of the Brookings Institute; the venue is the December 6-8, 2013 Saban Forum on US-Israeli Relations in a Dynamic Middle East; the speakers included the President, Secretary Kerry and Israeli Prime Minister Netanyahu; the audience - scholars, academics, Israeli politicians and press; the topics - the Nuclear Deal with Iran and Israeli-Palestinian Peace Negotiations.

The Iranian question, particularly now that Netanyahu has called the interim deal "an historic mistake", is prone to black/white, either/or conversations, interpretations, and positions. So is the question of an Israeli-Palestinian two state peace agreement. Almost no difficult problems are ever resolved with this level of thinking.  "If I win, then you must lose" thinking and negotiating is always a power game: the winner wins by defeating the loser, or by convincing them that they will be defeated - so why not surrender now. When dealing with an enemy - declared and agreed to by both sides, most modern and very smart leaders stay with win/lose, either/or thinking. These leaders might be good at win/win negotiations in certain situations; but with a categorized and labeled enemy, this seems too dangerous, and we rely entirely on black/white. either/or.

An integral thinker always thinks in a both/and frame. That doesn't mean they can't take decisive action - this is the mistake the GOP made in the shutdown: they thought Obama would cave and negotiate, because that's what he always seemed to have done. The President didn't blink; the GOP were clobbered. An integral thinker and leader can act decisively, and does so with deep conviction and confidence; just because he or she looks at every situation initially as both/and, does not mean a time won't come when the and disappears, and decisive action is taken.

Watch the video. Try to notice all the ways the President demonstrates both/and thinking. And remember: Congress and Conservatives are going nuts that Obama is abandoning Israel, and folks in the press are just waiting to pounce. And remember that Bibi is soon to be up on the stage as well. Here are just a few both/ands that I will point to:
  • He criticizes his opponents' frame for the discussion as a choice between We Get Everything We Want/Iran Gets Nothing and War ("other options"). He says he would love it if those were the true alternatives; but they aren't. Iran is not going to give up everything and say the US and Israel are right. The 6 month freeze to test if a deal can be made is a real option that Iran will consider; which is why we have a preliminary agreement.
  • He counters the "Iran is always our enemy; the shift from Ahmadinejad to Rouhani means nothing" camp by quite gently making the case that even nations can change; that the election of Rouhani is not absolutely, yes or no a sea change in Iranian politics; but we lose little by testing to see whether it might be a change -if they might really be ready to rejoin the world as a normal participant.
  • He is pushed a couple of times to criticize Netanyahu, to draw lines between their positions. He doesn't do it; he keeps repeating that he has been in  regular communication with the Israeli PM, that each leader shares the very same commitment to Israel's security, and that their differences are tactical, not fundamental. We are inseparable friends; AND we disagree here on the tactics of dealing with Iran.
  • In the discussion on Israeli-Palestinian peace negotiations, when faced with the problem of Gaza and Hamas - their unwillingness to come to the peace table - a problem which means "end of the line" to an either/or thinker, Obama goes both/and again - "We might have to do this in stages, where the deal is reached with the West Bank first, and then the youth in Gaza, seeing all the benefits and powerful economic growth happening in the West Bank,  will require their leaders to get the same deal for them." (or words to that effect).
Find your own examples. They show up in almost every answer the President makes. An astounding performance. This is not Munich-think/speak. This is what Jesus called us to be, peacemakers - developed enough to hold the contradictions and opposites gracefully, to create the safe spaces where the different parties to a conflict feel recognized and seen, and where they can talk together, in a mutual effort to find common ground.

"Blessed are the peacemakers, for they shall be called the children of God."
Matthew 5 (9)

Like Gandhi, King and Mandela, our President is a peacemaker.

Saturday, December 7, 2013

Mourning Mandela

(from @3ChicsPolitico)

Today, outside Mandela's home. As @3ChicsPolitico says, the fruits of his labor.



This knocks me over. Strong. Clear. Fully grounded. Inspiring. Full of Light. Generative.

If these are qualities you admire and are touched by, be sure to visit every day! TOD's site reminds me of a favorite quote, from a book I read 50 years ago:

"The lover of beauty finds it everywhere around him. The vein of gold in the basest of ores. And he takes the collector's joy in finding the fragmentary masterpiece that is commonly passed by."

Memoirs of Hadrian
by Marguerite Yourcenar

TOD is a lover of beauty. And she has deeply enriched my life by finding a great many fragmentary masterpieces I would never have found or seen.

Friday, December 6, 2013

Maya Angelou Celebrates Mandela

Watch this. Extraordinary.

Budget Aikido

Not many people understand the game - the long game - of Budget Aikido that President Obama has been playing. It's not easy to describe. Let's start with some highlights:
  • Obama decided early that he had to support deficit reduction in a smart, but aggressive way to absorb, transform and redirect the quite hysterical energy the GOP was channeling on deficit worry and fear of debt collapse. This is the essential aikido method: absorb and transform the energy of your opponent so that, in essence, he defeats himself.
  • Obama commissioned Simpson-Bowles in early 2010 to come up with a deficit reduction plan. The plan was released on December 1, 2010, and called for $4 trillion in deficit reduction over 10 years (combination of budget cuts and new tax revenues).
  • Obama was mostly mum on the Commission's report, saying later that he needed a negotiating partner to work out a deal. But in an April speech, he fully accepted the target of $4 trillion. And in early summer, he began his negotiations with Speaker Boehner, working to put together a tax and spending deal, totaling $4 trillion over 10 years. The deal failed, after seemingly coming very close to agreement.
  • The Budget Control Act followed the failed negotiations, running right up to the debt ceiling deadline before the bill was signed. The BCA put budget caps on discretionary spending, and set up a $1.2 trillion ten year sequester program, to start in January of 2012 (later moved to March 1, 2012), if a Budget Supercomittee failed to reach agreement on a similar sized deficit deal. The Supercommittee, predictably, failed to reach agreement.
  • Both Defense and Non-Defense Discretionary budgets would suffer across-the-board cuts, beginning in 2013, as compared to the CBO baseline. In the first two years, the cuts would be year to year reductions; after that each category would rise, but stay well under the Baseline. Non-Defense took almost the total year-over-year drop in 2013; but Defense was set up to drop over two years - about $20 billion a year. And that brings us to the current problem. Both sides yelled and screamed last year (i.e., Democrats looking to Non-Defense Discretionary and GOP (especially the hawks) looking to Defense). But this year Dems lose little; GOP/Defense loses $20 billion. So GOP hawks are more concerned than Dems; meanwhile Tea Party Conservatives don't want to budge off the sequester levels, counting this their single big win over Obama.

Thursday, December 5, 2013

Obamacare Enrollment Update


The pace is picking up!

ACA's Cost Control Protects Medicare

(from Council of Economic Advisers Analysis of ACA)

Conservatives attack Obamacare for creating a large group of injured parties - those people whose policies are being cancelled; who are being told they have to buy an ACA-approved Essential Benefits policy (even though they don't personally need all the benefits offered); and who have to pay more than before, so they can be counted as part of a large and balanced risk pool that will benefit the sick and the elderly. Many hurt; few helped - this seems to be the argument.

What few realize is that the cost curve-bending effects of the ACA is having a dramatic effect on two programs (Medicare and Medicaid) that benefit 100 million Americans, a much larger group than the 5 million or so who may be losing their current policies.

The above chart shows how the Medicare/Medicaid spending projection line has moved down and to the right in the last three years. The above graph lines were put together by the CBO in their four most recent 10 year budget forecasts. The "gap" between the August 2010 and the May 2013 lines represents reductions in estimates of what the Medicare/Medicaid programs will cost going forward. The next chart (CBO/Doug Elmendorf ACA Cost Control Presentation) shows the magnitude of the savings.

Wednesday, December 4, 2013

Healthcare Costs (Again)

(from Council of Economic Advisers Report)

I'm a real bear about healthcare costs. I read whatever I can find. You will find me blogging about this repeatedly. Why am I so obsessed? Quite simply: almost no one gets the full implications of what's happening. Here's a Tuesday New York Times article that talks about the cost slowdown and how it will lower ACA's total cost; but the explanation for the slowdown is primarily the impact of the recession, slowing down demand for medical services. And the article quotes a conservative source saying there is no cost slowdown, and talk of such is just another piece of the Administration's misinformation campaign.

So I was really happy when the Council of Economic Advisers put out the above report, doing a thorough presentation of the academic research on the healthcare cost slowdown, showing that one group (The Kaiser Family Foundation) argues that the recession is the primary cause; but other researchers have concluded that structural factors are at play, representing a possible seismic shift in how healthcare is delivered, moving from payment only for quantity of service, to more payment for quality delivered (see particularly CBO Working Paper, August, 2013).

Monday, December 2, 2013

CBO's ACA Enrollment Forecast and Current Status

(from CBO Enrollment Forecast)

The above chart is the "holy grail" CBO forecast for Obamacare. Key points:

  • In 2014, 9 million will sign up for expanded Medicaid (this was before 25 states decided to refuse the Medicaid expansion), 7 million will sign up for private insurance on the Exchanges, of which 2 million will come from the prior non group market. Total reduction in uninsured: 14 million.
  • Most everybody on the Exchanges will receive subsidies. Only 1 million out of 7 million will not be subsidized in 2014.
  • Employment-based coverage will stay flat in 2014, drop 2 million in 2015, and a further 6 million in 2016.
  • By the end of 2016, 25 million formerly uninsured will have coverage.
And here's where we are today:

Points to highlight:
  • A straightline extension of the Medicaid number (1.7 million enrolled with 34% of the time gone) would give us 5 million signups by March 31 - right on target, if the nonparticipating states are factored out.
  • Similarly, a straight-line extension for the private insurance signups would give us about 1 million, well under the 7 million target.
So what's your guess? Here's mine:
  • Medicaid - 7.5 million
  • Exchange - 5.0 million
Considering the horrible start, not too bad. Am convinced there will be a big surge at the end that will be handled mostly well by the website's front end and pretty well by the backend (the part that links to the insurance companies). The system will be seen to be working, to be self-correcting, and most experts will be predicting a smooth open enrollment, when October 2014 comes around. Further: employers will not be planning a wholesale dumping of employees into the Exchanges for 2015 and 2015 premiums will be coming in with only small increases over 2014.

If this is the picture next summer, what will the GOP argument be? Mostly unchanged. They will focus on whatever problems are present; they will argue that employers will begin dumping next year, and that premiums will surely start skyrocketing soon, etc.

Will the public begin to see the true picture? I think so, but I'm not sure. It's possible the MSM will start holding the GOP accountable for making predictions that don't pan out, but I won't count on it.

The sleeper might be healthcare costs overall. If they stay moderate for another full year, and more research analysis points to the ACA as a key factor in the cost slowdown, this could tip the analysis towards a conclusion that the ACA is a strong net plus, and that GOP resistance has been political, not based on sound policy estimates. If this is the tenor of the public conversation, the House will be in play.