A healthier America after defeat
Legislative strategy is not rocket science. But do me a favor and keep that between us since that’s what I do for a living. Editorial writing doesn’t pay like it used to.
For those of you who have never been involved with a legislative initiative, let’s cover the basics. First, getting a bill passed is wildly more difficult than defeating one. The difficulty rises exponentially as the reach of the new policy grows. For example, changing the length of time a dog license is effective is a pretty light lift. Conversely, allowing Sunday alcohol sales in Indiana is apparently impossible.
This is all by design.
So let’s talk contextually about the collapse of the GOP initiative to rewrite our nation’s governing healthcare law. With regard to size and scope, the passage of the Affordable Care Act seven years ago was as monumental as any law in my lifetime.
Democrats in 2009-10 made the ACA legislative initiative a campaign. President Obama toured the country selling it. Many would say he oversold it. It took the better part of a year. He tried to get Republicans to vote for it. And all of that occurred when his party controlled Congress, just like the GOP today. In the end, it was a party line decision with massive political ramifications that still has the issue parked atop the hierarchy of D.C. fodder.
And it’s foundational goal was clear: the ACA was supposed to help America become healthier.
In 2017, the “repeal and replace” mantra of the GOP has finally helped provide them with control of the Oval Office and all of Congress. Their top campaign issue for four consecutive elections has been the repeal of the wretched ACA. It has been their pitch that this massive legislative event is the number one reason for American’s rotten lot in life. Eradicating it is job number one.
Overlooked by the powers in Washington are the two main things needed for legislative success on a scale like this. First and foremost, they needed to have a better idea than the one that has been sold as so awful. Secondly, they needed to develop a cohesive and predictable legislative strategy.
Speaker of the House Paul Ryan, President Trump, and Senate Leader Mitch McConnell failed miserably at both of these things.
With regard to the “better idea” requirement, Americans still don’t know what the GOP plan really is. Largely, the “idea” hinges on replacing the mandate to purchase insurance with a tax incentive to encourage competitive choice for insurance and healthcare providers. The rest of the “idea” seems to be a series of tweaks to mitigate the flaws in the original weak idea.
The reason their “market based” strategy is flawed is because it fails to acknowledge that our healthcare system is not a true market. Consumers of health services don’t make decisions in the marketplace based on quality, quantity and all relevant information. And the providers of the products and services are not in complete control of those things on their side either.
And then the insurance phantom enters the picture.
So spare us the “market” debate. The one area where consumers can really affect their health outcomes revolves around choosing healthier lifestyles while consuming products sold in real markets like food and exercise services. The current debate is ignoring this part of the issue, and that is a big mistake.
The lack of attention to the second prong of Passing Laws 101, the legislative strategy, borders on malpractice. Sheila Suess Kennedy wrote this week that the initiative was being led by a president with a 37% approval rating on a policy initiative that had 17% support of voters. That alone, ladies and gentleman, is evidence that our new leaders in D.C. were not prepared for the big show.
President Trump blamed Democrats this week for the defeat of the AHCA. Blaming them is laughable, since there is no evidence that he even asked them for support. Reaching out to opponents is part of this job, Mr. President. They may not ever vote for your plan, but that part of the process actually is vital.
America is healthier as a result of the death of this bill. It’s defeat should be seen as an opportunity for those who actually have a better idea for our health policy to step forward and be heard.
The Democrats lost in November. The Republicans lost this week. So if misery truly loves company, this might be a great time for a little get together of leaders who want America to be healthier tomorrow than we were yesterday.
That is still the goal, right?