Saturday, January 09, 2010

Transparency? Not here, please.

Our friends at The Health Care Blog have posted a letter from the founder of C-SPAN to Speaker Pelosi asking for televised proceedings of the health care bill conference committee. This has generated lots of comments.

I think this is a bad idea. Maybe this will surprise those of you who know me for pushing transparency. But the world of negotiation requires some privacy.

The C-SPAN fellow confuses transparency of result with transparency of process. Sometimes, the process needs to be held in confidence to build the kind of trust you need to reach an agreement.

Negotiations like this need to be held in private for effective compromises to be reached. For example, part of a negotiation is for each party to discuss how they are going to help the other party persuade his/her colleagues to go along with the negotiated agreement. You can't really talk about such things in public.

If this set of meetings is broadcast, the real negotiations will take place in a quiet room somewhere else on Capitol Hill.


RalfLippold said...

Hi Paul,

You are right transparency is not about open up everything. Especially when needing a "safe container" for negotiating partners to come up with a joined agreement. Within such a "safe" conversation space people are able to name also the "undiscussable" issues (where "face losing" can be a threat if done in public).

In general transparency especially about operational issues and the backgroud of KPI (Key Performance Indicators) is well worth. It brings a higher value to the whole system as information is then able to freely float across and amongst formerly "siloed" departments and stakeholders.

Best regards


DavidRFlanagan said...

Hi Paul,

This is David Flanagan, I follow you on Twitter under DavidRFlanagan.

I agree with your comments. My take as follows from wordpress blog


Unknown said...

I like the distinction between transparency of process and transparency of result.
However, I worked in DC on HC reform during the Clinton push. I think the process could benefit from from transparency. It might prevent results like the Ben Nelson Medicaid "gift"...and other tradeoffs we don'r even know about yet.
Randall Gerber

Anonymous said...

Sorry, but you cannot prevent that. Indeed, those trades are part of the consensus-building agenda. You'll just have to relax and "enjoy" them.

Anonymous said...

Paul, While we are talking about transparency, love to hear your comments about why you and most of the other hopsital CEOs in town did not show up at Division of Insurance proceeding this week to talk about rising health care premiums. I know Globe said you had a scheduling conflict but what should we make of the reluctance of hospital executives to engage in this type of public conversation?

Anonymous said...

I did have a conflict with that day. They only gave about 2 weeks notice, and I could not reschedule. I'm happy to meet with state officials any time, and, as you know from this blog, I am happy to address the cost and quality issues at the drop of a hat! And I have personally spent many hours meeting with other members of the Legislative and Executive branches, as have my staff.

That being said, the DOI sent out very extensive and burdensome interrogatories to all the hospitals. Most of their questions were not relevant to the issue and would have taken hours to fill out. I'm guessing that most hospitals looked at those questions and said, "Why is this worth our while?" The agency was unclear at what it hoped to acocmplish. While it has supervisory authority over the insurance ocmpanies, it does not have that authority over hospitals. They should have been more clear as to what they were hoping to do.

e-Patient Dave said...

The comment I added on THCB:

I am no expert on the legislative process but I'm acutely, painfully aware of how dysfunctional today's system is, how many people can't even get the care they want, and I'm committed to causing change, after decades of lobbyist-driven resistance have gotten us here.

I'm disheartened that so many smart people [on THCB] only want to talk about the political aspects and not focus on whether the job is even getting done: saving lives and getting costs under control.

So in this case I support Paul's point re transparency of process vs transparency of result. On his own blog he put it this way: "If this set of meetings is broadcast, the real negotiations will take place in a quiet room somewhere else on Capitol Hill."

Please, rather than kneejerking a response, think about that.

Sicilian said...

I think that the media is giving the public, which includes all of us the idea that there are lots of sweetheart deals going on with the health care debate. If it takes opening up the discussions to move this forward, then so be it.

Ahier said...

The system is obviously broken. If our elected officials are unable to conduct business without their discussions being held in the open, then we have slid into a deeper morass than I had feared.
I'm actually amazed that usually clear thinking adults would find this position acceptable. The argument seems to be that if these negotiations were to be televised then the real negotiation would actually take place hidden away somewhere else, so let's just let them negotiate in secret???
The fact is that the President promised numerous times that these negotiations would be held in the open. There is also a reasonable expectation that the final bill will be published on line for at least 72 hours before a vote. These seem to be reasonable expectations and I supported the President's position. One of the greatest changes the new administration has made is to make government more transparent, thus creating more accountability for our elected officials. The world of negotiation in business certainly requires privacy. In government, there must be a much more compelling reason to keep secrets from the american people than Paul has laid out here.

Anonymous said...

Limiting my remarks to the scope of Congressional negotiations only (not just any organization), I am torn by this issue. While I certainly can see that being on TV would definitely distort the negotiations and result in "smoke-filled room" secret negotiating, I feel like Congress knowing they are private enables and encourages unnecessary and costly(to us) horse-trading. Perhaps one could phase in sunshine by publishing a verbatim transcript of such meetings 3 months afterward,or something. That way the public would get to see how the process works (and hopefully influence its future excesses), and Congress would know that they can get their deal done, but the way they did it will be public in retrospect. It would also screen out the casual viewer who becomes outraged over some insignificant issue, and essentially limit viewing to those interested enough to wait for it. Maybe, gradually, this would encourage greater integrity and less blatant earmarking over time.


Anonymous said...

Addendum to my previous comment:
not wanting to seem like a complete nitwit, I realize this stuff is probably all in the Congressional record. However, one has to REALLY be dedicated to plow through that stuff. How about publishing it online through the website for high profile proceedings that are of general interest?


e-Patient Dave said...


I vaguely recall hearing discussion of whether anything's improved since C-Span started broadcasting live. I don't recall specifics but I think the study (years ago) said the principal difference seemed to be increased use of big TV-friendly billboard displays that look impressive from a difference even if they're full of hot air.

That, and a rise in pompous speechifying intended to impress donors - not impress the mass of voters.

Anybody know?

Anonymous said...

Transferred from Facebook:

Pam: Interesting point of view, Paul. I'm not sure I totally agree with your argument on transparency of process...none of us really wants to see what is going into the sausage making, but sometimes it does influence our perspective on the result.

Stephen: Perhaps this would not be such an issue if the president had not promised the country on at least eight occasions that the proceedings would be transparent and would be televised on CSPAN. He brought it up, not CSPAN. Just another in a long line of broken promises. And this is something he CANNOT blame on Bush.

Dan: I agree with you, Paul, and Stephen. This became an issue when the President's statements/promises were highlighted....probably led to some expectations...and easy criticisms....

Bette: Could not agree more. As a mediator, I have learned countless times and in countless ways that privacy is critical to a negotiation. Without it, the parties will not be candid, they will worry about "tipping their hand", and they will not be willing to disclose their real interests. If given the choice, most parties would not even come to the table without a promise of privacy. They need a "safe" place to explore solutions, or the negotiation is superficial and disingenuous, making resolution is less likely, if not impossible.

Alex: but, oh, the loss of the teachable moment!

Mary Ellen: What parties are a part of this process? How many patients & consumers are a part if this committee, compromises and decisions? If there is representation than ok. In today's world of the medico legal politic - it would be good to get that information out there.

Me: Just a few of your elected representatives, Mary Ellen.

Dr. Val said...

I think the real reason people are calling for C-SPAN coverage is that we know how important this bill is, and that it's being rushed through congress without the American people really knowing what's in it. Social Media (and technology) have changed our culture and the way we communicate. We EXPECT to be able to participate in a national dialog and it feels wrong to be shut out of it now. This bill is likely to contain the most influential healthcare reform legislation in our lifetimes - so it'd be nice to know (generally) what our elected officials are up to, and to make sure it reflects the will of the people.

Lee Tilson said...

I agree with Dr. Levy's conclusions, but for different a different reason.

Providing access to health care for 30 million uninsured Americans is a moral imperative. Finally, after 70 years, 28 volumes of study by Dr. Wilbur from 1927 to 1932, and over 450 hearings, we are about to enact this reform. Finally. Finally.

Unfortunately, despite the open hearings and the hundreds of amendments allowed, the minority leadership in the Senate has announced its determination to do what it can to block progress now, and to undo this progress later.

Open hearings are not a good idea when the minority party participates in bad faith.

Thank you Dr. Levy. Thank you.