The impossibility of bipartisan health-care compromise

https://theweek.com/articles/811962/impossibility-bipartisan-healthcare-compromise

People yelling at each other.

If there’s one thing political centrists claim to value, it’s compromise. It’s “the way Washington is supposed to work,” writes Third Way’s Bill Schneider. “Centrists, or moderates, are really people who are willing to compromise,” The Moderate Voice‘s Robert Levine tells Vice.

What does this mean when it comes to health care and the developing lefty push for Medicare-for-all? The fresh new centrist health-care organization, the Partnership for America’s Health Care Future (PAHCF), says it is a “diverse, patient-focused coalition committed to pragmatic solutions to strengthen our nation’s health-care system.” In keeping with the moderate #brand, PAHCF may not support Medicare-for-all. But perhaps they might support a quarter-measure compromise, like allowing people under 65 to buy into Medicare?

Haha, of course not. Their offer is this: nothing.

Valuing compromise in itself in politics is actually a rather strange notion. It would make a lot more sense to determine the optimal policy structure through some kind of moral reasoning, and then work to obtain an outcome as close as possible to that. Compromise is necessary because of the anachronistic (and visibly malfunctioning) American constitutional system, but it is only good insofar as it avoids a breakdown of democratic functioning that would be even worse.

However, “moderation” is routinely not even that, but instead a cynical veneer over raw privilege and self-interest. The American health-care system, as I have written on many occasions, is a titanic maelstrom of waste, fraud, and outright predation — ripping off the American people to the tune of $1 trillion annually.

And so, Adam Cancryn reports on the centrist Democrats plotting with Big Medical to strangle the Medicare-for-all effort:

Deep-pocketed hospital, insurance, and other lobbies are plotting to crush progressives’ hopes of expanding the government’s role in health care once they take control of the House. The private-sector interests, backed in some cases by key Obama administration and Hillary Clinton campaign alumni, are now focused on beating back another prospective health-care overhaul, including plans that would allow people under 65 to buy into Medicare. 

Behind the preposterously named “PAHCF” stands a huge complex of institutions that benefit from the wretched status quo. This includes the PhRMA drug lobby (Americans spend twice what comparable countries do on drugs, almost entirely because of price-gouging), the Federation of American Hospitals (Americans overpay on almost every medical procedure by roughly 2- to 10-fold), the American Medical Association (U.S. doctors, especially specialists, make far more than in comparable nations), America’s Health Insurance Plans, and BlueCross BlueShield (the cost of average employer-provided insurance for a family of four has increased by almost $5,000 since 2014, to $28,166).

The human carnage inflicted by this bloody quagmire of corruption and waste is nigh unimaginable. Perhaps 30,000 people die annually from lack of insurance, and 250,000 annually from medical error. America is a country where insurance can cost $24,000 before it covers anything, where doctors can conspire to attend each other’s surgeries so they can send pointless six-figure balance bills, where hospitals can charge the uninsured 10 times the actual cost of care, where gangster drug companies can buy up old patents and jack up the price by 57,500 percent, and on and on.

One might think this is all a bit risky. Wouldn’t it be more prudent to accept some sensible reforms, so these institutions don’t get completely driven out of business?

But wealthy elites almost never behave this way. John Kenneth Galbraith, explaining the French Revolution, once outlined one of the firmer rules of history: “People of privilege almost always prefer to risk total destruction rather than surrender any part of their privileges.” One reason is “the invariable feeling that privilege, however egregious, is a basic right. The sensitivity of the poor to injustice is a small thing as compared with that of the rich.”

And so we see with the Big Medical lobby. The vast ziggurat of corpses piled up every year from horrific health-care dysfunction is just a minor side issue compared to the similar-sized piles of profits these companies accumulate — which they will fight like crazed badgers to preserve.

As Paul Waldman points out, this means a big resistance to the prospect of doing anything at all, let alone Medicare-for-all. However, the political implication is clear. If compromise is impossible, then liberals and leftists who want to improve the quality and justice of American health care should write off the corrupt pseudo-centrists, and go for broke. Democrats should write a health-care reform bill so aggressive that it drastically weakens the profitability of Big Medical, and drives many of them out of business entirely. If you cannot join them, beat them.

 

 

 

 

Health care fight shows Washington at its worst

http://www.sfchronicle.com/opinion/article/Health-care-fight-shows-Washington-at-its-worst-11303602.php?utm_campaign=CHL%3A%20Daily%20Edition&utm_source=hs_email&utm_medium=email&utm_content=54498266&_hsenc=p2ANqtz-8nW1z8XGp1RyWaBRZo1HR_YwqOWFq8gREqh7wzXohioPQ2kx3SMz2vwu8CMs2xJr1f1w3UqB1IbqGUtwIJvTN98D4mjA&_hsmi=54498266

The fight over repealing and replacing Obamacare was more about partisan politics than protecting consumers. Photo: Joe Raedle, Getty Images

The story of health care policy this week, this month and for the last decade (at least) has been a tale of partisan folly. But fear not, this isn’t another earnest pundit’s lament for the vital center to emerge, phoenix-like, to form a governing coalition of moderates in both parties. That’s not my bag.

After all, I have always argued that bipartisanship is overrated.

Bipartisan support often means unthinking support (as the founders could have told you). Partisans may be annoying from time to time, but they also can be relied upon to point out the shortcomings of what the other side is doing. When partisan criticism is missing, it might be a sign that politicians in both parties are helping themselves, not the country. Or, it might mean they’re pandering to the passions of the public and press rather than doing the hard work of thinking things through.

So you’ll get no warm and fuzzy pleading for moderates to scrub clean the word “compromise” so that it’s no longer a dirty word in Washington. Others can make the case for that. And besides, that argument misses the essence of this spectacular failure. Honest partisanship isn’t the problem, bipartisan dishonesty is.

Both parties have become defined by their lies and their refusal to accept reality. It’s a problem bigger than health care, but health care is probably the best illustration of it.

For seven years Republicans campaigned to repeal Obamacare. We now know that for many of those politicians, that pledge was a sales pitch that expired after the sale — i.e., the election — was final.

But before liberal readers pull a muscle nodding their heads: The Democrats aren’t any better. Obamacare itself was lied into passage. “You can keep your plan!” “You can keep your doctor!” “Your premiums won’t go up!” These were lies. If those promises were remotely true, Obamacare wouldn’t be the mess it is.

But these aren’t even the lies I have in mind.

The Republican “repeal and replace” bills debated for the last six months did not in fact repeal Obamacare. They kept most of its regulations intact — particularly the popular ones. The GOP did seek to repeal and reform the Medicaid expansion under Obamacare, but that’s not the same thing as repealing Obamacare.

Yet Republicans insisted it was a repeal because they wanted to claim that they fulfilled their repeal pledge. Actually fulfilling the substance of the pledge was a low-order priority. Heroically winning the talking point: This was their brass ring.

So, too, for the White House. Donald Trump just wanted a win. He has made it abundantly clear that he would sign anything the Republicans sent him — up to and possibly including the head of Alfredo Garcia if someone had written “Obamacare: Repealed” on the poor chap’s forehead. Trump has shown zero preference for any specific policy or approach during these debates. He just wants the bragging rights.

And that is the one thing Democrats are most determined to deny him. The Democrats know that Obamacare has been an albatross for their party. They often acknowledge, through gritted teeth, that the law needs a substantial overhaul.

More important, they also know that the GOP wasn’t pushing an actual repeal. But they couldn’t tolerate for a moment the idea that the Republicans would get to claim it was repeal. So the one thing both sides could agree upon was that this was a zero-sum war over repealing Obamacare — when it wasn’t.

This was all about bogus gasconade and rodomontade for Republicans and insecure rhetorical wagon-circling around Barack Obama’s “legacy” for Democrats. If Trump and the GOP agreed to abandon “repeal,” as Senate Minority Leader Chuck Schumer wants, one can only wonder how much replacing of Obamacare Schumer would allow the GOP to get away with.

Likewise, if Democrats could somehow give Republicans the ability to say they repealed Obamacare, many Republican senators — and certainly Trump — would probably be happy to leave the bulk of it intact.

It is this fact that makes the polarized, tribal climate in Washington so frustrating. I like partisan fights when those fights are about something real. The Medicaid fight was at least about something real. But most of this nonsense is a battle of liars trying to protect past lies in the hope of being able to make new lies seem just plausible enough for the liars to keep repeating them.

What a Bipartisan Approach to U.S. Health Care Could Look Like

https://hbr.org/2017/03/what-a-bipartisan-approach-to-u-s-health-care-could-look-like?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+harvardbusiness+%28HBR.org%29

mar17-30-551958429

As a friend once told me, “Government is about compromise.” That friend was Tommy Thompson, a four-term governor of Wisconsin who went on to serve in George W. Bush’s cabinet as secretary of health and human services.

With the failure of the American Health Care Act, recently proposed by Republicans in the U.S. House of Representatives, it is clear that the Affordable Care Act (ACA) will continue to serve millions of Americans for the foreseeable future. Of course, the ACA (or Obamacare) remains a flawed law. But rather than allow it to “implode” or “collapse,” as some suggest it will (e.g., President Trump), a group of Republican and Democratic leaders in Washington should take action and fix the broken elements of the ACA for the good of the millions of Americans who depend on it. It is time for a compromise.

What might such a bipartisan agreement look like? Here are some ideas.