Friday, March 31, 2017

Bringing Two Sides Together

I’ve been wondering if you already know how to bring two sides together. I doubt I can help you by listing the proven methods that help with that. I know I learned how to reconcile opposing factions from my experiences that worked and those that backfired on me. I don’t know what you have learned from your own experiences about arguing and resolving differences. All I can really do is show you how it’s done by what follows:

Show up with more questions than answers, accusations and arguments
  1. Have you noticed that it’s easier to learn from people who walk the talk and provide you with exemplary conduct than from people to only tell you how to act?
  2. Have you ever felt yourself becoming more interested because the speaker seemed more interested in you than in trying to be an interesting person?
  3. Have you experienced the tension fading from an argument when the other side starts learning about your side of the issue, your underlying concerns and your circumstances affected by the argument?
  4. Have you ever developed a casual acquaintance into a significant friendship by asking a lot of questions, by learning more about the person and remaining curious to discover their latest experiences?
  5. Have you influenced people to respect and trust you by obviously respecting and trusting them with the questions you ask them?
  6. Have you delved deeper into understanding others by asking follow-up questions? How did you do that? When did this work for you? What different approaches have you discovered to get the results you were seeking? 
  7. Have you noticed how much more relaxed you become when you prepare questions to ask an adversary than when you prepare opposing arguments and ammunition to shoot down their objections? 
Change the atmosphere before changing the conversation
  1. You might be afraid you’re weakening your own bargaining position by acknowledging your opponent’s concerns, constituencies and circumstances.
  2. You might be opposed to speaking your opponent’s mind about how they see you, how they may be interpreting your conduct and how they are preparing to defend themselves from your pressure tactics.
  3. You might wish your adversaries would lower their defenses first while they appear to be waiting for you to act somewhat vulnerable, accessible and flexible. 
  4. You might expect your opponents to open their minds because it is absolutely necessary to reach an agreement rather than because you took the initiative to approach them with an open mind first.

See through their tactics before they affect you
  1. Can you detect through his/her body language when someone is lying, exaggerating, bluffing or baiting you?
  2. Can you perceive their underlying weaknesses, insecurities and self-incriminations when they are trying to bully, intimidate or antagonize you?
  3. Can you see how desperate your adversaries are becoming when they resort to put downs, cheap shots and snide remarks?
  4. Can you remain disengaged when they try to provoke you to overreact, make a fool of yourself or lose your cool?

Look past opposing positions to their secondary interests
  1. When people are totally opposed to what I want, I have got to wonder what else they have going on in their world besides blocking my primary objective?
  2. When I get curious about their secondary objectives, I usually learn they have an audience waiting to hear how their side ended up and others who will help clean up the mess or take the next step — depending on how the reconciliation turns out for them.
  3. When I get a picture of who else has a vested interest in the outcome, I begin to wonder how I can help them out, make their lives easier or validate their concerns?
  4. When I discover ways to meet my opponents’ secondary objectives, my interest in them becomes a secondary objective of mine which can lead to reconciliation of the initial opposing positions.

I don’t know if you got this? I may have lost you if you were expecting a straightforward explanation. I cannot tell if you got a sense of confidence from this that you could do this too or became more hopeless about ever getting past some big disagreement, stalemate or standoff? I wonder if you could already bring two sides together in practice, but now realize how to do a better job of preparing or conducting yourself? 

Wednesday, March 29, 2017

Our Transition to Patient-Centered Health Insurance

The propagandists for big pharma and health insurance interests have been proclaiming an immediate need to “repeal & replace” the ACA to achieve “patient-centered” healthcare. They have spouted off about this crisis for seven years without formulating a better plan. They are also running around in circles because the sky is falling and the ACA is imploding. They have the right diagnosis but they have applied it to the wrong set of problems.  

This drama we are watching fits a pattern I have seen many times in my years as a management consultant. The marketing department proclaims amazing features, benefits, improvements and choices that neither the production or customer service functions can deliver. The investors fall for the marketing blitz even though the customers and product reviewers catch on to the false advertising quickly. The organization cannot deliver the goods and services as promised because of its arrogant outlook on customers, authoritarian internal governance and flawed competitive strategy to surpass its rivals. The enterprise freezes like a deer in the headlights of an oncoming vehicle. The frozen enterprise gets blindsided by a market entrant that was overlooked by its over-confident outlook. The approaching start-up can deliver the real deal and steal marketshare by delivering what makes the customers genuinely satisfied. The buyers then become:
  • eager to tell their friends and compare experiences once they join in
  • loyal to the new brand and customer-sourced reputation
  • helpful with feedback to improve products, services and support
  • curious to explore more offerings from this trusted supplier 
The Big Money Republicans in Congress added the private health insurance exchanges to the formulation of the ACA. They were certain these exchanges would maintain the competition to lower premiums and deductibles. They opposed an added public insurance option for fear it would weaken the market dynamics they relied upon to drive prices down from monopoly/captive market excesses to equilibrium prices. The market would then reward the efficient producers and incentivize innovations to better serve the customers. That has worked about as well as bloodletting did for a wide variety of illnesses during the century when Adam Smith concocted the sacred text for this approach to lowering prices and improving offerings.  

It appears the Republican Party is imploding, not the ACA. They are governing with “the consent of the governed”, but they are governed by special interests that became empowered by the Citizens United decision from the Supreme Court. The Republican Party is opposed by the Freedom Caucus on the right, the Democrats on the left and the Democratic Socialists on the far left. The sky is falling as they feared. Their giving lip-service to patient-centered healthcare is falling on deaf ears. These Republicans are about to get repealed and replaced by legislators who serve their constituencies who voted them into office. 

This bodes well for genuine patient-centered health insurance. However, health insurance is not a business. It fails when it is set up to be profitable. It punishes its customers for buying its products if the private insurer is beholden to quarterly earnings reports and stock prices. It rewards top management to excess while depriving everyone else fair pay and benefits or fair prices and services. It makes a pretense of offering quality products while delivering junk. It lobbies Congress to subsidize its flawed strategy, broken business model and corrupt internal governance. It gets away with this ruse until the real deal comes along and upstages their charade. 

Health insurance is an aggregator of health risks, setbacks and calamities. The customers are best served by the largest aggregator. Size is the prize winner among health insurance providers. An aggregator of health risk for every single citizen would be the best of all. That aggregator could be the most generous with benefits and coverages because it functions as a massive shock absorber. It would be the most motivated to fund long term medical research programs to lower the cost of treatments and prevention in the future. It could be the best to verify claims about new pharmaceuticals and treatment modalities. It would also have the largest purchasing power to impact the final cost of drugs, medical supplies and contracts with healthcare providers. It would function as the most patient-centered approach to out-of-pocket costs and protection from junk products, fraudulent claims and deficient providers. 

There is another side to the health insurance business that has nothing to do with aggregating health risks. The biggest health insurance companies have already migrated to this business model when big employers aggregate their own risk. This administrative role for claims processing and benefit plan selection is a viable business model. A private, for-profit enterprise could provide superior individual attention to each customer, streamline paperwork, accelerate response times and earn high ratings from those getting serviced. The administrative service providers could get reimbursed based on a formula that combined their number of enrollees and the customer satisfaction ratings. This reimbursement schedule creates competition among market rivals over a more comprehensive value proposition than mere pricing. 

Foreseeing this business opportunity in reimbursed administrative services could ease the transition. The health insurance providers could bow out gracefully from risk aggregation entirely, like their counterparts in Europe. Saving face with their investors becomes more likely when Republicans stop insisting that those big insurers aggregate health risks and try to profit from the flawed business model. 

Tuesday, March 28, 2017

Some New Pieces of the Healthcare Puzzle

The failure of the House to bring Ryancare/AHCA to vote last week has succeeded at inspiring a barrage of insightful essays about this very complex issue. My synthesis of these insights is forthcoming. Here are some of the new pieces of the healthcare puzzle for now.

The existing ACA has two big components: the expansion of Medicaid and the private insurance exchanges. Only the latter is broadly exposed to “hastening an implosion” by Secretary Tom Price or Trump’s Executive orders. The Federal government currently props up the Health Insurance providers when a state market is not lucrative enough to offer insurance. Those subsidies could be discontinued, forcing insurers to raise premiums, increase deductibles or pullout of the exchange entirely. 

The health insurance offered to “hard working Americans” is mostly a bunch of junk policies. The premiums and deductibles are repellant. The policies include the cancellation if the policyholder starts filling big claims for illnesses that were not preexisting. The voters’ pushback against the “health insurance mandate” in the ACA could be more about those junk policies than against contributing to the common good by being insured like everyone else.  They want freedom of choice, not freedom from health insurance. 

Health insurance companies have been more profitable than ever since the ACA was enacted. They are getting out of the business of aggregating the health costs risk and simply providing administrative services for big employers who have become self-insured. The biggest consumer of conventional health insurance policies are those citizens on Medicaid who use Federal money to buy policies. 

A majority of voters now want single payer, Medicare for all, insurance. They are benefiting from the ACA and do not want it taken away. They want it improved, simplified or expanded. The government can no longer be trusted to formulate and pass a complex piece of legislation. The 17% approval rating of AHCA provided how clueless Congress is about considering diverse constituencies. They appear far better suited to make enemies of the State Governors, seniors, disadvantaged citizens, physicians, private healthcare providers and more. The Republicans are expected to take a hit in the midterm elections next year, whether they were in favor of or opposed to the AHCA. 

Lots of the voters for Trump could have just as easily voted for Bernie Sanders. These voters are not located on the political spectrum where political issues spawn loyalties. These voters want change from the do-nothing government that answers to special interests and hostile campaign funding sources. They want a return to “consent by the governed” as if we are living in a democracy, not an aristocracy or oligarchy. 

The adversarial tactics of the Freedom Caucus appear to be more focused on Republican lawmakers than on the AHCA itself. They suspected the late night “closed door sessions” to formulate the AHCA was only Paul Ryan meeting with health insurance company lobbyists. The loyalists to Speaker Ryan need to be exposed, humiliated and discredited. The Freedom Caucus’s blocking the passage of the “undemocratic” bill worked superbly toward their objective.

Trump’s approach to negotiating the passage of the AHCA indicates that he doesn’t really care what is in the healthcare legislation. All he wants is a win. He leaves it up to the legislators to resolve their differences, just like he left the architectural and engineering plans up to those professionals in his real estate deals. He expected that the Republicans had been preparing blueprints over the seven years they were raised a stink about “repeal and replace Obamacare”. He discovered he was working with a bunch of loudmouth amateurs in Congress. #sad! He has not discovered who else is a loudmouth amateur in power just yet.

Trump’s only “skin in the game” is for a personal win. This could be making him increasingly amenable to working with Democrats on upgrading the AHA. He also has clearly demonstrated that he is pragmatic, not ideological. He’s inclined to do what works to gain popularity with some interest group, though not the same one all the time. Pragmatism does not make for consistency, but it does make him susceptible to bait that promises approval and adulation. Democrats have been dealt a hand to be played strategically, not politically. 

All this is shaping up into a wonderful opportunity for universal health coverage in the near future. I will explore how that could unfold in my next post

Friday, March 24, 2017

The Casino and the Resort

Each US health insurance provider is in business for many more reasons than to only make money. Those different aspects of their business model are much easier to understand with an analogy I’ve been playing around with this morning. Imagine a typical casino with a hotel/restaurant included. The multiple restaurants include a cocktail lounge and live entertainment. The hotel includes swimming pools, tennis courts, golf courses and spa facilities. There is a large staff serving the individual patrons and aiming to deliver exceptional customer service. There is a lot happening besides the gambling operation. 

On the surface, it appears the patrons are gambling their own money at tables and slot machines. A deeper look reveals the casino is gambling on the number of patrons who lose money compared to those who win, as well as how big those wins and losses will be. They maintain tight security to insure that no one is gaming the system and changing the odds. For the casino to make money, the odds have to favor the House. 

Health insurance companies resemble these casino/resort operations. Here’s some of the facets which match the food service, lodging and resort operations:
  • processing payments for premiums due periodically from enrollees
  • processing claims from patients who have received medical services
  • reimbursing the medical service providers for their services rendered
  • assisting new applicants in choosing among different plans, levels of protection, etc.
  • processing applications and payment setups for new enrollees
  • terminating enrollees for reaching policy maximums, violating policy terms or falling behind on payments
Each of these services thrive in the private sector with market competition to lower costs, improve services and inspire innovations. There is no hidden harm, delayed damage or unintended consequences from these business operations conducted in a free and fair market. A government bureaucracy would have fewer or no incentives to improve. 

Health insurance companies also resemble casino operations:
  • luring more healthy people (losers) to enroll in order to offset the cost of sick people (winners)
  • lobbying Congress and State Insurance Commissions to not require more coverage (winning) or lower premiums, copays, deductibles (winning) without improving the profitability (losing)
  • reducing the schedule of benefits to insure more profitability and management rewards (losing) at the expense of enrollee protections, guarantees (winning)
  • colluding with other insurers to fix prices and actuarial odds so none of the rivals gain an “unfair” competitive advantage in luring the healthy people (losers) to change insurers
  • increasing the size of the entire insurance operation to better aggregate risk (diluting winners with more losers), to realize “economies of scale” and to lessen the impacts of catastrophic illnesses (big wins) 
The 27 countries that have “single payer” programs in place have shut down these casino operations in health insurance. Their private insurance companies continue to run the resort operations and compete on customer service measures to attract more patrons. It is now illegal to profit from citizens’ wellness and compromise care for financial gain. The public sector is the only casino in the entire country. The government aggregates all the healthcare risk for the entire nation. It can breakeven by balancing benefits and enrollee costs. Eliminating the expense of six or seven figure salaries and huge bonuses among insurance executives contributes to lower costs for premiums, copays and deductibles.

Germany has kept private insurance for 15% of their wealthiest citizens. Everyone that does not qualify for the private insurance is enrolled in the public, single payer system. This works well because all customers are not the same. There are little differences between insurance buyers like those who want maternity benefits or nursing home benefits. There is also a big difference between customers who believe:
  • “you get what you pay for and the more you pay - the more you get”
  • “you don’t get more tangible benefit by paying more and paying more amounts to paying too much” 
Private insurance works well for those who want to pay more to get more. They are not looking for bargains, guarantees or protection from ripoffs. They also appreciate HSA’s (health savings accounts) to aggregate their personal risk and level-out their spending. Public insurance works well for everyone else. It’s a win/win arrangement that realizes the best of both in a hybrid solution. 

The big problem with the ACA (Obamacare) is the perpetuation of private casino operations for everyone not on Medicare, Medicaid or VA benefits. The market incentives to gamble with citizens health are getting thoroughly exposed by the recent debates on the “Repeat & Replace” agenda. It’s clearly time to make health insurance “casino operations” illegal for everyone or for all but the wealthiest citizens.

Thursday, March 23, 2017

Our Lopsided Healthcare Debate

The United States is the only Western Democracy with “winner takes all” elections. Other democracies have proportional representation that accommodate numerous political parties. I’ve been wondering if the deep divisions among both the Dem’s and GOP is a forewarning of our need to upgrade our structuring of legislative bodies at the Federal, State and Local levels.
One price we pay for “winner takes all” election outcomes is lop-sided debates that over-emphasize political agendas and neglect comprehensive policy concerns. It appears we cannot have both so political victories become the top priority. Solutions where we can have both sides of contentions work much better. These winning combinations realize the best of both stances. They are self-regulating and self-equilibrating. The deliberations are balanced and inclusive. The diverse constituencies appreciate the legislative outcomes. Policy issues that have been overlooked or excluded get factored into more complex formulations of policy.

Looking through a system lens at this, hybrid systems function much better than opposing systems. They “raise the water level and float all the boats” instead of favoring one side over the others. The lop-sided healthcare debate would be upgraded by hybrid systems for each of the following:
  • Private sector and Public sector involvement, contribution and protections
  • Top-down/centralized and Bottom-up/distributed power, control and discretion
  • Federal and State levels of decision-making, prioritizing and spending
  • Short term fixes, heroics, crisis management and Long term investment and cost-savings
  • Politically-driven and Policy-driven concerns, interests and agendas
  • Urban and Rural constituencies, issues, and policy impacts
  • Advantaged-contributions and Disadvantaged-dependent participations
  • Medical outcome priorities and Economic sustainability priorities
  • Innovation, creativity, experimentation and Safety, security, continuity issues
Germany has a hybrid healthcare system where 85% of the population subscribes to the government single payer system and 15% have a choice of private insurers. The public system is equal to or better than the private system on many outcome measures. It does not fit the pictures of GOP lawmakers who imagine endless lines, long waiting lists and inadequate care if bureaucratic care overtakes private providers. The experience of Germany highlights some of the issues absent from our current healthcare debate.

The GOP believes the only way to control healthcare costs is to ensure marketplace competition. They are afraid of a “lack of choice” due to a single monopoly provider or no provider at all. The “implosion” and “complete disaster” labels applied to ACA reflect this lop-sided faith in marketplace competition. They cannot consider or realize they are missing:
  • A single payer system aggregates demand and purchasing power which enables negotiating for lower prices from drug and medical service providers.The less gigantic private insurers lack this purchasing power. (Medicare and Veterans Administration do this now)
  • A single payer system eliminates transaction costs that private insurers escalate. Doctors become experts in which insurer offers which benefits. Patients struggle to compare insurers with dozens of plans, deductibles, copays and premium schedules. (Kaiser Permanente attracts numerous physicians from private providers with their freedom to focus on caring without insurance hassles)
  • Limiting coverage is essential for private insurers to make a profit. A single payer system takes coverage issues off the table. Every citizen is covered, not merely given access or choices they dislike or cannot afford. The aggregation of risk makes this financially feasible. Rather than establish health insurance as money-making enterprises, public insurance delivers guaranteed coverage of medical costs at the cost to the non-profit provider. 
  • A single payer system only manages the aggregation of risk, reimbursement to providers and collection of premiums. The medical services remain private enterprises in competition and rewarded for providing more and better services, preventative care and coordination between specialties.  Rather than becoming more profitable at the expense of patients, they earn high ratings from patients for improved responsiveness, communication and access.
A “single payer” system is a misnomer. Insisting “healthcare is a right” is a weak argument. Single payer is really a hybrid system which rewards every component for its participation, cooperation and contributions. It realizes the best of both public and private approaches to policy, enterprise and governance. If our healthcare debate was not so persistently lop-sided, the reasoning behind 27 other countries deployment of a singe-payer system would enter the deliberations and policy formation. 

Wednesday, March 22, 2017

A Seat at the Table

When we are seated at a table, we are seeing eye to eye. There’s is no one with a physical location to look up to or down at from where we are seated. We are experiencing ourselves as equal in stature. We are cognizant of many other viewpoints and visions. We might even be accepting or supportive of different outlooks from our own. Our situation at the table would appear complex, nuanced and intriguing to all of us seated at the table. 

If we were to stand on top of the table, we would look down on everyone seated and anyone under the table. There would be no significant difference between those under the table and those seated at the table. They would all appear inferior from our vantage point. The arrangement would support a binary outlook on winners and losers, insiders and outsiders or supporters and the opposition. 

If we were to hide under the table, we would necessarily look up at everyone seated or standing on top of the table. There would be no significant difference between those on top of the table and those seated at the table. They would all appear superior while making our own inferiority an indisputable fact. The arrangement would also support a binary outlook on powerful and powerless, lucky and unlucky or visible and invisible.

Sitting at the table is an analogy to help us anticipate how we can evolve past the extreme polarizations in our political landscape. Anyone dancing on the tabletop has no aspirations to take a seat at the table. That move would be a serious comedown, a fall from grace, or a big slice of humble pie. Likewise anyone under the table dismisses the possibility of sitting at the table. They have incontrovertible proof that they are too unworthy and unqualified to take a seat.  

Both extreme locations above and below the table maintain robust justifications for their positions. You can read a sampling of GOP self-righteous justifications for avoiding town halls in yesterday’s post. These justifications produce endless self-confirming evidence. Justifications get us saying to ourselves: “I knew it”, “Here we go again” or “Boring!”. Justifications talk ourselves into “more of the same” and “no change for me until the others change first”. 

Through the lens of systems mapping, both locations above and below the table are trapped in vicious cycles. Their minds are reacting to another’s reaction in the same old way. Vicious cycles are closed and lacking a switchover to another cycle. This makes them “entropic” which means they eventually run out of energy. There’s no choice for how to react to another’s reaction. It all runs the same routine on autopilot until burnout.

Systems become negentropic by adding a switch to a second loop. The new approach to balancing becomes dynamic and energizing. When a change was always impossible to consider before, now it depends on an added complication to the thought process. Something else is taken into consideration like a tradeoff, inquiry, or indicator. There’s a new tangent to think through. The little change changes everything. This could occur if the polarized legislators started considering how they could lose their reelection, how they are getting branded as “unAmerican” or how they are functioning as their own worst enemy

Through a lens of negotiating expertise, this polarization looks like a proverbial deadlock, stalemate or standoff. Any attempt at progress or reconciliation would be “spinning our wheels” or “going nowhere quickly”. Trying to change only plays into everyone’s insular justifications, defensive postures and mistrust of the opponents. When an opponent’s mind is made up, it only becomes undone by doing something unexpected to them, for them or with them. If polarized politicians publicized portraits of their opponents as respected legislators, valued colleagues and insightful strategists, these portraits could become self-fulfilling prophesies. The opponents might take up the challenge to meet these expectations and fit these pictures. 

Through a lens of screenwriters and story doctors, this incessant polarization looks like a plot that is not moving forward. The story is in need of a sudden reversal of fortunes, a new character or an unforeseen setback that amps up the suspense and promise of a resolution. This could come about in the political landscape by a reversal of the parties holding the majority in both houses of Congress in 2018. It would certainly happen if President Trump was impeached or removed from office by Amendment 25 of the Constitution. The plot could also move forward if both the RNC and DNC continued to lose voters to Independent and Undeclared status. This development could spawn coalitions of moderate conservatives and progressives demanding representation in Congress and collaborative legislation coming forth.

In any case, it transition out of polarized politics will not happen without a human or fateful intervention. Until then, it is extremely likely that polarization will persist with robust momentum. 

Tuesday, March 21, 2017

Why the GOP are avoiding town halls

When Town Halls were springing up all across the US after the Inauguration of Donald Trump, I was mystified by the reticence of Republicans to show up at gatherings in their own districts. It appeared they were trashing their reelection chances, fueling stereotypes of listening to wealthy donors exclusively, acting blatantly unresponsive to many voters and shirking their duties as elected representatives.  It was equally puzzling when a few did appear before their hometown crowds, they assumed they were facing paid protestors. They interpreted the furor as sore losers following the November election. Several ducked out early (on live TV) as if they found the confrontations completely objectionable. They knew the crowds did not represent the majority of voters who put them in office. They knew our country is founded on the principle of “majority rule”. However, they did not expect to be questioned about health care legislation, immigration policy, Cabinet appointments, Congressional investigations, the Supreme Court nomination or the President’s outpouring of Executive Orders and tweets. They were surprised by the surge in civic engagement among the usually apathetic voters. 

Over last weekend, it dawned on me what the Republican members of Congress were thinking. Suddenly their mystifying conduct made sense on their own terms. They were acting very reasonably in light of free market capitalism. There campaigns get funded by Big Money because of their common faith in market mechanisms and protections. What follows is a way to look through their GOP eyes and make sense of everything they are not confessing:

Any town hall looks like a free-for-all. There are no barriers to entry that could qualify the players and raise the standards from the start. There is a surplus of complaints, questions and sob stories and no demand for any of it. It’s a dumping ground for people who would rather complain than take responsibility for the lives.There is no market mechanism to balance the supply of whining with demand for it. There is no comparisons between the loudmouths to weed out inferior producers with superior competition. It’s as bad a communist country with inefficient planned production and chronic supply shortages. The whole arrangement is disgusting and making a showing at the town hall could only be disgraceful, compromising and possibly stigmatizing. 
If a town hall was true to free market capitalism, participants would be prescreened like entrepreneurs seeking startup loans to enter a market. The town hall would be protected by barriers to entry that kept unqualified producers out. The participants would compete for air time on the merits of what they say and how they say it. They would learn quickly when their production was not getting bought, believed or put to use. They would see competitors who produced contributions that did both sell well and generate requests for more. The entire marketplace would quickly learn how to please the customer, a.k.a the member of Congress at the town hall. Contributors would then tell the representative what he or she wanted to hear. There would be no more complaining about, confronting or rejecting the customer. The hope for free handouts of airtime would vanish. Nobody would get to speak that did not earn prior respect or prove his/her worth in advance with reviews, testimonials and credentials.
The participants in other town halls seem like transients dumping their trash on private property. They show no respect for others who want privacy, security and control. They expect everyone to show them sympathy and to provide handouts. They act if Congress should subsidize losers who are a drain on the economy instead of rewarding winners who strengthen our economy. To spend all their time and energy showing up and contributing without getting paid suggests some market has become distorted by government regulations and excessive taxation. Their interest in the issues facing Congress seems like idle busybodies paying attention to things that are none of their business. They are neither elected to handle those issues or paid to do research and prepare briefs on those topics. If the topics are so interesting to them, they should get a job with a news outlet or think tank. Then they could compete respectably with paid professionals who handle those issues every day with expertise and experience.

I suspect that most of the GOP members of Congress think this way among themselves. They cannot say these things out loud because they would only get 1% of the votes while getting 70% of the campaign financing. 

This can also explain why GOP MOC’s are so consistently reticent to show up at town halls. They may be afraid of getting upset and speaking their minds in this alienating way. They may be afraid on condoning the obnoxious displays of self pity and dependency on big government by making a personal appearance. They may dread more “fake news” coverage about their being selfish, insensitive or cruel when they think that they are merely protecting how our economy works. 

While this may explain the behavior and motivations of the GOP MOC’s avoiding town halls, it also shows why they cannot explain themselves.