Thursday, November 29, 2012

"Honest Abe" and ObamaCare

“Passed by corruption, aided and abetted by the purest man in America” is how anti-slavery Congressman Thaddeus Stevens described President Lincoln’s successful effort to enact the 13th amendment, banning slavery.   This historically accurate quote, which runs counter to the public image of “Honest Abe” Lincoln, is among the many  fascinating  stories recounted in the Steven Spielberg’s masterpiece  “Lincoln” playing  now in movie theaters nationwide.  

The movie doesn’t claim to get every fact right, but its description of Lincoln’s single-minded determination to get the 13th amendment passed by Congress in the final months of the Civil War-- over the objections of his own advisors and knowing he initially was at least 20 votes short-- is spot on.  And to get the votes he needed, Lincoln did whatever he thought was necessary, including offering jobs to lame-duck members of Congress who had lost re-election.  (This practice was not illegal at the time, although undoubtedly ethically suspect).   Today, offering jobs for votes would be against the law and grounds for impeachment.
But the movie depicts Lincoln’s commitment to banning slavery in an extraordinarily favorable light.  Human bondage was such a moral wrong, the source of misery for enslaved millions, and the cause of heart-breaking bloodshed for the entire country, that if there ever was a case of the ends justifying the means, this surely was it.

The film depicts “politics as hand-to-hand combat, and it portrays Lincoln not as idealist or moralist but as pragmatist and realist. Doing so does not diminish him but elevates him.”   For his efforts, though, Lincoln was called a tyrant by his critics.

There are lessons from Lincoln that we might keep in mind as we consider our current political divisions.   As much as the fight over taxes and spending cuts seem like a big deal to us, and seemingly outside the reach of compromise in an ideologically polarized Congress, it is not even close to the stakes and divisions Lincoln faced over the 13th amendment.   The movie shows the unseemly side of politics but also shows members of Congress acting in an extraordinarily honorable ways:  voting their consciences, voting against the position of their own (in this case, Democratic) political party, and putting their careers at risk for voting for the amendment.  It shows abolitionist Thaddeus Stevens tempering his rhetoric in favor of full equal rights for African-Americans in order to win votes for the amendment. 

Wouldn’t it be something if there were more members of Congress today who would vote their consciences and buck their parties?  Who would be willing to hold their tongues and compromise when needed to advance long-term priorities?

The lesson we can learn from Lincoln is that politics can be both high-minded and unprincipled.  The process of getting legislators to vote your way always has, and always will, involve some degree of wheeling and dealing. So it was in Lincoln’s time, so it is today.

To be clear, I am not arguing in favor of offering jobs or money for votes, or selling out to the highest bidder, or even bending the rules by flying members of Congress around in corporate jets to elite golf outings.  Those things today are for the most part illegal, and we are better for it. 

But let’s stop looking at politics through Rose Colored glasses.  ObamaCare’s critics got themselves into high dudgeon over the “backroom deals” the Obama administration made to win support from interest groups and individual Senators (The Democrats were equally indigent when House Republicans kept the vote on Medicare prescription drug coverage open for four hours in 2005 to arm-twist the final votes they needed for passage).

The promises made to get interest groups and lawmakers on board with Obamacare (all legal, by the way) don’t come close to the “do what every is necessary” Realpolitik exercised by Lincoln.   But as the National Journal’s Jill Lawrence writes “If Lincoln were operating now, though, Americans would be following all the wheeling, dealing, and good-government lamentations in real time on Twitter and cable TV. I’m guessing there would be plenty of cynicism, and certainly no halo — at least until decades later.”

I am not equating ObamaCare to ending slavery, by the way.  For all of the good that health care reform may do in my opinion, it doesn’t rise to ending slavery.  Nor am I saying that Obama is the measure of Lincoln:  no one today can say how Obama’s presidency will be viewed by historians, and Lincoln sets such a high bar that it unlikely that any contemporary politician will come close.
But I am saying  that sometimes achieving a principled end—like covering the uninsured—requires a certain degree of arm-twisting and deal-making.  Sometimes, the end (within reason) does justify the means.  Jill Lawrence concludes that the film “exalts ends without sugar-coating means, and holds out the promise of vindication — in history, if not their lifetimes — for leaders who wield their ‘immense power’ to perfect the nation as they see it.”   Just take it from Honest Abe.

Today’s question: What lessons do you draw from the account of Lincoln’s deal-making to pass the 13th amendment?


ryanjo said...

Abe Lincoln was looking to free our fellow human beings. The Union had just sacrificed over 300,000 men in the War between the States, and the American people wanted the job finished. And the 13th Amendment was 2 sentences, about 2 dozen words.
Now, the ACA: hundreds of pages, some of which are probably self-contradictory or may be challenged on constitutional grounds ( Dozens of new taxes, new bureaucratic structures, none of which are enabled as yet.
Good luck to Obama, even with his background in Chicago politics, on pulling this one off.
Again, Bob, the cinematic simile falls flat. You are backing the wrong horse in this race. Get the feds out of medical care.

Harrison said...

I agree Bob that the movie is a treat.
And it shows politics working even when the individual components within the political machine are far less than pure.
I think the scene showing Lincoln being willing to almost lie to Congress to get through an impasse was wonderful.

I don't think the affordable care act is comparable in stature. And one thing they didn't have to do to the 13th amendment was add clauses to it and weaken it or change it in order to gain votes. Obamacare is full of lots of concessions to powerful interests in order to gain votes and political points.

And as an amendment the 13th did not have to suffer through a 5-4 vote by the Supreme Court -- who almost certainly would have found the emancipation proclamation to be a war power and to have no enduring authority.

I think we have a ways to go before we know what the implemented version of Obamacare will look like.
I know that here in CA there are already PPO products that are using scare tactics to get doctors to sign on to very low reimbursement rates claiming that they could otherwise be shut out.

I think it is time for the ACP advocacy group to start giving us advisories on what to be aware of as implementation is rolled out.

Those of us who are in small group practices and not part of big organizations will be at a lot of risk in the next several months.

Help on what to watch for would be very much appreciated.
The time for political arguments is over.
It is happening, and with that comes good and bad.
Help us get through it.


Steve Lucas said...

A better view of Obamacare may be found in the interview with Harvey Mansfield of Harvard in the Dec 1-2 WSJ Opinion section. His sense of history is based on his life experience as well as his academic studies.

As ryanjoe points out, Lincoln only wanted to free a people.

Steve Lucas

rcentor said...

The movie is a must see for any civic minded citizen. Politicians have functioned this way since before Machiavelli.

If one believes that the ACA has extreme importance, then Bob's analogy works. We easily empathize with Lincoln's goal in 2012, but not everyone agreed in the 19th century.

If you look at the data on the importance of medical care for the Medicaid population (for example) then the stakes are almost as high, or perhaps higher.

I do not like everything in the ACA. I particularly dislike the lack of an SGR fix, true malpractice reform (it did fund some pilot projects), sufficient actions to increase the numbers of primary care physicians and a better payment system. But on the whole it achieves some important advances.