Tuesday, July 26, 2011

Health Reform: I Don’t Belong To An Organized Political Party, I’m A Realist

I don’t belong to an organized political party, I’m a Democrat.

Will Rodgers (1879-1935)

July 26, 2011 -
Will, don't turn over in your grave.

I hate to tell you this. But Democrats no longer have a monopoly on disorganization.

The Republicans are just as bad. The GOP has three parts – the establishment, the RHINOs, and the Tea Party, and never the twains shall meet.

When They Say It’s the Principles And Not the Money, It’s the Money

With health reform, neither side is willing to abandon their “principles,” for fear of losing their campaign contributors. With Democrats, this fear translates into not cutting a dime out of Medicare and raising taxes on the rich. With Republicans, the message is to cut government programs without raising taxes so as not to offend the “job creators,” i.e., those with the money to hire and invest. As an aside, the health care sector has created a million jobs since the recession began, and is the most vibrant part of the U.S. economy.

Lack of Realism

Neither side seems to take a realistic position, namely, that we’re going to have to reform Medicare to save it, and we could begin to do it be raising the age of entry to 68 over the next ten years and means test more affluent older Americans.

Impasse, Chicken, Bluffs, and Political Poker

Meanwhile we have an impasse. Each party is playing games of chicken, and issuing public bluffs without showing their hands, while negotiating behind the scenes. The President has withdrawn from the game. And we have name-calling with the favorite words being “irresponsible,” “intransigence,” and “extremist.” The favorite talking-points are “fair and balanced,” a “balanced approach,” “shared sacrifice,” “adult in the room,” “compromise,” “the problem is spending,” and either “crisis, “ or “Armageddon,” or some other apocalyptic warning.

The Realities

The realities are:

• In a divided government in which the executive and legislative branches are “co-equal,” no party has a whip hand, or bragging, gagging, or fragging rights.

• We had an election last November. Republicans, led by the Tea Party, won in the biggest rout since the Depression. Consequently, calling the Tea Party “extremists” and a “minority” may be a mistake, for the Tea Party represents an enraged Middle America, rising up against Big Government and Big Deficits and motivated by fears for the fate of its children and future generations.

• The American people, in poll and after poll since the March 23, 2010 passage of the Accountable Care Act, disapproves of the new law by overwhelming, consistent margins of 12% to 13%.

• In the face of a mounting deficit and continued unemployment since Obama took office, the old order of things - expansion of the welfare state to achieve equity, perpetual economic growth to maintain employment, and belief in American exceptionalism has been shaken.

• What needs to happen in health care – expansion of the physician supply, greater access to care in rural and inner-city America, prevention and coordination of chronic diseases, curtailment of sedentary and excessive life-styles, a decrease in the proportion of specialists to generalists, hospitals working in harmony with physicians, disruptive innovations to enhance quality and reduce costs – isn’t happening yet, at least fast enough to make a difference.

Expectations have not yet met reality for either party or for most Americans.

No comments: