Johnston and Yurgine: Is the super majority ignored?

March 24, 2019

Joe: Tim Wu is a Columbia law professor. He has written an interesting essay on how the defining political fact of our time is not polarization but the oppression of the super majority. As examples, he cites 67 percent of Americans favor paid maternity leave, but Congress refuses to enact such a law. Ninety-two percent favor background checks for all gun sales. Same result. The list continues. Looks like we have representatives in Congress who can’t deliver on what the super majority of Americans want. How should we correct this, if at all? (Hint: Follow the money).

Ken: You didn’t say where we are going with this. I’ll just say those poll results show everybody wants something different from government. Before enacting another expensive entitlement, legislators need to make sure it’s affordable and all the details are covered. Right now, most of congressional energy is going into investigating the president.

Joe: The point of Tim’s article is that on many important policy issues, Americans are not divided. There is just an inability for large majorities to get what they want on certain issues. Take universal health insurance and Medicare for all, an issue 70 percent of Americans according to one poll favor, and which again according to polls is more of a concern than immigration. Is the will of two-thirds of the population supposed to be ignored by Congress? When I mentioned, follow the money, Congress doesn’t pay attention to what we want. Instead, they do what the large corporate and individual donors of its members want. As I recall, in a back article, you indicated you favored a single payer health system for all Americans. Is that still the case, and, if so, as a retired doctor, what is your reasoning for this?

Ken: Polling is an imperfect science. A lot depends on who is polled and the way the question is phrased. Recall all the polls in 2016 favored Hillary Clinton by 5 percent up to 15 percent. I do lean toward a single payer nationwide plan for two reasons — Medicaid patients get the shaft for access to care, and doctors and hospitals get the shaft for reimbursement for providing care. I believe replacing Medicaid would do much to fix the U.S. health care metrics gap in comparison with other developed nations. The big problems with O’Care are that it was based on expanding the Medicare program, and the cost of eliminating “pre-existing conditions” largely fell on middle-class families buying O’Care insurance. Considering commercial insurance companies are profitable, why can’t Washington scoop up the dollars families would otherwise pay for commercial insurance to pay for the program? Of course, the socialists would finance health care by giving anyone who can afford to drive a Buick and up a real close haircut.

Joe: So, you are becoming a disciple of Bernie Sanders on at least one issue, namely Medicare for all. Who would have thought? There are a lot of different proposals out there regarding single payer, so let’s define it as a government system that handles the financing backed by taxes, where everyone gets health care run by the government. This, as you indicate, would do away with Medicaid. It also would wipe out the health insurance industry, the overlords now in control in the driver’s seat, such as when they informed you when you were in your ENT practice that they were not going to pay for a tonsillectomy you recommended for a patient. The insurance industry also controls premiums,which they raise about 4 percent per year, and we pay for all their administrative costs, which are plus 14 percent. Medicare overhead amounts to about 2 percent of its expenditures. In 2017 the CEO of Aetna Insurance reportedly made $59 million. All of this explains why health insurance companies (which as you note are very profitable) donate a lot of money to the campaign chests of Republican congressmen who strongly oppose Medicare for all. I join you in leaning toward single payer, which is fair, benevolent, cheaper and not dysfunctional, all reasons which, unfortunately, are insufficient to overcome the pernicious effect of money.

Ken: Socialist no; pragmatist yes. It’s an accepted fact that once enacted, government can’t take back an entitlement. I believe O’Care never was meant to be the long-term solution but was slapped together to break down the barriers. Too complex. No solution to escalating costs, which weighed disproportionately on middle-class workers. It would be nice to get the next iteration right on the first try. Maybe the John Roberts decision about government selling a mandatory insurance product within constitutional boundaries will prevail — just call it a tax. The details need to be crafted by a transparent process with input from every involved sector, not solely the Washington bureaucracy. And there still would be an opening for commercial insurance to sell “Medicare-For-All” supplemental policies. Finally, the answer (partial answer?) to the negative effect of lobbyist cash is term limits. We can dream.

Joe: Which brings us back to the beginning. There is a M&A poll that shows 82 percent of American voters support term limits for Congress, which again highlights Tim’s point that large majorities do not get what they want on a lot of issues. The political system is financed and lobbied heavily by corporations, industries, and special interests who have a stranglehold on Congress.

Ken: These are times when American government is highly polarized and dysfunctional and federal power is divided. The parties have locked horns like never before. Thus, given the constitutional checks and balances, the wheels are turning slowly. I heard a cable news contributor liken our time to the lead up to the Civil War. Assuming the media hangs left and the military right, is the pen really mightier than the sword? Hopefully, we won’t find out.