At USA Today columnist Andy Slavitt makes an impassioned plea for legislators to seize the moment and come to a bipartisan agreement on reforming health care rather than subjecting us to endless “do-overs”:
Everywhere I turned, as I listened to people’s stories, I heard another fainter, but still distinct, note. When and how do we make the cycle of partisanship stop? One thing I’ve learned is that the desire to have a regular source of care and not worry about going bankrupt from a medical bill is not a partisan sentiment, it’s a human one. And when the human system depends on the vagaries of who’s in power in Washington, no one can sleep well at night.
President Trump is on a different page. He is still goading his party to run over rather than work with Democrats. He also has repeatedly expressed his intention to do real damage to the insurance markets, and he possesses the arsenal to make it happen. He may follow through as soon as this week on his threats to cut off subsidy payments that make health care less expensive for low-income people. Members of Congress, in both parties, ought to use every tool they have to hold him accountable for delivering for the American public.
Any long-term solution for our country lies at least in part in an end to the epic partisan battles. When I left government, I began to regularly visit Washington and other parts of the country to meet with Republican counterparts and trade ideas with policymakers, state officials and policy experts from both sides to look for common ground. As I advocated against a bill I believed would harm our country, I found it challenging to listen to people who disagreed with me, and sometimes I was too dismissive of their points.
He should have spoken up in 2010 in opposition to the enactment of the PPACA along strictly partisan lines. The time for such prescriptions is prior to the attack rather than on the riposte. And, as I’ve been saying since 2010, as long as providers create most demand by determining courses of treatment and prices are not controlled, it will be like the movie Groundhog Day. The program will need continuing revisions, expansions, and increased subsidies and there will be an ongoing partisan squabble. It’s baked in.
Dave, I’ve just posted something new (and short) about the effects of technology on our cycle of partisan counterattack, and about our escalating societal need to find common ground:
https://medium.com/@piercello/justification-eb149b907e8f
I also submit that, because partisans seem to believe they are always riposting (never attacking), there is never going to be a _good_ time to speak up, is there? Zero ground doesn’t exist. All we have is now.
I therefore welcome Slavitt’s stated interest in finding common ground. I do, however, find it telling that he doesn’t seem willing to move much to help find it. But that’s politics for you, isn’t it?
Cooperation and consensus have become dirty words. Too frequently “consensus” either, self-servingly, means capitulation or slavishly splitting the differences.
What I would suggest is something more closely approximating synthesis. Neither one (thesis) nor its opposite (antithesis) and not something in the middle but a completely different way of addressing the problem (synthesis).
In the here and now what I think should happen is that Democrats should accept the repeal of the PPACA while Republicans should accept the stated goals of the PPACA to create a new program to accomplish those goals along with the most urgent reform, cost control. Instead we have counting coup.
Agreed on all points, Dave. The kind of synthetic approach you suggest is what I had in mind when I proposed my “radical consensus” approach a few months ago.
We need to redefine these sorts of problems as something other than a zero-sum, winner-takes-all conflict. Otherwise, everybody loses in a recriminatory storm of retaliatory policy sabotage.
@Dave Schuler
… Democrats should accept the repeal of the PPACA …
Doing so would be an acknowledgement of Obama’s presidency being a waste of time.
… Republicans should accept the stated goals of the PPACA …
Doing so would be an acknowledgement of their whining about Obamacare being a waste of time.
The only possible solution would be to hollow out Obamacare but to keep the name Obamacare (PPACA, ACA, or whatever it is called this week). Then, Obamacare (or whatever) could be rebuilt into ‘TrumBamaCare’.
On the other hand, we could all stock up on hotdogs and marshmallows and watch healthcare burn to the ground.
(I am well stocked on hotdogs, marshmallows, guns, ammo, etc.)
Yes, that’s the alternative. In the alternative that I presented Democrats cede the political victory for the policy victory. In your alternative it’s reversed—the Democrats take the political victory but lose the policy war.
However, in either event each of the parties must be willing to give something up. Neither is; consequently the impasse. Paradoxically, the Democrats seem to think that time is on their side. It isn’t because of this:
Had the Republicans been working on the replacement instead of pissing, whining, and moaning, they would have a chance of repealing Obamacare, but for eight years, they assured everybody that repeal and replacement was just a few votes away.
Like it or not, they own it. For non-never Trump crowd, it will not hurt him. He was waiting with his pen for the Republican Congress to deliver the plan they had been touting for the last eight years.
We have Obamacare or hot air. Ding, ding, ding! We might have the winner of “Who is the Next Whig Party?”
I don’t believe the Republicans expected Trump to win; I think they’ve expected Hillary Clinton to be elected president since 2012. That’s the simplest explanation for why they’ve looked so flat-footed in repealing or replacing, to coin a phrase.
Indeed, I think that may well be the common thread running through a large number of the stories these days. The Democrats expected Hillary Clinton to be elected president; the Republicans did; the Russians did; for all I know Trump did.
As to which if any party will vanish, even in the worst case (for them) scenario the Republicans will be around until 2024. Check back at the history of the Whigs. They collapsed because they were too darned much like the Democrats and, like the Cheshire Cat, they vanished little by little until nothing was left but the smile.
Right at thie moment it’s the Democrats who look more like the Whigs c. 1854. They don’t hold either house of Congress or the White House. They hold a minority of governorships and state legislatures. In most of the country there just aren’t that many Democratic elected officials other than at the county or city level.
“That’s the simplest explanation for why they’ve looked so flat-footed in repealing or replacing, to coin a phrase.”
That is part of it but mostly they just don’t care that much about health care.
Steve
Hmmm. Which came first: Obama’s decision to push health care, or Mitch McConnell and the Republicans deciding they would never vote in favor of ANYTHING that came out of the White House, no matter what it concerned?
I.e, the only real alternative to a health bill passed just by Democrats was nothing at all, just a continuation of what worked so well in 2009.
I got another thought on that!
Let’s suppose an ideal Republican-Trumpist world, and imagine that Obamacare bites the dust, maybe with a little White House helping, and that by 2018 or 2020 we’ve managed to finally restore our wonderful 2009 health system. Happy happy happy!
Sort of. At the moment, there are 46 million people over the age of 65 or so receiving social security, about that many on medicare, plus another 20 million or so people getting disability or survivors benefits from social security. How’s these numbers going to look in a few years?
Well …. Disability numbers keep going up and up. We know why, sort of. Physically run down older people can’t handle jobs which require much labor, and most of such people lack the disposition or training to adjust to office work — assuming office jobs were there, which generally isn’t the case . So, it makes conservatives unhappy, but the number of people on SSD is likely to continue rising.
How about regular SS? Expect the numbers to go up again. During the first half of the 20th century (1910-1945 anyhow) it seems the US had 2.5 to 2.9 million births each year. Then the Baby Boom came along and 3.5 to 4.0 million births were recorded each year, up till 1970 or so. Back of the envelope calculations …. I’d expect those 46 million people currently on social security to rise to 56 million over time. Make this a bigger number if you think Medicare and/or improved medicine and pharmacology will have an impact.
More people, longer lifespans. Oh joy! More people in old age homes, many of them needing Medicaid to foot the bills. Many more people.
And of course wages haven’t been going up all that much for most of us, especially since that wonderful year 2009. I know there’s a happy understanding in every conservative’s mind that old people who have run their lives properly have large nest eggs to cope with their post-employment financial needs. Just my guess, of course, but I suspect many Baby Boomer oldsters have not lived properly.
In short, I’m suggesting restoration of “traditional” American health care probably leads to financial disaster for millions of elderly Americans, and their families. This will have a large impact on the federal deficit and possibly on politics as well/
Of course, there will be an additional large effect from cutting off healthcare insurance for those getting it through Medicaid or the various state exchanges. I do not think the freedom to buy catastrophic coverage from insurance companies operating out of mail boxes in North Dakota and Connecticut and Florida will be adequate recompense.
I’m pleased as ever to notice not an economist nor a politician nor any blogger in captivity is considering such issues. The Future, as ever, looks … well …. imposing.