Hyp­o­critic vs. Hip­po­cratic

Dis­trust makes real progress dif­fi­cult

Northwest Arkansas Democrat-Gazette - - VOICES - Hoyt Purvis

As the na­tion con­tin­ues to stum­ble and bum­ble along a path that might lead to a rea­son­able, man­age­able health-care sys­tem, the is­sue is con­sis­tently dom­i­nated by po­lit­i­cal con­sid­er­a­tions rather than le­git­i­mate con­cerns about af­ford­able and ac­ces­si­ble med­i­cal care.

The sub­ject of med­i­cal care brings to mind the Hip­po­cratic Oath, his­tor­i­cally sworn by physi­cians en­ter­ing the pro­fes­sion, pledg­ing to up­hold high eth­i­cal stan­dards and do no harm.

What we have seen with all the squab­bling, blam­ing and se­cret con­claves over health-care leg­is­la­tion, and in po­lit­i­cal ac­tion in gen­eral, sug­gests there might be a “Hyp­o­critic Oath” as hypocrisy ap­pears to be the pre­vail­ing mode of po­lit­i­cal be­hav­ior.

At this point the fate of health-care leg­is­la­tion is un­clear. What is clear is it is more a po­lit­i­cal is­sue than a pol­icy is­sue, even though there are highly im­por­tant pol­icy is­sues in­volved. It ex­em­pli­fies the sad state of our politi­cized and po­lar­ized public af­fairs.

Eight years ago, I wrote that if de­bate and de­ci­sion-mak­ing on over­haul­ing the health-care sys­tem could be con­ducted in a vac­uum we might see some real progress. But as long as we treated it as a po­lit­i­cal is­sue, mean­ing­ful ad­vance­ment would be dif­fi­cult. Mak­ing that prognosis didn’t re­quire rare in­sight but rec­og­nized the com­plex knots and hard­ened po­si­tions in both par­ties.

While Pres­i­dent Obama was still in of­fice, the House of Rep­re­sen­ta­tives reg­u­larly voted to re­peal and re­place Oba­macare, know­ing, of course, that Obama would never sign such leg­is­la­tion. As can­di­date and pres­i­dent, Don­ald Trump re­peat­edly said ít would be “so easy” to re­peal and re­place on Day One. How­ever, once Congress was ac­tu­ally deal­ing with the is­sue, he con­ceded that it would be “very tough.”

Al­though the ACA won con­gres­sional ap­proval with­out a sin­gle Repub­li­can vote in 2010, contrary to public per­cep­tion the bill con­tained nu­mer­ous Repub­li­can ideas and amend­ments.

This year, when con­gres­sional Repub­li­cans be­gan to con­sider the sub­stance of leg­is­la­tion, it be­came ap­par­ent that even with a Repub­li­can as pres­i­dent, they weren’t re­ally pre­pared — de­spite those years of pre­sumed prepa­ra­tion while Obama was in the Oval Of­fice.

The non­par­ti­san Con­gres­sional Bud­get Of­fice es­ti­mates the re­vised Se­nate Repub­li­can health-care bill would in­crease the num­ber of unin­sured peo­ple by 22 mil­lion peo­ple over the next 10 years if it passed.

Even though Trump de­rided the bill passed by the House as “mean,” he or­ches­trated a big cel­e­bra­tion at the White House. How­ever, it raised more ques­tions than an­swered, and when a small group of Se­nate Repub­li­cans headed by Ma­jor­ity Leader Mitch McCon­nell met be­hind closed doors (so much for trans­parency) the re­sult­ing pro­posal did not sat­isfy all those on the Repub­li­can side.

A good ex­am­ple is West Vir­ginia Repub­li­can Sen. Shel­ley Moore Capito, who said, “I didn’t come to Wash­ing­ton to hurt peo­ple,” ex­plain­ing her stand against her party’s pro­posal to re­peal Oba­macare with­out a re­place­ment plan. She noted that her state had sig­nif­i­cantly ex­panded Med­i­caid un­der Oba­macare (as has Arkansas and 30 other states). Arkansas Repub­li­can Gov. Asa Hutchin­son said, with more than 300,000 in the state on the ex­panded Med­i­caid pro­gram, the Se­nate bill would shift too much cost to states. He sug­gested a bi­par­ti­san ap­proach is needed. How­ever, hard-lin­ers in both par­ties have shown no in­ter­est in find­ing com­mon ground.

At one point, Trump said, “We’ll let Oba­macare fail, and then the Democrats are go­ing to come to us.”

Arkansas Repub­li­can Sen. Tom Cot­ton said, “Oba­macare is hurt­ing lots of Arkansans” and con­tin­ues to fa­vor re­peal and re­place. Na­tional polls, how­ever, in­di­cate de­clin­ing sup­port for do­ing that. While Trump un­doubt­edly has strong sup­port in Arkansas, ac­cord­ing to the lat­est Talk Busi­ness & Pol­i­tics- Hen­drix Col­lege sur­vey his job-ap­proval rat­ing in Arkansas has gone from a 60 per­cent-35 per­cent ap­proval-dis­ap­proval rat­ing in Fe­bru­ary to just 50-47 cur­rently.

Trump has sent mixed sig­nals on the leg­is­la­tion, but af­ter the bill failed in the Se­nate, he wanted to make clear that “I’m not go­ing to own it.” Un­like Harry Tru­man, he didn’t as­sert that “The buck stops here.” He tweeted, “We were let down by all of the Democrats and a few Repub­li­cans.”

Re­gard­less of where you as­sign the re­spon­si­bil­ity, the episode demon­strates again the po­lar­ized and politi­cized at­mos­phere that per­vades Wash­ing­ton.

Trump boasts that he has com­piled an ex­tra­or­di­nary leg­isla­tive record, sur­pass­ing those his pre­de­ces­sors in the open­ing months in of­fice. How­ever, the leg­isla­tive record is ac­tu­ally very thin, mostly rou­tine mat­ters. He has signed high-pro­file ex­ec­u­tive or­ders, in­clud­ing with­drawal from the Trans-Pa­cific Part­ner­ship, and, im­por­tantly, his Supreme Court nom­i­nee won Se­nate ap­proval, al­though it re­quired McCon­nell chang­ing Se­nate rules to lower the thresh­old for ad­vanc­ing Supreme Court nom­i­nees from 60 votes to a sim­ple ma­jor­ity – the “nu­clear op­tion.”

“There is such a pro­found lack of trust be­tween the two par­ties,” said Maine Repub­li­can Sen. Su­san Collins. “It’s hard to know whether the po­lar­iza­tion in the Se­nate re­flects the coun­try or whether the po­lar­iza­tion and di­vi­sive­ness af­fects the coun­try.”

There are more po­ten­tial con­fronta­tions com­ing soon, in­clud­ing rais­ing the debt ceil­ing. And the air is filled with charges and counter-charges about re­cusals, col­lu­sion, par­dons, staff shake­ups, sanc­tions and leaks.

What we need to see is more of a Hip­po­cratic “do no harm” ap­proach rather than con­tin­ued Hyp­o­critic politi­ciza­tion.

—––––– –––––—

Hoyt Purvis is an emer­i­tus pro­fes­sor of jour­nal­ism and in­ter­na­tional re­la­tions at the Univer­sity of Arkansas. Email him at hpurvis2@cox.net.

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