Two networks, one public and one private, have been in the news this month. The first network is the one created by the Patient Protection and Affordable Care Act, aka ObamaCare, signed by the president into law last year--and under challenge ever since. The second network is Facebook, founded in a college dorm room on February 4 back in 2004--and a popular commercial phenomenon ever since.
The question is: Could we ever fuse the two in some way, so that Americans could enjoy the benefit of a network that delivers health and is popular? Maybe even profitable?
The two networks, ObamaCare and Facebook, might seem to be very different, but, in fact, they share many common characteristics. They are both, after all, intended to provide information for the benefit of hundreds of millions of people. In the case of Obamacare, which is intended to cover some 300 million U.S. citizens, the goal is to provide individuals with the information--and the financial wherewithal--needed to get health insurance, even as it provides the government with the information, as well as the legal and financial resources, to make sure that people do, in fact, get health insurance--whether they want it or not.
And what will this program cost us? About a trillion dollars in new expenditures over the next decade, according to the government’s estimates--although we know the track record of those kinds of estimates. In addition, there’s the considerable cost and friction of a regulatory makeover, or takeover, of the whole U.S. health care sector.
ObamaCare came at a high cost politically, too, for the party that pushed it. Enactment of the legislation arguably cost the Democrats control of the House and their working majority in the Senate in the November midterm elections.
Indeed, fear of over-empowered bureaucrats and “death panels” helped to set in motion the Tea Party movement, which has made a permanent change in the political landscape, ending any hope of an Obama “realignment.”
A January poll from the nonpartisan Pew Center found that, by a 48:41 margin, Americans disapprove of the new health bill. And earlier last week, a federal judge in Florida ruled Obamacare to be unconstitutional; the entire legislative effort, all 3,000 pages of it, plus 15,000 or so pages of regulatory supplementals, now faces an uncertain fate in the Supreme Court.
No wonder Democrats are not entirely happy with their legislative handiwork. In his State of the Union address last month, President Obama gave considerable rhetorical ground to ObamaCare foes, saying that he was willing to “look at” Republican ideas for improving the health care overhaul. Moreover, he volunteered that Uncle Sam’s bureaucracy needed a streamlining and a pruning. As he said, America needs “a government that’s more competent and more efficient.”
So how to get a government that is, indeed, more competent and efficient? Observers have long recognized that the private sector generally does a better job: We might consider, for example, the difference between the Postal Service and Fed Ex. But in the era of Moore’s Law and the Internet, change occurs ever faster--and so the gap in speed and nimbleness between the private and public sector grows ever wider, ever more quickly.
So now we come to Facebook, the other network--the popular network. The Silicon Valley-based startup defines itself as mostly for socializing and for fun. But of course, Americans take their fun seriously; indeed, leisure and entertainment is a big business in the U.S.
Increasingly, Facebook is an important platform for e-commerce and for e-politicking; it’s only a matter of time before people start performing civic functions, including voting, on Facebook. And so the company, which claims about 150 million voluntary users in the U.S.--and quadruple that worldwide--has grown into a huge enterprise, worth an estimated $50 billion or more. Which is to say, Facebook is already generating revenues for the federal treasury; those tax payments, individual and corporate, will ultimately be in the tens of billions. In other words, an entity that didn’t even exist a mere 7 years ago is now a significant revenue source for local, state, and federal governments.
Facebook, to be sure, has been controversial; last year a Hollywood movie, “The Social Network,” savaged Zuckerberg as conniving and unprincipled, even as it conceded his business brilliance and the popularity of his product.
And yet just this two weeks ago, Zuckerberg received a sort of pop-culture absolution, spoofing himself on “Saturday Night Live” to a cheering crowd. So Zuckerberg and Facebook, having taken their hits, continue to thrive; it’s hard to think of any web-industry player that doesn't seek to connect, one way or another, to Facebook. The company is here to stay, a major--perhaps the major--player in the Net ecosystem.
So as a thought experiment, we might ask: What would have happened if the United States government--or the United Nations--had set out to create the exact same sort of network? Answer: A populist rebellion against scary Big Government, be it national or international, would have erupted. (Yes, it is true that the government created the Internet, back in the 60s. But the feds wisely turned it over first to universities, and then to the private sector; it was Netscape and Yahoo and Google that made the Net what it is today, not the government. Not a bad model for health care, as we shall see.)
OK, so today we have two contrasting networks: one public, one private; one unpopular, one popular; one costing money, one making money. Still, what’s the connection--or possible connection--between the two?
The answer is that one day, one or both of the political parties will have to come to grips with making the health care system work--work, that is, in a way that merits popular support and respect. No politician has managed this trick for a long time. Obamacare is unpopular now, but we might recall that the system before Obamacare--a melange of public and private, of insured and uninsured, of rising costs and stagnating medical productivity--was not popular, either.
So Republicans have some work to do. Senate Minority Leader Mitch McConnell(R-KY), long an Obamacare opponent, declared this week that the Florida court’s decision proved that the health care law was a “massive overreach,” exceeding congressional authority and public tolerance. “We should repeal this health spending bill,” he demanded, “and replace it with commonsense reforms that will actually lower costs, prevent unsustainable entitlement promises and make it easier for employers to start hiring again.”
OK, but what, exactly is the “replace?” Today, Republicans are having a hard time agreeing on what “replace” would look like. GOPers know what they are against, but not so much what they are for. Fortunately for Republicans, their lack of an articulated replacement model hasn’t mattered much to the voters, because for now, such opposition is mooted by Democratic support; Democrats are mostly defending Obamacare as is. And so while certain minor tax-raising provisions of the bill, such as the hated “1099 provision,” seem destined for quick repeal, other features--the prohibitions on insurance companies rejecting customers because of pre-existing conditions, for example--seem destined for permanence, because they are overwhelming popular, not just with Democrats, but with the country as a whole.
So the smart money in Washington DC says that Republican repeal efforts will be thwarted. That is, much of Obamacare will survive, somehow--even as few insiders express optimism about the new law’s ability actually to improve health care. “Too big to stop? Obama's overhaul lumbers on” ran the recent headline in Bloomberg Business Week.
Meanwhile, out on the other coast, Facebook doesn’t “lumber on.” It skyrockets--in users, in revenues, in societal relevance. And of course, everyone who is on Facebook is there because he or she wants to be; that’s the non-coercive nature of market forces, as opposed to statist control.
Most people have confidence in Facebook, just as they have confidence in Google, Twitter and Apple. Average Americans probably could not name the executives involved in these companies, but they nevertheless trust the technical competence of the connected systems that these Silicon Valley types have created. Yes, ordinary Americans have concerns about privacy, but at the same time, they are obviously willing to trade some privacy for the convenience of the service. Indeed, we might observe that the loudest complainers about privacy are a different set of people from the biggest users. Once again, that’s the power of the free market: each to his own.
The point is that Silicon Valley simply put out a better product, a product that works better. Nor is this confidence limited to Silicon Valley; in the health field, a lot more people already look to health-information services--such as WebMD, The Health Central Network, or Patients Like Me--than to the Department of Health and Human Services. In addition, millions of people are actively involved in disease-awareness and self-help groups, sharing information. This grassroots phenomenon is entirely non-governmental; much of it occurs on social networks such as Facebook.
Yet all these private networks--from the smallest information-sharing group to Facebook-- exist in a different space than the public health network, Obamacare. And that’s a loss to the nation, because the American people have to pay tax money for a public network they don’t really want, and then they have to resort to a private network that they do want. Surely there’s a more efficient way to “do” health in the U.S.
What if Republicans--or Democrats, if they didn’t mind doing a 180 from the old-line statist model they pushed into existence last year--were to look at Facebook as a way of organizing health care? What if the value of a social network, defined as the useful sharing information for the convenience of the user--were applied to something more important than Facebook-based games such as Farmville and Mob Wars?
The American people are waiting for one or both parties to take the lead on improving health care--not just playing politics, slugging back and forth on Obamacare. For too long, the two parties have held only some of the necessary pieces to the puzzle. The private sector and the public sector both have a role to play, but they are different roles than we see at present. And so Republicans, who pride themselves on looking to the private sector for solutions, might start looking to Facebook and social networks for the beginnings of a better, and mostly private, model. And Democrats, who pride themselves on delivering for ordinary folks, might also look to the same model; they could call it Obamacare 2.0.
For both parties, the goal should be the same: a health care system that works to make people healthier.
What might that kind of network look like? How could a “Facebooked” version of Obamacare actually function? We will take a look in Part Two of this article, later this week.
James P. Pinkerton is a writer and Fox News contributor.