In his new book, Dangerous Convictions, Allen details how both Democrats and Republicans struggle to understand opposing views, which often makes compromise nearly impossible. In the excerpt below, Allen uses the battle over health care reform to illustrate our broken political system.
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The congressional debates over health care reform during the Bush and Obama administrations exposed the underlying clash of ideas and values that breeds the polarization about which the press and public complain. I spoke to countless rooms of people about the crisis in the American health care system. Often, the room was divided between those who believed health care should be available to everyone, regardless of wealth, and a smaller number who believed they should not be required to share the costs of illnesses or accidents suffered by others. It’s not that the latter group was cruel-hearted; many undoubtedly gave generously to churches, temples, and charitable efforts. But many also harbored the view that the poor brought on their own misfortune. The factions had fundamentally different moral views.
This dichotomy mirrored the various perspectives on the role of government: one believed that only the federal government could expand coverage and contain the excesses of the health insurers, and the other believed in “free markets,” even in health care. Advocates for comprehensive reform typically found it intolerable that millions of Americans lacked both adequate insurance and health care. Opponents typically preferred to do nothing rather than to expand the role of the federal government.
It is harder to understand that attitude among members of Congress, who meet thousands of their constituents every year. I visited subsidized housing facilities whose residents, mostly women, lived on $700 a month and were unable to pay for their prescriptions. I talked with students forced to leave college because of health issues, who then lost their health insurance when they left. My staff dealt with hundreds of constituents struggling with inadequate care and no insurance. The thought often ran through my mind, “How do Republican congressmen respond to these personal stories of neglect and lack of care?” I don’t know.
In short, each side finds the position of the other incomprehensible. That’s why my Democratic colleagues concluded that Republicans must be completely beholden to the health insurance and pharmaceutical industries, and Republicans concluded that Democrats wanted to expand the power of government for their own political purposes. The bottom line is that compromise on major reform, even the Affordable Care Act in 2009–10, was never realistic.
Before that bill passed the House I ran into a Republican colleague in Washington. He complained that the minority had been denied the opportunity to offer amendments. But when I suggested that even if given that chance and the amendments passed, he still couldn’t vote for the bill, he agreed. When the congressional minority party, Republican or Democratic, complains about being denied the opportunity to amend a bill, extend the debate, or a similar process issue, the real objection is almost always about the substance. The mainstream media typically gives too much credibility to the red herring of abuse of process claims and not enough to the decisive conflict of values and ideas.
A sign at a Tea Party rally in 2010 read: “Big Government Means Less Individual Freedom.” President Obama told a town hall audience: “I got a letter the other day from a woman. She said, ‘I don’t want government-run health care. I don’t want socialized medicine. And don’t touch my Medicare.’” That’s the level at which major political issues are fought today. The concept that better (or even some) health care, or more education, or improved services for children can create opportunity for Americans rather than limit them, or that government services need not make beneficiaries “dependent” is rarely debated in specifics—where evidence might matter.
When one side will only debate vital public issues in terms of “big government” and “individual freedom” instead of the nuts and bolts of policy, no amount of evidence can stop our slide to intensifying polarization. Meanwhile, the people without adequate care and the businessmen and women struggling to provide coverage for their employees could only wait—and wonder when relief might come. That question for millions is now tied to whether the systemic changes signed into law by President Obama can survive the continued relentless attack from the Right during the next few years.
The full-throated Republican opposition to the ACA, including the appeal to the Supreme Court, masked the underlying reality that they had no alternative proposal to expand coverage to the more than thirty million (of the fifty million now uninsured) projected to gain coverage under the ACA. I believe that if the Republican leadership had somehow been forced to produce a plan for comparable coverage, they would have relied on a somewhat less regulatory, competitive private insurance market with either an individual mandate or tax penalties or inducements to achieve the same result. In other words, they would have adopted legislation much like the bill they condemned. They had no free-market option that could expand coverage to millions of Americans for whom the current free market was impossibly expensive.
In the last two decades, despite the increasing saliency of health care concerns, no national Republican leader offered a plausible plan to expand coverage. There were, I believe, two reasons: (1) politically it wasn’t necessary to respond to their base, and (2) conceptually they could not escape the confinement of “smaller government, lower taxes.” Those core principles and the absence of any countervailing conservative principles took Republicans out of the health care coverage debate—except to say no to Democratic proposals. In that effort, they isolated the part of the ACA that by its very name would in America arouse intense opposition: the “individual mandate.” For a party sliding down a road of ever-increasing hostility to government, there could hardly have been a more inviting rhetorical target.
The equally troubling conclusion is that the combination of forty million to fifty million uninsured Americans and the financial consequences for American businesses large and small was not enough to make health care reform a pressing issue for both parties. In every congressional district there were thousands of people struggling with the costs and consequences of an inadequate health care system, and hundreds of businesses burdened by rapidly increasing insurance premiums. But that was not enough for Republican congressional leaders to develop an updated version of the 1989 Heritage Plan. The party’s fierce opposition to government action in health care ensured that their only viable political choices were small-bore proposals allowing insurance companies to sell policies across state lines medical malpractice limitations, and health savings accounts. In the end the ACA, although it included significant conservative ideas, attracted only Democratic support.
The legal challenges to the ACA reached the Supreme Court in March 2012. After listening to conservatives on the Supreme Court repeatedly describe the issue as “freedom,” one commentator wrote, “It’s about freedom from our obligations to one another . . . the freedom to ignore the injured, walk away from those in peril . . . the freedom to be left alone . . . the freedom to live like it’s 1804.” The clash of worldviews that played out in the political, legislative, and courtroom debates over Obamacare was intense and irreconcilable primarily because it was so abstract.
In the two years after its enactment Republicans had frequently claimed that they would “repeal and replace Obamacare.” After the Court upheld the law, Sen. Mitch McConnell was pressed three times by Chris Wallace on Fox News to explain how Republicans proposed to cover the thirty million Americans who would be covered under the ACA. McConnell’s response was, “That’s not the issue.”
WALLACE: You don’t think the thirty million people who are uninsured is an issue?
MCCONNELL: Let me tell you what we’re not going to do. We’re not going to turn the American health care system into a western European system.
It would be hard to find a clearer contemporary example of how ideological principles devalue people. Tens of millions of uninsured are “not the issue” because a libertarian ideology has no room for their problems and no respect for “western European” systems that provide near-universal coverage at lower cost and with better health outcomes than our own system. At some point, there is a moral equivalence between leaving millions of Americans stranded with the health and financial risks of being uninsured, and walking by a stranger lying bleeding in the street. And at nearly fifty million insured, we have long passed that point.
In NFIB v. Sebelius the Supreme Court upheld the central components of the ACA, including the individual mandate, although under the taxing power of Congress, not the Commerce Clause. Justice Roberts’s opinion protected the Court from being perceived as an institution driven entirely by conservative politics and yet confined the reach of the Commerce Clause for potential future cases. The Court’s resolution of the constitutionality of the ACA, passed by Congress without a single Republican vote—despite its conservative roots—will leave health care reform as another example of how deep-seated convictions about dependency, liberty, and the role of government can render nearly impossible the bipartisan congressional engagement that our largest, most complicated and pressing challenges require.
If you enjoyed this excerpt, purchase the full book here.
Reprinted from Dangerous Convictions: What’s Really Wrong with the U.S. Congress by Tom Allen with permission from Oxford University Press. Copyright © 2013 by Oxford University Press.
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