Tribalism Over Wisdom: Health Care Reform Just Because

Honestly, I don’t really like talking about politics, especially when the NBA playoffs are going on, but I think the new health care bill that just passed the House is worth discussing because it highlights so many things that are wrong with politics.  The American Health Care Act barely passed the House and will await the decision of the Senate, and it is, predictably, quite controversial.

I’m not going to discuss all the details of the bill and its differences with the ACA.  One reason is because, quite frankly, my understanding of healthcare does not go much deeper than surface level.  I’ve tried to do some reading on the bill, but I’m not going to sit here and pretend to be a policy expert on it.  Secondly, my aim is not even to defend or criticize the details of the bill over and against that of the ACA, though some details will arise.  My main purpose is to talk about the danger of political expediency over wisdom and the climate of political tribalism, a climate that makes it difficult to have honest, civil, and intelligent dialogue.

“We hate it because the other guy’s name is on it.”

There are Youtube videos of people ripping the Affordable Care Act (“Obamacare”), but when they are asked if they like such and such central provision (without being told that it’s in Obamacare), they respond with full support.  Liberals treated these people with contempt, and they kind of had a point.  This is not to say that Obamacare was good legislation, but it would be nice if some people would avoid opposing it just because Obama and the Democrats were responsible for it.

Fast forward to AHCA (“Trumpcare”), a bill that actually keeps many of the central provisions of Obamacare in one form or another (example: the individual mandate would be replaced by a continuous coverage penalty).  Despite this, many liberals have decried it as the worst thing ever.  There are actually fantastically stupid headlines that claim that the bill will make rape a pre-existing condition that insurance companies will use to avoid paying for rape-related injuries (seriously?).  You can also find many liberals who oppose the bill because it is associated with Trump and the Republican Party, not because of any knowledge of the bill itself.  Again, this is not to say that the bill is good (in fact, it has uniquely made both conservatives and liberals angry), but making exaggerated claims is not exactly helpful.

This is why reasoned discourse in this country is so hard now.  Instead of a sober analysis of the AHCA, the ACA, and the pro and cons of each (and other proposed solutions), it becomes a mudslinging contest of emotionalism and tribalism.  Even Jimmy Kimmel’s heartfelt monologue about his newborn’s surgery contributes to the problem.  Kimmel was sincere and everyone is glad that his son is okay, but the implication of what he said is that people who disagree with the ACA wanted his son and other children to not receive any medical treatment, which is neither true nor helpful.  The fact of the matter is that if there is an emergency situation, any hospital is going treat you, regardless of your insurance situation.  Now, the cost of it will be greatly impacted by insurance (and I have personal experience with this), though low-income patients often receive a lot of charity to help ease these bills.  Still, no hospital is going to watch a kid die, and nobody on either side of the aisle wants it to be legal for healthcare professionals to let kids die simply because they do not have insurance.

The complexity of the issue… or any bill, for that matter

Here’s the thing about any healthcare bill: It’s going to have to try to regulate a very complex issue for 320 million people.  In all likelihood, no bill is going to work favorably for every single individual.  This is why anecdotal evidence cannot be the basis for policy.  For every person who says they were screwed by a bill, there’s going to be someone else who tells a story about how that bill greatly helped him.  For the ACA in particular, there are a ton of middle class families who could not continue their previous insurance and then watched their premiums skyrocket for lesser plans.  On the other side, many lauded the ACA because they were able to find plans that they previously could not afford.  Who’s right?  Counting grievances on one side or the other can be an endless game.  Personal experience is still important to prevent policy discussions from becoming too abstract, but at best they should be concrete examples of arguments, not arguments themselves, and there is always someone else who has a counter-experience.

Here are a handful of reasons why healthcare is complex and has no easy solution:

-I’ve had lung surgery twice, and all that fancy equipment they used to perform the surgery and help with recovery require R&D.  You know what R&D is?  Expensive.  You know what’s bad?  If companies don’t get money for research and development because then there is no incentive for it.

-Many healthcare professionals, especially doctors and surgeons, have to jump through a lot of hoops to get where they are.  Many are six figures in school debt when they walk out of medical school, and they still have to find residency, pass exams, and then finally get a job.  Throw in malpractice insurance, which varies by state, and you have professionals who should command high salaries.

-Hospitals and other medical organizations, on average, recoup only a small percentage of what they bill.  That’s because many people don’t even bother to pay a bill at all, and that cost is often distributed to everyone else.  This is why the healthcare organizations (radiologists, surgeon, etc.) were excited that I even called to try to pay my bills back and would literally take any amount per month to see it happen.  Part of this might be the healthcare industry’s fault, but there seem to be a variety of factors for this.

-Insurance companies need to make a profit too or they’ll cease to exist.  That’s why they charge higher premiums for higher risk consumers.  Such a practice is not heartless in itself because it makes sense: The higher the risk of a large payout, the more a company has to charge monthly in order to balance out that risk.  To help lower those costs, there needs to be healthier, low-risk people in the system, but then you run into questions about how much the government should tell people how to spend their money.  In addition, when higher risk people are included and the insurance companies cannot deny them or charge them high premiums, those costs are then borne by everyone else, which is one cause of the aforementioned price spike for middle class people.

I’ll stop there.  My point is this: Bumper sticker arguments and emotional accusations are useless because this is not an easy issue.  It also requires some time and wisdom to deal with, but while Obama’s administration may deserve some criticism for ramming the ACA through Congress despite a lot of opposition and despite their own promises that they’d try to be bipartisan, at least they spent over a year on the thing.  Trump’s administration is trying to ram a healthcare bill through in a few months, and the result is a bill that even conservatives don’t like.  Good job.  But least it’s not “Obama”care, right?

Why not wait?  Why not get a team of smart conservatives to hammer out a bill over the next year, get into rational discussions with Democrats (especially more conservative Democrats who might be feeling a little out of place in an increasingly radical Left)?  I get that Trump promised to repeal Obamacare, but that doesn’t mean everyone wants shoddy legislation to replace it.  You can’t make everyone happy, but that at least shows some measure of wisdom and it will at least please his voting base.


Militant and emotional tribalism will get this country nowhere, and both sides of the aisle are getting worse and worse about that.  It’d be nice if Donald Trump was a calm, thick-skinned, and even-headed leader, but alas, he isn’t and never was, so he’s wasting time in a spitting contest with an extremely biased media that hates him while no real policy gets done.  It’d also be nice if the media would actually care about reporting things in a reasoned and unbiased manner (as much as humanly possible), but we’ve gotten to the point that they aren’t even trying to pretend that they’re interested in doing that.  And then we have air-headed people fall in line with whatever side they choose.

So screw it, back to basketball.


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