Category Archives: Health care

Patching health care

By Steve Brawner

Let’s get real. We’re not going to fix the health care system with this Congress, or maybe any Congress. But this past week, there were at least signs of hope that maybe we can patch it up.

Those signs of hope came when, in both the Senate and the House, some Republicans and Democrats started trying to work together.

That last sentence may dismay you if you believe the other side is evil, and the only way to get anything accomplished is to gain power and then do what you want.

But this is America. That approach might be the norm in Venezuela, where the increasingly dictatorial leader recently held a sham election and then arrested two of his opponents. But here, we don’t imprison each other over politics. We’re a big, diverse, free country, and we’re stuck with each other, so we’d better work together.

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The politics of failure

By Steve Brawner

© 2017 by Steve Brawner Communications, Inc.

American democracy works well when what’s best for the country coincides with what’s best and easiest politically for elected officials. It also can work when elected officials act sacrificially in the nation’s interest regardless of the politics.

Neither currently is the case with health care reform.

Arkansans following that issue might be suffering from health care reform-induced whiplash. On July 15, Senate Majority Leader Mitch McConnell said he would delay action on the Senate health care bill because one of his needed votes, Sen. John McCain, had undergone surgery. (We now know he has brain cancer. God bless John McCain.) On Monday, McConnell said the Senate simply would try to repeal Obamacare, with the change taking effect two years later to give lawmakers time to consider an alternative. Arkansas’ Sens. Tom Cotton and John Boozman said they favored that approach. President Trump said lawmakers should let Obamacare “fail,” and then pick up the pieces. Then on Wednesday, Trump did a 180, summoned Republican senators to the White House and urged them to pass a replacement, which as of this writing they are trying to do.

There’s no question that change is what’s best for the country. The health care system consumes 18 percent of America’s gross domestic product – twice as much as many countries – but produces no better results. But finding solutions the right way isn’t advantageous politically, and it surely isn’t easy.

Here’s what’s best for the country. The parties should agree that the status quo is broken, and they should resolve to fix it. Clear, bipartisan solutions should be sought with the help of health care providers, insurers and patients. The process should take time, actually years, as alternatives are considered and tested at the state level. The final package would acknowledge that perfection is impossible and that the solution requires either less government involvement and fewer services, or more services funded by higher taxes. The process would be messy and contentious, but ultimately a law would pass with support from the centers of both parties. That way, both parties would have a stake in its success and neither would try to make it fail.

None of those things is happening for reasons that run much deeper than the health care debate. The country is deeply divided, a reality the parties both reflect and amplify, so bipartisanship is unlikely unless the issue is noncontroversial – in other words, somebody has bombed us. Because so many states and districts are solidly red or blue, congressional representatives worry not about the general election but about the party primaries, when a partisan sliver of the electorate can vote them out. Because elections occur every two years, the campaigning never stops and action must be taken quickly, making a deliberate approach difficult. Voters have been propagandized into believing solutions could be painless if only the other side would capitulate. And laws can’t be passed by a centrist bipartisan coalition because there are so few centrists left in Congress.

For all of those reasons, probably the easiest thing that can happen politically is what we’re seeing now. Republican leaders just want to quickly pass something – anything – that will let them tell their voters they repealed Obamacare. If they can’t, they want to make enough of a show about it so they can say they tried, and then blame the Democrats. Democrats are happy to let them do this because they know from experience that the health care system is a mess, and that the party in power that tries to fix it will be blamed when it can’t.

So, the health care system’s problems will be addressed only when it becomes easier and more advantageous politically to do it right than to do it wrong, or when elected officials worry less about the politics and more about health care. Unfortunately, neither is the case, yet.

Related: Repeal, and then what?

Repeal, and then what?

By Steve Brawner

© 2017 by Steve Brawner Communications, Inc.

The Senate health care bill is dead. Senate Majority Leader Mitch McConnell killed it Monday after it did what President Obama couldn’t do – make Obamacare more popular – and after too many Republican senators said they’d vote against it and none expressed enthusiasm for it.

The unenthusiastic included Arkansas Sens. Tom Cotton and John Boozman, who both remained noncommittal even though Cotton was one of 13 Republican senators who wrote the bill behind closed doors.

McConnell’s new plan is to repeal Obamacare now, but it wouldn’t take effect for two years while Congress creates a replacement. In response, Cotton told conservative radio host Hugh Hewitt Tuesday that he was “pleased” with that direction. He said Congress already voted to repeal Obamacare in 2015, a move supported by all six members of Arkansas’ congressional delegation.

Of course, in 2015 everyone knew President Obama would veto the bill. This vote would actually count because President Trump would sign it.

Cotton seems to think this could happen and seems to support it, even though he told “Meet the Press” in January that any repeal vote should include a path forward and that “kicking the can down the road a year or two years is not going to make it any easier to solve.” He told Hewitt that senators who voted once to repeal Obamacare would have no choice politically but to do so again. Boozman also is on board with the idea.

Let’s hope they don’t get that chance.

Here’s the thing about businesses, including health care-related ones such as insurance companies and hospitals: Like a tree growing on the side of a cliff, they can thrive in difficult environments as long as they know the rules. They can make a profit even when taxes are too high, regulations are too onerous, and government is too big.

But it’s much harder to thrive amidst the shifting sands of uncertainty. In that environment, free market providers can’t make business decisions, so they play it safe and wait to see what happens next. If the Affordable Care Act (Obamacare) were repealed with only a vague promise from politicians of something coming later, the entire system would be thrown into disarray, leading insurers to leave markets and making health care more expensive and less available.

Besides, working off a deadline is not exactly Congress’ strong suit these days. Time and again, it’s funded the government through continuing resolutions – spending what it did last year, plus some, because it didn’t have time to do a real budget. It’s repeatedly extended the debt ceiling at the last minute, and it’s delayed important legislation because it couldn’t get its act together. One example: After the No Child Left Behind education law expired in 2007, Congress didn’t do anything about it until 2015, when it finally replaced it.

We can’t have years of limbo with health care, because people will die. If Republicans don’t have an answer seven years after Obamacare was passed, they won’t have one in two more. It’s not hard to foresee an inconclusive election in 2018, and then the two-year deadline passes with no consensus, so there’s a new deadline, and then another.

Since “repeal and replace” is dead and “repeal, then replace” is a terrible idea, what’s left? There’s “return” – just go back to the old system, where insurance companies denied coverage based on pre-existing conditions, set lifetime limits, and cut people off based on technicalities. In other words, sell you insurance as long as you don’t need it. Want to go back?

Instead of repeal, replace or return, there’s a fourth “R” – reform. Change current law  incrementally, and then change it again as needed. This would require a bipartisan approach, along with listening to health care providers and other stakeholders, which did not happen this time. It would anger some supporters and media blowhards, and it would mean accepting that you can’t get everything you want in a democracy. But the health care system would be better.

There is another option, offered by President Trump: Let Obamacare “fail,” and then create a new system.

Presumably, he still could get the health care he needs after the system “fails” and policymakers try to figure out how to pick up the pieces.

The rest of us shouldn’t have to live with such uncertainty. Let’s go with the fourth “R.”

Steve Brawner is an independent journalist in Arkansas. Email him at brawnersteve@mac.com. Follow him on Twitter at @stevebrawner.

Drones, health care and the Constitution

By Steve Brawner

© 2017 by Steve Brawner Communications, Inc.

What do the emerging aerial drone industry and the health care system have in common? They both would benefit from a section of the Constitution that’s largely been ignored in recent years.

That would be the 10th Amendment, which says, “The powers not delegated to the United States by the Constitution, nor prohibited by it to the states, are reserved to the states respectively, or to the people.”

The political science term for this is “federalism.”

I’m bringing this up after reading that Arkansas’ Sen. Tom Cotton and three other senators – two of them Democrats – have introduced a bill that would let states and communities govern aerial drones flying under 200 feet of airspace.

In a co-written column in the Washington Times, Cotton and Sen. Mike Lee, R-Utah, said the nation’s drone industry has been stuck in a hover as it awaits regulations from the slow-moving Federal Aviation Administration. Meanwhile, Chinese manufacturers are beginning to dominate the developing market. Cotton and Lee argued that since it will take forever for the federal government to act, states and communities should be given control. A drone flying less than 200 feet over someone’s farm is a local issue, not a national one.

They’re right. Drones will be a growing part of our lives in the coming years. States and communities will have different uses and different levels of comfort with a technology that is both beneficial and invasive, so local solutions are preferable to a one-size-fits-all approach dictated by Washington.

Cotton also had a hand in a bigger piece of legislation, the Senate health care reform bill. He was one of 13 senators who crafted it behind closed doors but still hasn’t said if he supports the final product.

That’s because the bill is a mess and will never pass. After seven years of demanding Obamacare be repealed, Republicans are being forced to admit they never had a plan to replace it or fix its problems – and no, we can’t go back to the “old system,” either.

Health care is hard. Public policies result in allocating resources, but with health care, what do we want to limit, and for whom? Do we want more government involvement, which means more government control, or do we want health care decisions to be driven by the profit motive? Should health care be refused to people who refuse to work, or should they be treated in emergency rooms, or just given health care for free? As President Trump said earlier this year, “Nobody knew that health care could be so complicated.”

Thankfully, the United States has a valuable feature: its united states. The Senate health care bill does give states some flexibility – just as the Affordable Care Act that created Obamacare did – but maybe this is one issue requiring truly massive experimentation in 50 separate laboratories. Recently, California legislators seriously considered a statewide single payer system where the state government would pay everyone’s health care bills. They couldn’t make the numbers add up, but it’s good that we live in a country where widely varying alternatives can be considered – alternatives such as Arkansas Works, where the government buys insurance for poor people. Through experimentation, maybe an affordable health care system will arise that reflects American values but doesn’t cost 18 percent of the gross domestic product. We must try something, because what we’ve been doing the past few decades isn’t sustainable.

It’s not just drones and health care where a re-emphasis on federalism would be good for the country. As the United States has become more polarized, congressional gridlock is no longer a temporary problem but a permanent reality, meaning long-term problems can’t be solved or often seriously debated. The situation is leaving too much power in the hands of the one official who can act unilaterally, the president, and in the federal bureaucracy. In America, we’re supposed to address issues through deliberative legislative consensus. And that process still happens in state governments.

America’s diversity is one of its strengths. Let states like Arkansas and California try to address more problems on their own, learn from each other, offer lessons for the federal government, and in the end, still be a little different.

It’s OK. We don’t all have to be exactly the same. It’s in the Constitution, after all – about a third of the way through the amendments.