Thursday, November 3, 2016

Fear and Loathing on the Campaign Trail, 2016 Edition

Many regard Hunter S. Thompson’s book, Fear and Loathing on the Campaign Trail, which covered the 1972 Nixon versus McGovern campaign, as the best account yet of a modern U.S. presidential campaign.  Hunter’s reporting was based on his own conversations, often over copious amounts of alcoholic beverages (and sometimes, other illicit recreational substances) with the people involved in both campaigns, from George McGovern himself to the front-line worker bees whose job it was to get out the votes. In an introduction to the 40th anniversary edition of the book, re-issued in 2012, journalist Matt Taibbi observed that, “What makes the story so painful, and so painfully funny, is that Hunter chooses the presidential campaign, of all places, to conduct this hopeless search for truth and justice. It’s probably worse now than it was in Hunter’s day, but the American presidential campaign is the last place in the world a sane man would go in search of anything like honesty.  It may be the most fake place on earth.”

I think we would agree that the 2016 American presidential campaign is far worse than it was in Hunter’s day.  Polls show that for many voters, this election is viewed as a choice between two evils, or as Hunter put it in Fear and Loathing,  “How many more of these stinking, double-downer sideshows will we have to go through before we can get ourselves straight enough to put together some kind of national election that will give me and the at least 20 million people I tend to agree with a chance to vote FOR something, instead of always being faced with that old familiar choice between the lesser of two evils?”  (I know that many supporters of Mr. Trump or Mrs. Clinton would strongly disagree with the “lesser evil” description of their own preferred candidate, yet polls consistently show that both of them have historically high disapproval/approval ratios).

Framing the election as a “lesser of two evils” choice can’t obscure the fact that there are very real differences between Mr. Trump’s and Mrs. Clinton’s views on just about everything—including health care policy.  They disagree on climate change (Mrs. Clinton is for expanding on Obama’s policies to limit emissions; Mr. Trump has said the climate change is a hoax and pledges to increase production of fossil fuels), on firearms injury prevention (she wants to expand background checks and limit access to assault weapons; he opposes any intrusion on an individual’s “Second Amendment” rights to own guns, supports  greater enforcement of existing laws but opposes any new restrictions, and advocates a national “right to carry” law). 

Mr. Trump promises to repeal the Affordable Care Act (Obamacare) and replace it with a plan that would allow people to enroll in tax-free Health Savings Accounts to pay for their out-of-pocket costs, make premium payments by individuals tax deductible, create state pools to insure “high risk” patients who have not maintained continuous coverage, allow insurers to sell insurance across state lines, and convert Medicaid to a block grant program, where the states would get a fixed amount of federal funding per beneficiary to redesign the program as they see fit.  Mrs. Clinton pledges to preserve, build upon and improve on the ACA by increasing tax credit subsidies so families pay no more than 8.5% of income; working with states to establish a public option to compete with private plans in the marketplaces; allowing individuals aged 55-64 to buy into Medicare; create fallback for HHS to block unreasonable rate increases; repealing the “Cadillac Tax” on high premium employer-sponsored plans;  requiring plans to cover 3 “sick” visits per year without deductibles; creating a new tax credit of up to $2500/$5000 per individual/family for out-of-pocket expenses in excess of 5% of income; ensuring consumers pay no more than in-network cost-sharing for care received in a hospital in their plan’s network (surprise bills); providing 100% federal match for first 3 years if states adopt expansion, regardless of when they start; and allowing undocumented immigrants to buy coverage from exchange plans at their own cost.

The Rand Corporation conducted an analysis of the candidate’s proposals, and concluded that Mr. Trump’s proposals would add tens of millions of people to the ranks of the uninsured, while Mrs. Clinton’s plan would expand coverage to tens of millions.

No matter who the voters elect next week,  however, the new President will have great difficulty translating their plans into policies that have a chance to be enacted into law.  Should we have a President-elect Hilary Clinton, and even if Democrats narrowly take control of the Senate, she likely will have to deal with a Congress where  the House of Representatives will still be controlled by Republicans who have no interest in strengthening Obamacare, and where Senate Republicans can still use the filibuster to thwart her initiatives.  And she would still have to deal with dozens of states that will continue to be controlled by GOP governors and legislators who are not likely to jump on the Obamacare bandwagon.

Should Mr. Trump get elected, he likely will benefit from a Republican-controlled House and  continued GOP control of the Senate.  Expected Democratic gains in the Senate though likely will make it easier for Democrats to use the filibuster to thwart efforts to repeal Obamacare.  And, practically speaking, repealing Obamacare would mean kicking 20 million people off of the health insurance coverage they have gained from it, pulling the plug on federal funding of Medicaid expansion, and taking away some very popular consumer protections, like the guarantee that insurers can’t deny coverage or charge more to people with pre-existing conditions.

For sure, there are many things a Clinton administration could do to strengthen the ACA through regulations should legislation become impossible.  There are things that a Trump administration could do to ease Obamacare’s requirements on insurers and states through regulations should legislative repeal become impossible. 

Yet, unless we see a marked change in our political culture as a reaction to the 2016 election, the current toxic stew of partisanship, polarization, and gridlock likely will get worse before it gets better. “The American electorate has grown increasingly divided along party lines in recent decades, by political attitudes, social values, basic demography, and even beliefs about reality,” observed political scientist Gary Jacobson in an analysis published late last year in the Annals of Political and Social Science.  “Deepening partisan divisions have inspired high levels of party-line voting and low levels of ticket splitting, resulting in thoroughly nationalized, president- and party-centered federal elections. Because of the way the electoral system aggregates votes, however, historically high levels of electoral coherence have delivered incoherent, divided government and policy stalemate.”
The question is whether the 2016 election will lead to continuation and even intensification of the “incoherent, divided government and policy stalemate” that has engendered growing voter rage and historic declines in trust in government, and even in our democratic system of government itself?  Or act as a catharsis for voters and politicians to begin pulling us back from the brink?

As Abraham Lincoln said in his first address to Congress in December 1862, when our nation’s politics had grown so toxic that the country was in the first year of a bloody civil war, “We can succeed only by concert.  It is not ‘can any of us imagine  better?’ but, ‘can we all do better?’ The dogmas of the quiet past, are inadequate to the stormy present. The occasion is piled high with  difficulty, and we must rise – with  the occasion. As our case is new, so  we must  think anew, and act anew. We must disenthrall ourselves, and then we shall save our country?”

Now, to be clear, I don’t believe that the stakes in this election are anywhere near what President Lincoln confronted, we aren’t going to fall apart at the seams and start taking up arms against each other.  But if we the voters don’t begin to “save our country” by embracing politicians who believe that compromise to achieve a common good—so “we can all do better”—is a virtue, instead of voting for those who put their own partisan and political interests and ideological purity above what is best for all, then we will continue to weaken and undermine our great American democracy.  This, I believe, is what we should fear and loath most long after the ballots are counted next Tuesday.

Today’s question: What do you think is at stake in the 2016 election, and afterwards, for healthcare, and our democracy itself?