Legislating medical care

This week the news is full of “Ryancare,” “McConnellcare,” and “Trumpcare.” To me, it appears that Republicans are scrambling to produce anything that they can call “repeal” or “repeal and replace” and pass.

So I back away and start asking questions: If the Congress were legislating for an activity such as medical care, which is vitally important to all of us, makes up about one sixth of our economy, and is a complex institution in its own right, what would we expect from Congress in the way of knowledge, deliberation, care, and attention? What would a good effort look like?

First, I suggest, a good effort from Congress (and us) would provide a good, informed, and decent response to this question: If Americans are ill or injured and have no money, what should happen?

Second, I suggest, a good effort from Congress (and us) would have a good, informed, and careful answer to this question: If we compare the US medical care system to that of other wealthy countries, how does it stack up in regard to costs and results?

Third, I suggest, a good effort from Congress (and us) would be a bipartisan effort with a bipartisan result, so that both parties could take credit for the legislation, both parties would have a stake in the legislation, and therefore would monitor the medical care policy and make adjustments and corrections as will inevitably be needed.

It appears to me that neither we nor Congress have ever been anywhere near a good effort in the past ten years. In 2010, Democrats used reconciliation procedures to avoid a Republican filibuster in the Senate and pass the Affordable Care Act. Caught up in their “just say no” fervor, Republicans swore—again and again and again and again and then again– to repeal the ACA. For any major, complex legislation like the ACA, we would expect that Congress would have to refine, improve, and correct it over time; none of that happened. In 2017, Republicans are trying to use reconciliation procedures to avoid a Democratic filibuster to pass some “repeal” or “repeal-and-replacement” of the Affordable Care Act. Congress has been nowhere near a good effort at any time, and neither have we.

Each party no doubt could shout for hours about the stupidity, perfidy, and incompetence of the other party. They could; but would that get them or us even one step nearer to a good effort? I think not.

In the matter of medical care for Americans, we and our Congress have been failing abjectly. We are stuck in our polarized partisanship, and that makes it difficult or impossible to make practical progress on any issue we face.

I think I might be asked, Tom, do you see no issue worth fighting for? When I see how much unproductive fighting we have been engaged in, I think my retort would be this: Do you see no issue worth compromising for? Let me put a point on that: The polarized partisans, left and right, have been collaborating to make it difficult or impossible to make practical progress on any issue. They have no business lecturing anyone about the importance of issues.

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