Who Do We Want To Be

               As I have been contemplating various policy issues I have found myself focusing more and more on what kind of country we want to be.  What kind of nation we want our children to grow up in.  And I find myself realizing that none of the policy problems that face this country are really going to be answered until we decided what kind of nation we want to be.

               We hear a lot about red states and blue states, especially during this past year.  And we’ll probably hear more about it in 2018 and a lot more about it in 2020.  Given the narrative that seems to pit “Red America” against “Blue America” you might think this question is about which side I want to win.  It’s not.  I don’t want either side to win.  Life in the United States shouldn’t be a game where one side wins and the other side loses.  And we definitely shouldn’t be a country where there are only two sides.  Let me take a brief moment to generalize about the two sides that seem to be dominating the conversation.

               Republicans want a small federal government with most of the control vested in individual states.  However, they also want a very large military.  Republicans insist on a balanced budget, so they want to pay for the massive increases to military spending by slashing funding for public assistance, the arts, sciences, National Parks, etc.  Staying within the economic sphere, Republicans share a belief that the free-market will always provide a better solution than the government.  Earning power is strictly a function of individual initiative.  If an individual isn’t making enough money, the blame lies solely with the individual; there are no societal factors to the limited income.

               Socially speaking, Republicans prefer to little to no change to existing norms.  Changing social norms is only done slowly over a long period of time.  This leads the party to opposing increased rights for the LGBTQ community.  It also means the party tends to ignore/dismiss the disparity that exists between men/women and whites/minorities.  A strong segment of the party is dominated by white Evangelical Christianity which is currently working to move their belief system out of their private lives and into the public space.  The resulting effect is that white men keep a dominant position vis-à-vis the rest of the population.

               Democrats want a robust federal government in an effort to make things uniform for all citizens regardless of the state they live in.  While a balanced budget would be nice, it cannot be achieved at the expense of the populace.  Democrats see government spending as a way to increase the well-being of all people regardless of where they started or where they are.  While the free-market has its benefits, it must be constrained by strong government regulations lest it run out of control.  While there is some individual responsibility, Democrats place a strong emphasis on societal factors in understanding the reasons for the existing income equality.

               While these two sides have some severe opposing viewpoints, it doesn’t necessarily mean that the two sides cannot get along.  And this is where we have to start talking about who we want to be.  The current direction of the two parties is one of increasing distance and disengagement with the other side.  Republicans want nothing to do with the Democrats and vice versa.  It’s why Republicans don’t want to continue reforming health care; they want to “repeal and replace” the work of Democrats.  Democrats don’t get any points here either; they ramrodded the bill through the Senate along strict party lines 60-39.  I could also point out the ridiculous Republican opposition to Merrick Garland’s nomination and their anger that Democrats would dare oppose Neil Gorsuch.

               Of course, the most egregious example of this refusal to work across party lines comes from 2013.  At that time, a group of Republican and Democratic senators, the “Gang of Eight,” crafted legislation to address the problem of immigration in this country.  We all know the sides here, so I don’t need to expound upon the positions.  The thing is, this bill would have achieved some aims of both parties.  Democrats got the path to citizenship that they want; Republicans got an increase in border guards.  In addition, the Congressional Budget Office projected that the bill would cut the deficit and increase revenues for Social Security.  More wins for both sides.  Sadly, the bill never made it out of the Senate.  The House blatantly refused to even bring the bill to the floor for debate.  House opposition was driven in large part by members of the Tea Party wing within the Republican Party.  A group that represented roughly 10% of the House at the time.  So, in order to placate a group representing less than 10% of Congress, a bill that would have taken a comprehensive approach to repairing immigration didn’t even get the debate it deserved.  Such terrible abdication of legislative responsibility does nothing to actually help this country.

               America works best when we all work together to tackle the challenges that we face.  Under the Articles of Confederation, the states had too much power and there really wasn’t much in the way of a federal government.  The arrangement didn’t work as the states maintained their strong independence and did not unite as our Founding Fathers intended.  So they drafted the Constitution.  Of course, there was some very strong and robust debate over the Constitution.  Our founders had some very strong feelings on the subject.  That’s why John Jay, Alexander Hamilton, and James Madison worked so hard on the Federalist Papers.   It’s also why others worked on the less well know Anti-Federalist papers.  There were two very strong, and opposite, groups.  In the end, they worked together to draft the Bill of Rights – the piece that cinched the full ratification of the Constitution. 

Less than 100 years later, sides were drawn in Congress over the issue of slavery.  Compromises were necessary in order to keep the country from coming apart at the seams.  The Missouri Compromise of 1820 kept the peace by maintaining the balance between slave and free states in the Senate.  In 1850, another compromise was needed that included strengthening the Fugitive Slave Law.  There is some thought that failure to find a compromise in 1850 would have caused the Civil War to start a decade earlier.  As it was, by 1861 it was no longer possible to find compromises and war resulted.

               Imagine if today’s political climate existed in 1787.  Neither side would have budged an inch.  The Federalists would have pushed for a vote with no changes.  The Anti-Federalists would have refused to even discuss the matter until every one of their concessions had been granted.  The two sides wouldn’t have found a way to compromise and the Constitution likely wouldn’t have been ratified.  The ramifications should be rather obvious – the United States of America wouldn’t exist.

               This is the crux of the conversation we must have.  Do we want to be the people who find compromises and ways to move forward together or, do we want to be people who dig in our heels, “stand on our principles,” and refuse to compromise?

               Don’t get me wrong, there is a place for principles.  But, there’s a difference between standing on principle and insisting on a “my way or the highway” approach.  I’m all for principled leaders in office, but we also need leaders who work across party lines.  Any look at the current political landscape should make this obvious.  When looked at from a national view, neither party garnered 60% of the vote for the House of Representatives during the entire time President Obama was in office.  In fact, since President Reagan took office, neither party has held 60 seats in the Senate*, Democrats have managed a 60% House majority 3 times, and Republicans have never managed a 60% majority in the House.  The last President to gain 60% of the popular vote was President Nixon in 1972 – right before the Watergate scandal broke and he had to resign.  Even in 1984, when President Reagan won 525 of 538 electoral votes, he only won 58.8% of the popular vote.  I could keep going, but the point is that we are fairly equally divided between Democrat and Republican in our voting.  If we treat roughly half the country as the enemy, we will descend into war.  It might not be armed conflict with guns and bullets, but it will be war all the same.

               I know I’ve said this before, but if we are to tackle the challenges we face, we must answer the question of who we are as a country.  Are we truly the United States of America – united despite our different opinions, races, origins, genders, political affliations, etc?  Or are we going to throw that away and become the Untied States of America?

*Democrats held 58 seats in 2013 and 2 independents caucused with them to effectively create a 60 seat majority.

The Case for Universal Health Care

               In my previous post I laid out some of the issues with our health care system and attempted to propose a middle ground for a public option with a neutral board overseeing pricing negotiations.  In this post, I want to take the opportunity to argue for Universal Health Care.  I realize this is a strongly left position and one not often palatable to those on the right.  I may be a bit off here, but I think the biggest objections are rooted in two principles of the right:
1) General objection to any expansion of the federal government
2) General belief that the free-market will always provide better services than the government.
These two principles seem reasonable on the surface, but I think they fail under closer scrutiny.

               When it comes to health care, these two principles are intertwined and yet separate issues to be addressed.  I’ll start with the expansion of the federal government and work quickly into free-market issues.  There are several ways in which government is the primary provider of services to the public, most of them having to do with public safety and protecting the citizenry.  We all pay taxes to support our local police and sheriff departments, state police department, and the FBI.  All of these organizations are government entities designed to protect the welfare of the citizenry.  These services are considered essential to the public good.  I think most of us cringed when we read this story of a fire department deliberately watching a house burn.  It just seemed wrong.  Regardless of the issues behind it, the fire department came across as cold and callous.  The story violated our sense that the fire department is there to serve and protect us. 

               How does this relate the health care?  It comes down to viewing quality health care as a public safety issue.  Many communities in the U.S. have free vaccine clinics.  Why? Because studies show that getting vaccinated early can provide a lifetime of protection and not just for the vaccinated individuals.  There are individuals within our society who cannot get vaccines because of severe medical issues that leave them immune-compromised.  Vaccinating those who do not have a clear medical reason preventing it provides herd immunity to the vulnerable.  Visit vaccines.gov for more information.  Vaccines aren’t the only public safety aspect of health care.  Roughly 28 million Americans were uninsured at the end of 2015.  Those 28 million people have one place to go for care – the ER.  Probably the single most expensive entry point to the health care system.  And these people aren’t going for a simple case of the sniffles.  They’re going because they think it’s a heart attack or they’ve had a headache for 3 straight days that turns out to be an undiagnosed brain tumor.  These treatments are expensive and the hospital probably isn’t going to be able to collect on the full bill.  Either the hospital will settle the charges with the patient and write off the rest as a loss or the patient will file bankruptcy and the hospital will write off the uncollected balance as a loss. 

               In a free-market system, operating at a loss is simply unacceptable.  Companies must make a profit, and preferably a bigger one than last year.  (Note, it simply is not possible to continue to make larger profits year after year).  This is why hospitals (and, to a lesser extent, other companies) build in anticipated losses into the cost of their products and services.  Wal-Mart knows it is going to suffer some loss due to theft, bounced checks, food spoilage, etc.  Wal-Mart also needs to make a profit.  So, that t-shirt that cost $2 to make sells for $10.  Hospitals and the entire health care system do the same thing.  The difference is the cost.  Open heart surgery isn’t cheap.  A stay in an ICU ward for any length of time can add up real fast.  Pile on a similar mark-up in price and now that hospital visit that cost them $20k sees the patient getting billed $100k.  Yes, insurance will cover some of that, but even a typical 80/20 split leaves the patient on the hook for a $20k bill.  Sadly, most Americans don’t even have $1000 in savings, let alone $20000.  In fact, 1 in 3 Americans has no savings at all.  It’s pretty hard to pay for an unexpected stay in the hospital when you have no savings.  I don’t want to take away the need for individual responsibility, but without really understanding the reasons why Americans have little to no money saved up for emergencies, I find it hard to simply blame the problem on irresponsibility. 

               If we remove the free-market need for profit from the cost equation, imagine the change in what we pay.  In fact, change the entire dynamic to running health care as a non-profit government run charity.  In this scenario, costs are not overly inflated to cover expected losses.  Services are charges at, or just slightly above, cost.  Taking a loss because someone can’t pay isn’t a big deal because we aren’t worried about making a profit.  Assuming we use taxes to fund the health coverage (like we do for Medicare) then everyone is still paying something into the system.  The other advantage here is that consumers no longer have to play the game of trying to find an in-network provider.  Anyone who has ever had any long-term illness or needed emergency care knows the challenges in finding an in-network provider outside your normal locale.  If I’m traveling someplace, I actually check to see where in-network providers are before leaving.  Not too onerous if I’m staying in Indiana, but it gets to be a real pain if I am traveling out of state.

               In the end it really comes down to how we think about those words from the Declaration of Independence – “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty, and pursuit of Happiness.”  Do you consider quality, affordable health care as essential to securing our “unalienable Rights?”  If so, then that would imply that there should be a guarantee that every single American should have coverage.  Following that line of thought leads me to believe that the best way to ensure that every American has access to quality, affordable health care is through a single-payer Medicare for all type system.

               I know some will disagree with me and so I have two questions.  1) Do you believe that access to quality, affordable health care is essential to securing the Rights our Founding Fathers fought for? Why?  2) If yes, how do you propose to provide that health care for all Americans without using some form of universal health care?