Wednesday, June 14, 2017

Maybe health care CEOs are just greedy and don't care about people

Almost every segment of the health care industry technically opposes the new Republican health care bill, but overall the industry's opposition has been rather tepid. David Leonhardt at the New York Times offers this explanation:

Why haven’t the big lobbying groups done more? I think there are two main answers. First, in past campaigns, groups were largely defending their own financial interests. People fight hard when their own money is at stake. Today’s opposition is at least as much about principle as profit, and lobbying groups haven’t been willing to go all-out for principle. 

Second, the groups are wary of attacking the Republican Party, given its current power. “We’re living in a world in which it’s just Republican votes,” one lobbyist told me. Speaking loudly against the bill risks alienating powerful politicians — and risks making the health care groups look partisan.

I think there is a much simpler solution. Health care CEOs are just greedy and really don't care about regular people who might need care.

The American Health Care Act would cut government spending on health care by cutting poor people off from insurance. This would marginally cut health care companies' profits, so you would think health care companies would strongly oppose it. But the law would also be a big tax cut for the rich

Leonhardt acknowledges as much in his column: "Virtually every big health care group views the Republican plan as a disaster, one that would harm many Americans largely in the service of cutting taxes for the wealthy."

The simple fact is, lobbying by large health care companies is directed by industry CEOs and other top corporate officers. All of these people will see their taxes cut by the law. Even if the law makes their companies slightly less profitable on net, most will likely be personally better off. The fact that the law would hurt a lot of poor people simply doesn't bother them that much.

There is plenty of evidence to suggest health care industry leaders are willing to put personal and corporate gain above the public good. During the negotiation with President Obama over the Affordable Care Act, the industry's top demand wasn't "make sure everyone has coverage." Instead, PhRMA pressed Obama to oppose drug re-importation and to keep Medicare from negotiating drug prices; this kept drug profits high. Similarly, hospitals wanted the ACA to omit a public option that would reduce their profits. The hospitals made this demand knowing full well that the absence of a public option would increase costs, resulting in the law covering fewer people.

For many rich people, greed is more motivating than principle. In many cases, greed is what drove them to become rich in the first place. Leonhardt writes, "I feel a pang of discomfort every time I describe the radicalism of today’s Republican Party." It can also be uncomfortable to acknowledge that many people are simply greedy.

Friday, June 2, 2017

A party's platform is about succeeding after the election

Since the national Republican and Democratic parties divide themselves along ideological lines, American politics has followed a very predictable pattern. It is defined by a punctuated equilibrium.

One party wins total control of Washington and has a brief moment to make a big impact. Inevitably, the party in power messes up and loses control of Congress. This is followed by a period where little happens until the opposition also wins the White House. The other party now has their tiny moment to make their mark-- until they mess up.

The Republicans didn’t win in 1994 -- the Democrats lost. The same is true for the Democrats' 2006 victory and the GOP's 2010 victory.

Each time, the party in power screwed up badly and could have been beaten by a group of monkeys in clown suits. Bill Clinton's job approval rating was terrible heading into the 1994 election, due to failed health care and energy tax plans. In 2006, George W. Bush owned the failed Iraq war and the aftermath of Hurricane Katrina. By 2010, Barack Obama had failed to respond to the massive housing crisis or go after anyone who caused it. People spend a lot of time studying winners to divine the secret to their success, but often the answer is they were just facing super easy opponents.

This is why an opposition party shouldn’t focus on simply winning again at all costs: that is mostly determined by the party in power stumbling. They should focus on what they want to do once they do win. These brief moments when a party has total control are the rare times anything big happens, but it only happens if the party is united behind a set of ideas.

Taking advantage of these moments of total control is also critical because of one other major characteristic of American politics: we almost never reverse legislation. Once a policy is enacted, it tends to stick. No matter how much the opposition rallies against it and promises to repeal, they almost never do.

Democrats in 2008 rallied against the corrupt Medicare Part D law, the Bush tax cuts, and Guantanamo Bay. Yet after they gained power, Obama pushed to keep the corrupt Medicare Part D deals intact, backed a law to save almost all the Bush tax cuts, and never closed Guantanamo. Similarly, the Republican party ran on the promise to “repeal and replace” Obamacare for years, and now their effort is bogged down in the Senate.

Trump has become the poster child for why a party shouldn't do anything to win, just for the sake of winning. With a lack of cohesion and discipline, the GOP is possibly squandering their moment for the next decade.

Democrats have become very focused on beating Trump, but Trump is going to do most of the work defeating Trump. The real focus should be on what they will do in that moment after.