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Health Care Reform: The System Actually Worked (Forbes.com) March 25, 2017

Posted by daviddavenport in Op/Eds.

While conservatives and Republicans join in choral lament over their inability to repeal and replace Obamacare in the first 64 days of the Trump administration, allow me to sound a different and slightly positive note:  the governance system actually worked, or at least lurched in that direction.  I may be singing a solo on this but, as Congressman Joe Barton concluded when he surveyed the situation, “democracy is messy” and, I would add, sometimes something good can arise from a mess.

My premise is that when you are dealing with the biggest and most important federal takeover in 50 years, and one that affects one-sixth of the economy, you should deliberate with some care.  And you should not be tempted into such a huge overhaul by party-line votes (or executive orders, either, for that matter).   The whole notion of our representative democracy—divided as the power is among two branches of the legislature, the vast executive branch and the court system—is to find, as the founders put it in The Federalist, the cool and deliberate sense of the community.  The point is most assuredly not to rush things through on a narrow party-line vote in order to hit an anniversary of the law you are trying to undo.

Even House Minority Leader Nancy Pelosi sounded that note, saying Trump should “build consensus…not the shortest, quickest monstrosity you can bring to the House floor.”  Of course her line would have had more credibility had she followed it herself in passing Obamacare in the first place, which was enacted rather quickly and on a straight party-line vote.  In that case, she famously said “we have to pass it to find out what’s in it,” not exactly the kind of deliberation and consensus-building she wants now that voters have moved her party from the driver’s seat to the back seat.  Sadly, important principles of our representative democracy like deliberation, consensus-building and federalism seem to be important only when you are not in power.

And that’s my point:  here a failure of the majority party to drive yet another party-line vote on a major domestic policy may actually force those in power to pay attention to deliberation and consensus-building.  It’s bad enough that, as Senate Majority Leader Mitch McConnell said last month, Republicans plan to repeal Obamacare and reform the tax code without any Democrats.  But here there was sufficient diversity of views within the Republican ranks themselves that further deliberation was needed.  Several moderate Republicans feared that the Ryan-Trump bill left too many Americans uninsured, or paying too much, while other conservative Republicans were adamant that it didn’t go far enough in repealing expensive mandates of Obamacare.

To the extent this was a failure of Republican leadership—and many are saying that about Speaker Paul Ryan and President Donald Trump—it was a failure to take enough time to develop the ideas around which a consensus could be built, at least a consensus of Republicans if not a majority from both parties.  Last-minute tinkering and compromising was making the bill worse, covering fewer people with less cost savings.  Since Washington is in this mode of—as President Franklin Roosevelt put it facing the Great Depression— “action, and action now,” any failure to take immediate action and obtain instant gratification becomes a failure.

As the famous inventor Thomas Edison concluded from his stumbles: “I have not failed 10,000 times—I’ve successfully found 10,000 ways that will not work.”  The lesson from this round of health care reform is that we don’t need one more party-line vote that can be undone by a new president or congress following the next election.  We need to stop veering from one direction to another based on party-line votes or executive orders and return to deliberation and consensus.  It is difficult in the short-run, but it produces the only kind of change that really lasts.

To view the column at Forbes.com:


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