Wanted: More Management Talent

Wharton management professor Lawrence G. Hrebiniak is less concerned with the legislation's minutiae as he is with the big picture. "The health care overhaul raises many questions about the bill's costs, effectiveness and political viability. But it also raises questions about effective management," he says. "The bill is terribly complex and opaque, but it is only one source of problematic complexity facing decision makers in Washington. The federal debt looms huge and, left unfettered, will create major financial and fiscal crises in the future, while burdening U.S. taxpayers tremendously. The intelligence community has problems that defy easy solution. The viability of Social Security, Medicare, and Medicaid presents major challenges. Immigration issues, record unemployment, the economy, infrastructure repairs, energy questions, wasteful earmarks, etc., only add to the multitude and complexity of the issues facing leaders in Washington."

The health care "debacle -- with its political bickering, name-calling, blocking tactics, lack of clarity of costs and benefits, length and general painful legislative process -- makes me wonder if our leaders can handle the many complex problems facing the country," Hrebiniak notes. "Are our decision makers up to the task? Can the politicians ever become effective strategic managers? The health care overhaul suggests to me that the country lacks the management talent to handle the mounting problems facing the nation."

Rosoff echoes that concern. Health care reform "devolved from a policy debate into a political game," he points out. "Shame on these people for allowing it to become so political." Rosoff, who has spent five years studying how Argentina, France, Italy, Japan and Singapore made the transition to universal health care, believes the United States "has made a major step" by passing health care reform, but it remains in jeopardy. "The stars are just barely in alignment to get [the reform] passed now," Rosoff says, but "it's not solid. It could be significantly rolled back.... There's a tremendous amount of state push-back."

More than a dozen states have filed suit in federal court challenging the validity of the health care mandates. Some states are working to pass laws to counteract parts of the health care reform. And many Republicans are gearing up for an electoral battle this November in hopes that they might muster enough votes for a repeal.

"I believe that Republicans should take the unequivocal position that if they are given a majority in Congress in November, they will stop the implementation of the government takeover," Phil Gramm, a former Texas senator, wrote in an op-ed piece in the Wall Street Journal on March 26. "And if a Republican is elected president in 2012, they will do with Mr. Obama's health care bill what the American voters will have done to the Democrats: Throw it out."

Rosoff suggests this is the wrong approach. "Instead of wringing our hands, look at all the ways we can meet the challenge to deliver health care to the population," says Rosoff, who believes the overhaul opens up business opportunities in medical information technology, education, retail stores and methods of delivery, among other areas. "Change brings pain to people who are too heavily invested in the status quo, but it brings opportunity to everybody else.... Adding 32 million people is going to put stresses on all of our systems. We're going to have to create more doctors, re-orient who does what. By starting in the direction of universal health care, we have committed to making major changes ... and these have tremendous business potential."

Grande also sees opportunity. He believes that the mandate for coverage increased the likelihood of substantive discussions about cost containment. "The requirement that people have health insurance is the transformative piece" of the legislation, he notes. "Everything follows from that. No longer is the starting point whether to expand coverage. The debate going forward is how to do it and how to make it affordable."