I admit my dark side knee-jerked when I read UNC law professor Gene Nichol declare in this space, “I am not saying all Republicans are racist.” So, I thought, he believes the rest of us are just stupid and angry.
Then I recalled a recent N&O editorial that described Nichol as someone who “listens to his critics” and responds “without rancor.”
As a cup-half-full kind of guy, I decided he was leaving open the possibility that some Republicans might have good faith reasons for holding opposing views.
My hopes and imagination took off. I started to see his comment as the game-changer our divided nation needs to come together to address our seemingly intractable problems. Without denying anyone’s right to define their enemies with -isms and -ists – racists, sexists, socialists, whatever – his statement suggests we might profit from ignoring the extremes and paying greater attention to those who are acting in good faith, who have seemingly sound reasons for their thoughts and beliefs.
Consider the recent discussion regarding health care. Many on the left contend that Republicans oppose the Affordable Care Act simply because it was the signature achievement of America’s first black president. They might believe it; and feel good saying it. But how does this help us reform a broken system?
That approach is doubly problematic because it invites high-pitched emotion to dominate what should be a serious debate. It transforms a complex discussion about money – the costs, benefits and wrenching tradeoffs of our health care system – into a simplistic moral crusade. It leads otherwise intelligent people to dig in their heels and declare the ACA a great success.
It isn’t. And don’t take my word for it. Progressive leaders including senators Al Franken, Elizabeth Warren and Chuck Schumer have admitted the law is deeply flawed. While campaigning for his wife last year, President Bill Clinton committed the ultimate gaffe – defined these days as when a politician utters an inconvenient truth – when he described Obamacare as a “crazy system where all of a sudden 25 million more people have health care and then the people that are out there busting it, sometimes 60 hours a week, wind up with their premiums doubled and their coverage cut in half.”
My family of five, which does not qualify for a subsidy, has seen our premiums rise four-fold – from $440 a month to about $1750 – since the law kicked in. We’re lucky that we’ve never come close to meeting our $13,000 deductible, but that means we are paying about $21,000 a year for our yearly physicals.
I’m not suggesting that GOP efforts to repeal and replace the ACA are a magic bullet. Indeed, the first step toward having a productive discussion about health care is to admit that there are no easy answers, only painful choices. Nobody knows how to make everybody happy.
Health care is so complicated – the ACA, for example, ran more than 2,300 pages with tens of thousands pages more of rules and regulations – that anyone who claims they know how to make everything right is blowing smoke. Similarly, those who blithely call for a public-option or single-payer system never explain how to make that work in America, given our current health care infrastructure. Even Obama couldn’t do that!
Nevertheless, once we get past the name-calling and fix-it fantasies, the problem is relatively simple: How much can we and should we spend on health care? It gets a lot more complicated when we consider that every dollar we spend on health care is a dollar we can’t spend on education, infrastructure, defense and other needs.
In 2016, more than 16 percent of North Carolina’s state budget – about $3.6 billion – went to Medicaid (the feds chipped in another $10.6 billion). And that is without Medicaid expansion.
Currently, Medicaid is an open-ended commitment; Senate Republicans have been attacked for trying to limit costs by turning it into a block grant program with fixed costs. The CBO says this would save $772 billion by 2026.
Yes, this will affect the poor most directly. As the prime beneficiaries of most government programs, they always are. But it is also a first step toward addressing what President Obama called our unsustainable federal spending.
Perhaps there is a better way. But we will never find it if we see fiscal issues as moral crusades. In public policy, morality, like health care, is a commodity: You can only have as much as you can afford.
Contributing columnist J. Peder Zane can be reached at firstname.lastname@example.org.