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John "Z-Bo" Zabroski

Interesting 'key questions'.

Barack seems to understand why McCain's plan will fail, but can't see or admit the weaknesses in his own. McCain's newest proposals are just so asinine. His campaign advisers appear to be ill-equiped.

On one hand, you could argue McCain's plans will help out the long-term picture, but we should let investors worry about that, not gov't.

I also think both health plans are really just a tax subsidy, and that Barack's tax plan is overrated but not for the reasons Republicans say: We simply shouldn't endorse a tax cut that creates a higher maginal tax rate on each dolar earned, which is what Obama's does.

However, I think Obama may move the ball on alternative energies, since he's said it is his #1 concern. I really disliked McCain's arrogance that we don't need to prioritize and that we can do everything at once. In reality, the US will not face a long-term energy crisis, but developing nations will.

Mark Sigal

So much of this comes down to philosophy of the role of government, and whether there is a place for government to take a leadership role or whether it should just be a facilitator of the market.

Areas like health care, energy, education and banking/finance reform seem to hit to core of voters sense that there are places where trickle down and pure market forces fall short.

There is obviously a slippery slope to pursuing that path, but the alternative doesn't seem any better, and in case of health care, it is both a major national economic cost item and quality of life issue for which the aging baby boomers and those with potential or real health risk feel seriously exposed.

Chris Corbett

The premise of your contention seems to be that ideology and mechanics are separate universes in the decision we face. I believe this is a wrong assumption. The choice is not "ideology" vs. "competence" but which choice offers the best combination of the two.

Which is why I'm a McCain supporter. Ideology matters. Obama is an adherent of the traditional "progressive" left, which I believe is an outdated and inherently flawed ideology. But more to your point about leadership style, Obama's record in government contexts demonstrate that -- off the campaign trail -- he is more reflexively ideological, perhaps even in a knee-jerk fashion, to the left than Bush has been to the right. Do we really want that? It doesn't matter what his campaign talking points and proposals sound like; they will be obsolete on November 5th. McCain, I believe, while ideological, is flexible. A flexible free-marketer, prudent reformer, and flexible national defense advocate with a record consistent to such a characterization.

Is how a man runs his political campaign the best marker of his governing skills, above all else? Only if you're ready to accept the disastrous "permanent campaign" governing styles of Clinton and Bush 43 -- a model Obama has promised to follow, and McCain has pledged he would abolish.

That last point, I think, is enough to tilt me to McCain.

Mark Sigal

Hi Chris,

First off, thanks for the comments and the counter-perspective. My sense is not an either/or but an AND on the ideology versus mechanics topic.

I think that vision and strategy provide a context for tactics, and this is where I think that McCain falls short. It's all tactics and no coherent vision for the country.

That said, I believe that senators inherently lack the experience bucket of organizing and managing large organizations. Governors and/or mayors come closer but that's not what we are dealing with in this election so the best proxy I have seen wrt leadership gauging is a two year cycle of agenda selling, fund-raising, organization building and a balance between conviction and agility.

As to permanent campaign, I hear you 100%, and that will be a challenge for Obama if he wins, although I don't accept your assertion that this is something that Obama has pledged to follow.

If anything, its about establishing a narrative and a vision in the same way presidents like Reagan, Kennedy, Lincoln and Roosevelt did.

We will see how things shake out in the next few weeks. Thanks for the comments, Chris.

John

The way to lower the cost of health care is to set-up clinics. However, this would benefit hospitals and take money away from HMOs.

This relates to the change in the 90s in how HMOs worked: underwriting became impossible, and so to hedge risk they turned to group policies. On the state level, the poor qualify for gov't sponsored health care, and the state has to pay the HMOs whatever it takes.

The biggest challenge to setting up clinics is not getting assassinated, though.

John "Z-Bo" Zabroski

(By the way, the current start-up I work for does advanced analytical work for hospitals. I actually have a good degree of understanding of what the books look like at a major US city hospital.)

John "Z-Bo" Zabroski

Oh, one other thought: The recent change to Medicaid/Medicare, which attempts to refuse to pay hospitals for infections that occurred during the patient's stay, is phenomenal. Maybe finally proper IV Administration procedures, etc. will get used. The excuse thus far at hospitals across the US is that nurses and doctors don't need checklists to ensure quality, even though studies prove checklists greatly reduce risks, including that of infection.

Mark Sigal

Thanks for the comments, and color, John. In Atul Gawande's, "Better" he specifically talks about the shockingly high rates of cross-contamination as doctors and nurses go from room to room forgetting simple procedures. He shows exactly your point; namely, that when procedures with specific checklists and an owner that tracks compliance are plugged in, cross-contamination related infections drop dramatically.

Here is a link to the post on the book if interested:

http://thenetworkgarden.com/weblog/2008/02/on-doing-better.html

He's a great writer.

Mark

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