Congress’s Struggle Over Health Care: The Path to Nobility

Congress’s Struggle Over Health Care: The Path to Nobility

In January, I reflected on the wisdom of promising. The inspiration was the task before the new Republican majority in Washington: to fulfill their promise to repeal the Affordable Care Act (ACA).

Opposition to Obamacare is almost a Republican article of faith. Nonetheless, even with majorities in both houses, Republicans are finding it difficult to strip the ACA from the statute books.

There’s some irony here.

There is much to criticize about the Affordable Care Act. The process by which Democrats ultimately rammed it through left even supporters dissatisfied and concerned. Subsequent experience has revealed several areas in which the legislation has fallen short of its goals. The larger question, whether its goals and methods were the right ones, remains a subject of intense disagreement, even among Democrats.

Had Republicans promised to create a more cost-effective health care system, or to reduce burdensome regulations, or any number of other promises, two things would have been different than they are today. One, Republicans would not have been as vulnerable to attack from their own right flank for failing to keep their promise.  Two, some (possibly many) Democrats would have offered their support as Republicans sought to improve both health care and the economy.

The net result: the odds that Republicans would keep their promise and do so in a way that Americans would view as helpful, not harmful, would have been much greater.

So perhaps the lesson here is less about the wisdom of promise-making than I thought. Maybe it is about the form our promises should take.

A promise to buy a specific make and model of car for a member of our family is less prudent than a promise to make sure they have the transportation they need. The car they love in the abstract might prove a bad purchase in practice.

A promise to send our child to a specific university is less prudent than a promise to send them to college. The love of a campus or tradition may, upon careful consideration, fade in favor of an institution with the programs and resources that match our child’s needs and aspirations.

And a promise to repeal a specific act of legislation is less prudent than a promise to address problems that act caused or sought to address.

Had Democrats and Republicans spent these last seven years negotiating health care reform, rather than jousting over a specific law, health care today might be more affordable, and we might have better care. Instead, we have a lingering war of words.

Democrats have banded together in opposition to Republican efforts like a medieval town securing its gates against carriers of the plague. Meanwhile, Republicans present themselves as knights errant promising to slay the evil giant known as the Affordable Care Act.

But those knights today resemble Don Quixote, and the ACA giant is proving to be a windmill, built on a surprisingly strong if crumbling foundation and, in some ways, seen by many as essential to the well-being of the people.

The fictional Don Quixote made the ‘giant’, not the people the giant might threaten, the focus of his quest. He vowed to defeat the giant, believing that the path to nobility lay there.

He was wrong.

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