We have watched the drama surrounding the American Healthcare Act (AHCA) with entrenched Democrats opposed because of the CBO projected loss of insurance for millions under that plan as it now sits. Moderate Republicans opposed for similar reasons and yet other far right Republicans say the bill doesn’t cut enough.
What is really in play here is the distinct difference between conservative thinking and liberal thinking. Liberals, at least during this incarnation, tend to say what they want and it is usually in the interest of solving problems for the poor or disenfranchised. They believe the government has a role in providing aid to those uninsured.
The conservative view has not been very clearly defined until Rep. Jason Chaffetz commented recently about the AHCA. Not the best choice of examples but to the point, Chaffetz said that maybe those people spending hundreds on an iPhone, for example, should put that money in a health savings account. Chaffetz’s statement coupled with the AHCA as we know it so far says this; ‘health insurance coverage should be your responsibility and if you can’t afford it think about giving up other spending to pay your premium or pay your medical bills yourself. In the meantime conservatives are working on a more vibrant economy and cross-border competition that will lower premiums and so make insurance affordable and available to everyone. With a vibrant economy, increased employment, and higher wages it will all work out.’
The conservative view, then, is about taking responsibility for yourself and your needs with little or no help from the government and assumes that if people are put in the position of having to find ways to provide for themselves they will find their way. As most of us know, do-it-yourself efforts can be very rewarding providing you have the knowledge and skills to actually do them. It is an important argument about self-sufficiency that is strengthened by the life experience of many who have taken on something insurmountable and got it done on their own but the absence of such explanations leads to a more so ‘acceptable’ explanation that tends to leave out the bad stuff such that you end up with what late writer Kurt Vonnegut described as a grand falloon equal, the author explained, to what you have when you remove the skin from an inflated balloon.
Why can’t House Speaker Paul Ryan (R-WI), the front man for the AHCA, just say about the new bill that ‘this bill is almost completely in line with conservative thinking with the possible exception that some House Members think the tax credit aiming to replace the Obamacare subsidies is not. The reality is that once the Medicaid expansion is removed and replaced with a per patient amount sent to States some of you will still not be able to afford health insurance and those who are very sick may get that insurance through a State-sponsored high risk pool, an idea that has yet to show the type of coverage you now have under Obamacare.’
But they are not doing that so we all waited for the bill analysis from the Congressional Budget Office, the non-partisan analyzer of legislation, to show those of us using basic addition and subtraction that the bill will save a lot of money when the Medicaid expansion, the subsidies, and the numerous revenue creating tax provisions in the Affordable Care Act are removed but the cost of coverage will go up especially if you are in middle age (you are more likely to get sick) and / or you let your insurance lap for more than three months (Insurers are allowed to charge you five times what they would charge a younger, healthier person).
What everyone was worried about turned out to be true as per the CBO and that brings us to the other type of behavior that conservatives seem to have taken up; questioning the integrity and objectivity of the CBO and its ability to use math.
The CBO report showing that fewer will be covered was refuted even in advance of the report being issued. This Trumpian approach to vilifying an agency producing data you don’t like is becoming the new normal but fails when one simply looks at the fact that the $1.7 trillion over ten years Obamacare was designed to provide and pay for the law is to be removed from the AHCA and no clear source of revenues are mentioned. The removal of those revenue provisions are tax cuts and so, by federal budget rules, spending. Simply put the ACA tax revenues are tax cuts and tax cuts are spending money expected to be in the treasury.
Healthcare and public spending are important, very important to Americans making life decisions. It’s time to be honest.
Hamilton on Congress
In Praise of Pragmatism
By Lee H. Hamilton
As you watch the healthcare proceedings on Capitol Hill, imagine what things might be like if we lived in more functional political times. In particular, what if Congress were run by pragmatists?
It would not change the issues at hand. On the one side, you’d have the Republican majority in Congress, which for the most part believes that the healthcare system should be left to the private sector. On the other side would be Democrats who, to varying degrees, see an important role for government to play.
What would change would be how the two sides reconciled their differences. Rather than maneuver the proceedings for political gain or worry first about their political bases, they’d be dead-set on a healthcare overhaul that improved the system and was politically sustainable.
I don’t think our system can work without such an approach to our problems – healthcare and everything else. So what do I mean by “pragmatism”?
At heart it’s a mindset, a preference for a practical, workable solution to problems. It recognizes the diversity of our country and the need for compromise, negotiation, dialogue, and consultation in order to reconcile conflicting interests and viewpoints. Pragmatists ask themselves how they can best navigate the differences, factions, and political frictions inherent in any substantive issue so that everyone can leave the table having achieved some gain.
Let’s be clear that this is hardly an easy approach. On Capitol Hill, you work under intense scrutiny and pressure in a dynamic, always-changing, politically supercharged environment. You can’t make the world stand still while you work through the problems.
And if you’re trying to hammer out agreement, you have to keep the conversation moving; when a group or a participant threatens to walk out, you have to calculate whether you can get the votes you need without them. If not, you have to keep them at the table, even if it means nights that stretch into the early morning. And always, of course, you have to try to keep things as courteous and civil as possible.
You also have to be very careful of labels. When you’re trying to solve problems, labels get in the way. I’ve had my share of fraught negotiations, and what I focused on most was trying to figure out whether people at the table wanted to solve the problem and advance a solution, not whether they were Republican or Democrat. And you’re constantly counting votes, because you don’t get anywhere without a majority of them.
So you have to pause, hesitate, weigh the situation, calm the passions, figure out what’s achievable – and then decide whether or not what’s possible is actually worth getting.
Because there are risks to pragmatism in politics. For starters, some issues should not be compromised: to my mind, they include basic values involving torture and the right to vote.
And the pragmatic approach tends not to produce dramatic breakthroughs; it’s incremental, step-by-step, unglamorous work. It means downplaying ideology. This is difficult in these partisan days, yet I was always wary when I heard a fervent ideological speech in the middle of negotiations – it’s an expression of principle, yes, but it raises the question of whether the person giving it is going to help you reach an agreement or not.
Which is why you get a lot of criticism as a pragmatist. People inevitably accuse you of not doing enough or of giving away too much. You’re often accused of abandoning your principles. You have to ask yourself what’s really important in this negotiation, both to yourself and to the others participating: how much can you give to get support for that principle, how much do you have to give up, and is it all worth it?
Yes, indeed, I’d argue, because the country would implode without the pragmatists. The challenge that our political leaders face is how to get through the thicket of conflicting principles, interests and dogmas in a sprawling democracy like ours. All too often, politicians lock themselves into a position: they give a speech to loud applause, then another, and soon enough they have no room to maneuver. In the end they, too, often have to rely on the pragmatists to get things done.
Lee Hamilton is a Senior Advisor for the Indiana University Center on Representative Government; a Distinguished Scholar, IU School of Global and International Studies; and a Professor of Practice, IU School of Public and Environmental Affairs. He was a member of the U.S. House of Representatives for 34 years.
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Iran / Iraq
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