Commentary on Policy and Politics–which includes pretty much everything
Mike Koetting’s career has been in health care policy and administration. But it has always been on the fringes of politics. His first job out of graduate school was conducting an evaluation of the Illinois Medicaid program for the Illinois Legislative Budget Office. In the following 40 years, he has been a health care provider, a researcher, a teacher, a regulator, a consultant and a payor. The biggest part of his career was 24 years as Vice President of Planning for the University of Chicago Medical Center. He retired from there in 2008, but in 2010 was asked to implement the ACA Medicaid expansion in Illinois, which kept him busy for another 5 years.
I am infuriated with the barrage of media comments about Democrats “in disarray” or “being divided”. Hello, boys and girls! This is democracy. People stake out different policy positions, argue about them, and make compromises. It doesn’t happen overnight and hardly anyone winds up totally happy. The issues in the infrastructure package are of mind-boggling complexity and in degree they are all interrelated.
This is what all the people who have been clamoring for “bipartisan” legislation have wanted: debate and measured compromises around policies to make them a better reflection of the varied will and needs of the populace.
Okay, it’s true this is all within what’s nominally one party—although, as the debates have made clear, these poles represent a very large spectrum of American political thought. In that sense, it is the closest to “bipartisan” that America can now get because the Republican Party has simply opted out of policy discussions. They automatically oppose anything that Democrats support and have ceased making policy proposals of their own. Waiting for a meaningful proposal to come from Republicans is waiting to hear the sound of one hand clapping.
Upcoming news will no doubt be full of the imminent big deal Glasgow Climate Summit. But that’s just the political deal. The real deal was the UN report on climate change that was issued in August. It wouldn’t be totally surprising if you don’t remember it since it seems there is a new UN report on climate every couple of weeks that are all variations of the same theme. But suppose you really took note back then. What do you hope for?
Most fundamentally, we should all hope that the 234 scientists who participated in this report got it substantially wrong. They would all admit there are certain margins for error and they would be relieved to be found out wrong.
But maybe you’ve got kids and grandkids and you are worried the reports’ authors might be substantially right about the speed of the trajectory. What then do you hope for?
I assume all readers of this blog are familiar with the current state of play in the massive infrastructure expenditures proposed by the Biden administration. In very short, the Senate agreed on a bi-partisan “hard” infrastructure bill with the idea, among Democrats at least, that a larger ($3.5T at proposal) “softer” infrastructure bill be adopted by House Democrats and be passed by reconciliation in the Senate to avoid a filibuster.
At present, both are stalled in the House over the size and contents of the total package and, as really a subsidiary issue, the process for moving forward. The stall in the House is caused primarily by a small group of centrist Democrats, reinforced by the specific threats of Senators Manchin and Sinema to not support a reconciliation bill that is $3.5T should it get to the Senate. Their argument, made by Joe Manchin in a Wall Street Journal op-ed, is that we can’t afford this much infrastructure.
While I’m reluctant to make iron-clad pronouncements about the future, I think the odds are pretty good that they are just wrong. Also, since it doesn’t require as much future gazing, I think the odds are even better they are not being precisely honest about their motivations, perhaps to themselves as well as the voters.
Among other things, the ongoing controversy over the public health response to Covid serves as a kind of political x-ray machine illuminating the gap between our mental image of how our government works and how it actually works, something that can get lost in the trivia of day-to-day politics.
With the announcement that a third shot (or second for J & J recipients) may be desirable as a booster—arguably running ahead of the science on the issue–many Americans are already jockeying to get one. Understandable. I expect I will get one soon myself. We all want to avoid Covid and the delta variant is scary.
But, at the same time, we also need to consider context. And the key contextual fact is this: unless the virus is brought under control on a global basis, there will continue to be waves of deadly variants. There will be some regardless. The only absolute is the lack of absolutes. But we are talking about speed, size and odds, things that make a big difference in how world-wide reality plays out.
As much as extreme weather conditions have caught our attention, we don’t seem ready to acknowledge those are just the warnings. The main events are the ones that fundamentally change life conditions—persistent lack of water, rising sea levels, acidification of the oceans, loss of species.
At its core, the issue is simply that the environment isn’t free forever. Each action creates a reaction. It’s a system with feedback loops, long and, to a point forgiving feedback loops, but eventually the accounts have to get balanced.
I think it is obvious that one of the duties of a nation is to protect its citizens. But to what extent should this go? And when does it become overreach—either philosophically or practically?
I have been thinking a lot about these issues in recent weeks because I have been thinking about obesity in America. Simply looking at people on the streets suggests that, despite decades of official concern, American obesity continues to rise. The data bear this out. Research published in the New England Journal of Medicine predicts no state will have an obesity prevalence rate below 35% by 2030. In 2000, no state had an obesity rate above 35%.
The Republican Party has gone full-out on equating Democrats with Socialism. That, of course, is absurd. It is absurd not simply because it is so far from accurate but also because the entire distinction between “capitalism” and “socialism” is so dated as to have questionable relevance in today’s world. No serious analysis could call China a purely socialist country or the United States a purely capitalist country.
Just before the 2016 election, I was taking my then five-year old grandson home from swimming. As we drove through a residential neighborhood, he asked what was that sign in someone’s front yard. Then, before I could answer, he announced: “It has a flag on it. It must be for that bad man.” (Trump was, of course, the “bad man.”)
On the way home, I got a chance to look closer. It did indeed have an American flag motif, but it was hardly a Trump poster.
What struck me was that a five-year old had picked up the idea that American flags were emblems of the right. Although this sharpened my appreciation for how much five-year olds pick up, it left me feeling something had gone very awry in the country where, growing up, I started every school day pledging allegiance to the flag of a country that promised “liberty and justice for all”.
In today’s political environment, there is a lot of discussion about thwarting the will of the majority or attempting to establish minority rule. This way of taking about it presumes a majority-minority scale where it is possible to determine particular spots on the spectrum. But the actual structure of American government, for better and worse, includes no such yardstick at the national level. There are a series of independent electoral processes which, historically, come enough together to form a national will in service of a shared national story. In that respect, it is more like a marriage—where two people decide to marry their way through life. Counting votes doesn’t really matter; the issue is whether there is will to proceed and flexibility to accommodate each other’s particular issues.
When the differences over the issues become too large, when every discussion turns into rancor, the will to continue wains and suitcases are packed.