Tag Archives: Congress

A Retrospective on Healthcare, and Where Do We Go from Here?

800px-Capitol_Building_Full_ViewRegular readers of this blog know that I am not a fan of Obamacare. It is overly prescriptive, too costly, and has been poorly implemented. Readers also know that I have said from the beginning that it needed corrections.

I have never been hung up on whether Congress called it repeal or replacement, as long as our healthcare system was fixed . . . or at least improved.

In November 2013, I recommended the following reforms:

  • Put all forms of health insurance (employer-based and other) on an equal footing
  • Permit a wide variety of insurance plans, from catastrophic plans to high-deductible plans to those with varying levels of coverage and exclusions
  • Provide direct subsidies to the poor and seriously ill so they can purchase healthcare coverage on the open market
  • Repeal the individual and employer mandates

I said,

“In short, the type of healthcare insurance to buy should become a decision that individuals make, not the government. Insurers should be free to design policies that consumers want, and to price them at levels that are profitable. We should abandon the notion that the federal government knows what one-size-fits-all insurance programs are ‘best’ for Americans.”

The Republican bill that Congress could not pass, the American Health Care Act (AHCA), was far from perfect in addressing my concerns, but it addressed some of them. I thought it was better than the Obamacare statute as it exists now. Frankly, the fact that no one liked it made me think the AHCA was as good as we were going to get.

But it went nowhere. Apparently, the split between the ultra-conservative and the establishment branches of the Republican Party is wider than 218 votes, and no bill could bridge the gap.

As the Wall Street Journal stated on March 24, 2017, in The ObamaCare Republicans:

“[The AHCA] worked off the reality that the U.S. health system has changed under ObamaCare and thus an orderly transition is necessary to get to a free-market system without throwing millions off insurance. The GOP also is a center-right coalition with competing views and priorities. The bill had flaws but was the largest entitlement reform and spending reduction in recent decades.”

So, given that Obamacare needs reform, where do we go from here?

I don’t know.

HHS sealHHS Secretary Tom Price can work on regulatory reforms, but only within the confines of the Obamacare language. Some of the most pressing issues are part of the statute and cannot be changed (though the Obama administration delayed some of them, or gave exceptions, and perhaps the Trump administration will do the same). Some of these issues include:

  • The tax on medical devices
  • The details of the mandated benefits (“essential health benefits”)
  • The Cadillac tax on employer healthcare plans, which, if implemented, will suck in more and more employers over time as the cost of mandated benefits rises

The fundamental problem with healthcare in the U.S. is that most Americans have not paid the full cost of their care since the 1930s, when employers began offering medical insurance as a benefit. As with all consumer goods and services, Americans want high quality, high quantity, and low prices on healthcare. Any economist can tell you that you can’t have all three—two of the three is the best you can hope for. The ideal system is often a compromise on all three. When healthcare prices are artificially lowered for the consumer, they make irrational decisions on quantity and quality—overusing the system and expecting Cadillac care for Fiat prices.

In my opinion, our healthcare system will not be fixed until employer-based plans are no longer the preferred way of covering the cost. Don’t get me wrong, many employers do an excellent job of managing their healthcare benefit plans. But the distortion in the market caused by these plans is increasing and is only made worse by Obamacare.

The different tax treatment of employer-based premiums and premiums for individual plans is unfair. The proposed AHCA would have helped in that regard, though it wouldn’t have fixed the problem entirely.

As the Wall Street Journal editorial said:

“An ideal free health-care market is never going to happen in one sweeping bill. The American political system is designed to make change slow and difficult, thank goodness. Republicans have to build their vision piece by piece, carefully gauging how to sustain their policy gains politically—the same way Democrats expanded the welfare and entitlement state over the last century.”

I suppose that’s where we go from here.

What do you think?


1 Comment

Filed under Benefits, Law, Politics

The Best We Can Hope for Is Gridlock

vote-stars1In some states, voting has been underway for weeks. For the rest of us, we have to endure this presidential election campaign for another eight days. A truly ghoulish proposition this Halloween.

For almost all of us, it has been a miserable year. We have two of the least liked candidates for President in our nation’s history. Both have flaws as candidates, with the flaws evident in their personal traits, in their histories in public life, and in their positions on issues. New evidence of their flaws surfaces almost daily, with the latest being the FBI’s announcement on October 28 of its renewed investigation into Hillary Clinton’s emails.

I’ve written before about the difficulty of choosing between two bad options. I keep remembering the quote from Thomas Merton I included in that earlier post: “an evil choice can never have wholly good consequences.”

The more we have learned about Hillary Clinton and Donald Trump over the last year, the more difficult the choice has become. I’ve made my decision. I’ve considered the four candidates on every state’s ballot. I’ve considered not voting in the presidential race (but I’ve rejected not voting at all, for reasons described below). I’m not going to disclose here how I’ll cast my vote in the presidential race, because this year in particular there is no good decision, and I do not fault anyone for reaching a different conclusion than I do.

Instead, the purpose of this post is to urge voters to make independent and thoughtful decisions when they select their choices for all races on the ballot. This is not a year to blindly vote a straight party ticket to avoid making choices in down-ballot races. Whatever the reasons a voter has for choosing a presidential candidate—or for not choosing anyone in that race—there are separate reasons to consider Congressional, state and local races.

Our Constitution deliberately sets up checks and balances on each branch of the federal government. The framers must have considered the potential for unsavory candidates for President. Frankly, having Congress and the Supreme Court as checks on the presidential candidates we have before us this year sounds like a good plan to me.

We’ve had gridlock in Washington for the past six years since Republicans gained the majority in the House of Representatives in 2010. The split deepened in 2014 when Republicans took control of the Senate as well. And it hasn’t been all bad. A lot of people fume about nothing getting done in Washington. But getting nothing done is certainly better than getting the wrong things done. Witness the problems with Obamacare and Dodd-Frank after unfettered Democratic actions between 2008 and 2010.

Those of us who were extremely frustrated at the lack of any effective conservative voice in opposition to President Obama between 2008 and 2010 were happy to see gridlock for the remainder of his presidency. Yes, there are important issues that have been kicked down the road for future leaders. That isn’t good, but again, it is better than resolving these issues in the wrong way.

At this point, the best outcome I see for the next four years is continued gridlock. Because I do not trust either of the individuals likely to be our next President to act wisely (meaning, usually in accordance with my beliefs), I hope that Congress and the Supreme Court will continue to check actions that do not appeal to the majority of our nation or that go beyond the Constitutional powers granted to the President.

I might hope for compromise between divided branches of government, and perhaps that is possible. But I would be satisfied with gridlock, given the alternative.

So choose your candidates for the House and Senate with care. If you don’t have a good option for President, perhaps you have reasonable men and women to vote for in these other federal races. And choose your candidates for state and local races thoughtfully also—these elected officials have a tremendous impact on your daily life, and we can hope that the best of them will be our next national leaders as well. Choose people who will represent you better than the presidential candidates we have.

Whatever you believe, vote on or before November 8. Make your choices thoughtfully and deliberately in every race on the ballot.

1 Comment

Filed under Philosophy, Politics

Negotiation and the Fiscal Cliff

U.S. CapitolAs an attorney, mediator, and Human Resources executive for the past thirty-plus years, I’ve participated in a lot of negotiations. I have to shake my head as I watch our politicians trying to avoid the looming “fiscal cliff” of tax increases and spending cuts. Congress and President Obama are operating in the worst possible circumstances to find a workable compromise to resolve the pending cataclysm.

Here are a few of the problems with how this negotiation is set up:

     1.  Too many parties.

I’ve been in several multi-party negotiations. With every faction added, the difficulty of reaching agreement grows exponentially. It’s like a family with many children – with each child, the family adds relationships between that child and every other already existing family member. With one child, there are only three relationships; with two, there are six; with three, there are ten.

To pass any legislation, the House of Representatives, the Senate, and the President all must agree.  But the House and Senate each has two parties, and there are factions within those parties. We actually have 536 votes involved in any legislation, and we need 217 House representatives, at least 51 Senate members (or 50 and the Vice-President, or 60 Senators with the current filibuster rules), and the President to agree before any bill gets passed.

In fact, our Founders designed this system of checks and balances to require lengthy deliberations before laws are passed. I believe that’s a good thing most of the time, except when it’s not – such as now, when the stakes are high and deadlines threaten.

     2.  Lack of confidentiality

There are reasons that settlement negotiations are usually kept confidential and cannot be used in later legal proceedings between the parties. In order to convince the other side to moderate its position, the parties often need to make disclosures and admissions against interest that they wouldn’t want held against them during trial (or later election campaigns).

We may say we want transparency from our lawmakers, but if they are on the record as being for or against something, it is very difficult for them to back down without losing face. The nature of negotiations requires posturing – no one starts by presenting a bottom-line position. But once someone draws a line in the sand publicly, it is hard to change positions.

Yet in legislative negotiations, we hold our legislators accountable for representing their constituents. This means they have to make their positions public to some extent. Otherwise, how can “we the people” decide if they are representing us well? We don’t want our representatives working in a black hole and then announcing the outcome.  But transparency places our elected officials in a very awkward position in the negotiations.

As Mark Twain said, “Those that respect the law and love sausage should watch neither being made.” They are both messy processes. But a strong representative democracy requires that we watch.

     3.       A long history of arguing, and no mediator

MP900289068The factions in Congress and the White House have been in place for four years now, and the November election didn’t change anything. The current Democrat and Republican leaders in Congress and the President have a history of distrust. Their positions are set in concrete, and it will take a bulldozer to budge them.

Both sides say they want a settlement, but moving away from firmly stated positions is difficult. Both sides need to get something to save face. Yet their history of distrust may mean that they are more interested in seeing the other side lose than in reaching a settlement.

In this situation, there is no mediator, no neutral to bring the parties together. In the past, when the two houses of Congress have been at impasse, a statesman-like president could work to break the logjam. But President Obama maintains a partisan perspective in this debate. There is no one with the stature or trust of both parties who can broker a deal.

It doesn’t help to have non-parties to the negotiation (the media, etc.) who favor one side or the other, and who all pontificate about what their side and the other side should do. Yet that, too, is part of our democratic process under the First Amendment.

Because of these factors, the fiscal cliff negotiations are as difficult as they are important to our economic future.

At the time I write this, we don’t know what will happen. Will we fall into the abyss through inaction or find a way around it? Regardless of the outcome, remember that our political system is perfectly designed to get the result we get.

What else do you see getting in the way of effective negotiations?

1 Comment

Filed under Mediation, Politics