Medicare, Medicaid, Global Warming and Gun Control– Can Liberals and Conservatives Find Middle Ground? Should They? Part 1

 In a nation divided, “compromise” has become an extraordinarily appealing idea. Weary of the acrimony and endless wrangling, more and more Americans are asking: Why can’t conservative and liberal politicians come together and forge bipartisan solutions to the problems this nation faces?

Keep in mind that it is not only our elected representatives who are having trouble finding common ground. The Pew Research Center’s latest survey of “American Values” reveals that as voters head to the polls this November, their basic beliefs are more polarized than at any point in the past 25 years. In particular, when it comes to the question of government regulation and involvement in our lives, the average Republican has gravitated to the right. In 1987, 62% of Republicans agreed that “the government should take care of people who can’t take care of themselves.” Now just 40% support this proposition. Democrats haven’t changed their views on this issue: most continue to believe “there, but for fortune . . .”

In Congress, where polarization has led to paralysis, some argue that Republican leaders are responsible for creating gridlock by insisting on “party discipline.” But liberals in Washington also are accused of “dividing the nation.” Even President Obama, who set out to unite the country, has been described as “the most polarizing president ever.” During his third year in office, Gallup reports, “an average of 80 percent of Democrats approved of the job he was doing, as compared to 12 percent of Republicans who felt the same way. That’s a 68-point partisan gap, the highest for any president’s third year”–though this may say more about the temper of the times than the man himself. Nevertheless, many commentators believe that progressives, like conservatives, need to cede ground. The debate has become too contentious, too “political,” they say. I disagree. There are times when we cannot “split the difference.” Too much is at stake. We must weigh what would be won against what would be lost.

But reporters who have been taught that they must be “fair” and “balanced” often write as if all points of view are equally true. After all, they don’t want to be accused of “bias.” Thus they fall into the trap of what veteran Supreme Court reporter Linda Greenhouse calls “he said, she said” journalism. To them, the “middle ground” seems a safe place– a fair place– to position a story.

This may help explain why so many bloggers and newspaper reporters are calling for “bi-partisan consensus” as they comment on some of the most important issues of the day.

Global Warming

Writing about global warming, Huffington Post senior writer Tom Zeller Jr. recently declared: “Compromise is the necessary first step to tackling the problem. What ordinary Americans really want is for honest brokers on all sides to detoxify and depoliticize the global warming conversation, and then get on with the business of addressing it. That business will necessarily recognize that we all bring different values and interests to the table; that we perceive risks and rewards, costs and benefits differently; and it will identify solutions through thoughtful discussion and that crazy thing called compromise.” [ my emphasis] (Hat tip to David Roberts (Twitter’s “Dr. Grist”) for calling my attention to this post.)


Zeller concludes his post by saying that he sees “a promising sign in the revelations last month that a broad spectrum of thinkers and stakeholders — left, right and center — have been holding secret meetings on the topic of global warming under the auspices of the American Enterprise Institute, the conservative Washington-based think-tank.” [For my comment on these secret meetings, see part 2 of this post.]

Medicare Reform

Embracing the spirit of the times, last week, the Incidental Economist’s estimable Aaron Carroll suggested that “In a rational world” politicians might embrace “a bipartisan plan” for health care reform.  Republicans would accept “the Affordable Care Act as it stands for all those younger than 65, without further talk of repeal, in exchange for implementing the Ryan-Wyden plan for those 65 and older.  . . .  This would require compromise,” he adds, “something that is in short supply in election years.”  

Carroll seems to see this as a balanced solution: On the one hand, everyone under 65 would be protected by the Affordable Care Act (ACA) and wouldn’t have to worry about Republicans trying to dismantle it, piece by piece. At the same Democrats would agree to follow the Ryan-Wyden proposal, offer Americans over 65 vouchers, and send them off to buy their own insurance in the private market. Seniors would be free to choose the benefits that best suit their needs–assuming that they will be able to afford them.

Vice-presidential candidate Paul Ryan argues that “free market competition” among insurers will bring down the cost of care.  But this is not what has happened in the Medicare Advantage market where insurers compete for seniors’ business. Indeed, as Carroll himself acknowledges early in the post: “There is little evidence prices would come down in the [private] market, and this could result in some seniors forgoing necessary care, which would have negative health consequences.”

 Extending Medicaid to Millions of Poor Americans

Then there is the question of expanding Medicaid. Not long ago, an editorial in the Baltimore Sun declared: “Compromise is Needed on the Affordable Care Act.” Now, you might believe that in the process of moving that massive piece of legislation through a Congress dominated by moderates and conservatives, progressive Democrats did nothing but compromise.  They conceded and yielded, surrendered and settled to a point that some accuse them of “selling out.” You might also think that now that the law has passed, and the Supreme Court has found it constitutional, the time for concession has ended. 

But according to the editorial’s authors, Jack Meyer and Karoline Mortensen, just because the case has been decided doesn’t mean that reformers shouldn’t continue to yield ground. “The court upheld the Medicaid expansion under the ACA as constitutional” they observe, “but stated that the federal government cannot punish states that opt out of this provision by taking away existing Medicaid funding for current enrollees. Some state officials now say that they plan to opt out of the Medicaid expansion.”

Flexibility is needed” say Meyer and Mortensen. If we want to bring an end to “the ongoing theatrics and shrill debates over health reform,” we should “declare a ceasefire and develop a ‘peace plan.’” [my emphasis]

They propose giving states federal funding to expand Medicaid –while letting those states adopt the rules laid out in the ACA as they see fit. After all, some conservative states may not want to give Medicaid beneficiaries the “comprehensive” package of benefits that the legislation provides.  For instance, the ACA stipulates that in 2014 states “will no longer be able to exclude” drugs that help smokers quit from their list of covered drugs.  Reimbursing for these medications could save Medicaid an enormous amount of money; over one-third of Medicaid beneficiaries smoke, and the program now spends a fortune on diseases caused by smoking. Nevertheless, this provision might not be popular in states where politicians believe that smokers should take “personal responsibility” for their health

The Affordable Care Act also calls on states to open up Medicaid to everyone earning less than 133% of the federal poverty level (FPL), or $25,390 for a family of three. But Meyer and Mortensen realize that reluctant states may not want to go that far. Today the average state only covers working parents who are living on less than 63 percent of the poverty line ($12,790 a year for a family of three).

Moreover in most states, adults are not eligible for Medicaid unless they have children–no matter how little they earn. The editorial’s authors suggest that states be allowed to “phase in” the expansion. Rather than opening the door to childless adults in 2014, they might wait until 2015–and then cover them only if they earn less than 50% of the FPL ($5,580).  In 2016, states might (or might not) lift the bar to 100% of the poverty level.

Alternatively, the authors suggest that a state could move toward expansion by making it easier to qualify for Medicaid “in certain counties.” (One can only imagine the politicis that would be involved in choosing the counties.) 

Finally, Meyer and Mortensen warn that liberals must beware of letting “ideological warfare triumph over practical policy solutions.”  Above all they must avoid “politicizing issues.” This, we are told, can be “toxic.” 

Gun Control: Progressives Must Not Create Discord

Thus in the wake of mass slaughter in Aurora, Colorado, “the twitter scolds began lecturing progressives” Hullabaloo’s Digby noted. “We are not supposed to talk about this mass murder except to share clinical details about what happened and express condolences to the victims. This of course shuts down any discussion of the social, cultural and political implications of yet another horrific act of deadly gun violence is becoming more and more successful after each event. Some people are talking anyway,” she added, referring to a piece by the New Yorker’s Adam Gopnik that take a stand on gun control “although I’m sure they’ll be excoriated for their bad manners and divisive conduct.” Bowing to the censors, even President Obama felt obliged to tip-toe around all of that spilled blood.  It’s slippery.  Saying too much about “gun control” might alienate gun owners–and bring out the NRA.                              

When Compromise is Unreasonable– the Media’s Role in Substituting “Balance” for Truth

I find this emphasis on “flexibility” and “accommodation” disturbing.  On the face of it “compromise” sounds eminently reasonable. Very often, it is appropriate.  But everything depends on what is at stake. Sometimes one can’t compromise. When we debate issues such as Medicare, Medicaid, global warming and the right of a civilian to purchase automatic weapons, the stakes are too high, Lives are at risk. The price we pay for an end to conflict is too great. 

 Some values are not negotiable.  Yet when liberals fight for a principle, they are called “ideologues.” According to the dictionary, these are people who believe in
“a body of ideas that reflects the beliefs and interests of a nation, political system, etc. and underlies political action.”   Ideologues are not always wrong. What if that body of ideas is “civil rights”?  Or, women’s rights, including the right to healthcare and affordable access to contraception? (When resisting efforts to rewrite the Affordable Care Act, President Obama, to his credit, refused to “compromise” the heath of American women.) All ideas are not equal.  Some are worth fighting for.

Moreover, in these debates all arguments do not deserve equal treatment. Some are grounded in facts and empirical evidence.  Others are mere opinions. Some are based on science. Others are based on religious beliefs.

Why Reporters Believe That They Should Cover All Sides of A Controversy As If Are Points of View Are Equally True                                                                  

Journalists have been taught that “balance” should be their goal–they must be “even-handed.”  As a result, says Linda Greenhouse,a Pulitzer -Prize winning reporter who now teaches at the Yale Law School, writers fall into the trap of  “he said, she said” journalism that leaves it to the reader to figure out what is true– and what isn’t.

In this summer’s edition of Harvard’s Neiman report, Greenhouse challenges the “commitment of mainstream journalism to the goals of fairness and objectivity.”  She suggests an alternative: “Truth. How about truth for a goal?

Greenhouse, who pulls no punches, quotes Neal Galber, a cultural critic who has commented on the media’s performance in covering the health care debate:: “We may not have a journalism of truth because we haven’t demanded one. . . by simply reporting the latest guided missile from Sarah Palin or Rush Limbaugh, the media ‘marshal facts,’  but they don’t seek truth. They behave as if every argument must be heard and has equal merit, when some are simply specious.”

I agree. In newspapers and on the blogosphere, discussions of health care reform have been muddied by reporting that attempts to embrace all points of view, often without attempting to sort out which opinions are valid. “One the one hand . . . on the other hand.” Thus the public remains badly confused about what is actually in the Affordable Care Act.

Greenhouse admits that “journalists would no doubt say that it isn’t really their job to ferret out the ‘truth.’ It is their job to report ‘facts.’  But too often a ‘fact’ is simply a quote that will sell newspapers, or bring more viewers to a cable station:  If Palin says that Obama intends to euthanize her child, they report it.” Greenhouse writes. “If Limbaugh says that Obama’s healthcare plan smacks of Nazism, they report it. And if riled citizens begin shouting down their representatives, they report it, and report it, and report it. The more noise and the bigger the controversy, the greater the coverage. This creates a situation in which not only is the truth subordinate to lies, but one in which shameless lies are actually privileged over reasoned debate.” [my emphasis]

“Don’t think the militants don’t know this and take full advantage of it,” she adds.  “They know that the media, especially the so-called liberal mainstream media — which are hardly liberal if assessed honestly — refrain from attempting to referee arguments for fear that they will be accused by the right of taking sides. . . . That is how global warming, WMD [weapons of mass destruction] and ‘end of life’ counseling have become part of silly reportorial ping-pong at best and badly misleading information at worst.”

Greenhouse offers a pointed example: “To report, without elaboration, a politician’s charge concerning the ‘death panel’” in the health care bill is—assuming the politician is quoted accurately—certainly to report the truth. Does such a report convey a more useful or meaningful truth, the contextual truth of the situation? Obviously not. But just as obviously, it would not require a correction.”

Little wonder then, that today, so many bloggers and journalists call for–or fall for– compromise as the solution to all of our problems.  In an era where we assume that all opinions are equal, many truly believe that the truth must lie midway between what their most extreme sources tell them. Greenhouse quotes a telling excerpt from See How They Run: Electing the President in an Age of Mediaocracy, by Paul Taylor, formerly a reporter at the Washington  Post:

“Sometimes I worry that my squeamishness about making sharp judgments, pro or con, makes me unfit for the slam-bang world of daily journalism. Other times I conclude that it makes me ideally suited for newspapering—certainly for the rigors and conventions of modern ‘objective’ journalism. For I can dispose of my dilemmas by writing stories straight down the middle. I can search for the halfway point between the best and the worst thing that can be said about someone (or some policy or idea) and write my story in that fair-minded place. By aiming for the golden mean, I probably land near the best approximation of truth more often than if I were guided by any other set of compasses—partisan, ideological, psychological, whatever … Yes, I’m seeking truth. But I’m also seeking refuge. I’m taking a pass on the toughest calls I face.” [my emphasis]

Greenhouse calls Taylor’s book “trenchant” in part, I’m sure, because he is telling the truth about himself. But she also quotes Jay Rosen, “a press critic and journalism professor at New York University, who calls writing stories straight down the middle, ‘regression toward a phony mean.’”

In part 2 of this post I will suggest that “compromise” on Medicaid and Medicare is, at best premature, at worst, fatal. States that say they can’t afford to expand Medicaid are ignoring the numbers. Some will actually save money. As for Medicare, the Ryan- Wyden plan wouldn’t reduce government spending it would simply shift the rising cost of health care to seniors while letting an insurance companies marketing department decide what benefits they will offer. By contrast, the Affordable Care Act aims to reduce spending by using medical evidence to squeeze some of the waste out of the system.

I’ll also take a look at Adam Gopnik’s uncompromising piece on gun control, and the facts vs. the fictions about gun control in Australia.

 On the question of global warming, I’ll consider the “diverse points of view” being discussed, behind closed doors, at the American Enterprise Institute and compare “short term corporate interests” to the long-term goal of saving the planet. It’s worth noting that some corporations are taking the long view, and supporting liberal proposals, even if, in the short term, these solutions will cut into profits.   

Finally, I will go further in exploring how in its quest for “balance,” the media winds up seeking “someone-anyone”–to quote on “the other side of the issue,” and so winds up spreading misinformation.



8 thoughts on “Medicare, Medicaid, Global Warming and Gun Control– Can Liberals and Conservatives Find Middle Ground? Should They? Part 1

  1. On the suggestion that liberals attempt to compromise, I say it won’t work, especially if the requirement is for liberals to take the first step. I still remember Barack Obama sitting down with Republican leaders to have a open discussion about health care reform, even though the ACA was derived primarily from Republican ideas.. They had absolutely no intention to find middle ground. Instead of seniors being issued vouchers, put them into the ACA. And put our House and Senate members in it, too. I don’t believe it’s much different from the current federal workers health care plan

  2. Good points. I’m looking forward to the rest.

    Sunday’s “legitimate rape” moment seems to have set in motion a bigger than usual firestorm. The editor at Jezebel let loose a roman candle of rage which included “What needs to happen before spouting ignorant, anti-woman crap in public is uniformly met with the same sort of derision we now reserve for politicians who appeal to ethnic stereotypes during drunken tirades? How much longer are we all going to have to stay angry, after our mothers spent their lives angry? And is it even working?”

    And she’ exactly right. The saddest part for me is the revelation of a more durable level of ignorance and indifference than I thought was there. Akin, rather than a Trent Lott experience, is basking under the national spotlight building his name and face recognition in a way that may be more valuable than whatever financial penalties the rest of the party took back. The air and print time is costing him nothing and a lot of voters in Missouri are apt to look up, blink and say “Clare Who??”

    Reflecting political extremes are extreme positions focused almost entirely on beginning of life and end of life — with relatively little attention to life and death issues in-between… starvation, war, self-defense (what if Zimmerman had been carrying mace instead of a gun?), environmental hazards, capital punishment, land mines, homelessness, the list is endless. I’m so ready for someone to find a way out of this desert.

  3. Patricia& John

    Patricia You’re right– Republicans were not willing to compromise on health reform. Even when Democrats offered to include
    tort reform, Republicans made it clear that they wouldn’t vote for it.
    As for Medicare, I think it’s better that it remain a separate program. Becuase it is so large, it has market clout– more clout than any private insurer. This means that Medicare is
    able to lead the way in health care reform–refusing to
    overpay, insisting that hospitals do a better job when
    discharging patients (making sure that they understand their meds, have a follow-up appt. with a doctor, etc.), refusing to pay for preventable errors. Over the next couple of years, I’m also hopeful that Medicare will begin to negotiate for discounts on drugs. No private insurer has the market power to do that– but if Medicare leads the way, they could follow.

    I wonder if akin actually will be elected–that would be tellilng.

    Speaking of levels of ignorance–today Yahoo! tells us that a judge in Texas has announced that if Obama is re-elected we’ll see “civil unrest–maybe civil war.”

  4. John said>>>>>I’m so ready for someone to find a way out of this desert.
    Not sure you can, sans campaign finance reform.

    We must never forget that too many monied interests are making a fortune in the health business. Patients are a means to the end….very unfortunately. To quote the title of a book from a great author, it’s:”Money-Driven Medicine” ;^).
    Much less so in other developed countries.

    • Ruth & Run-75411
      You’re right that campaign finance reform would mean that many more Congressmen would
      represent the interests of voters rather than the interests of lobbyists.
      Speaking of the power of corporations in this country: Today the tobacco industry defeated a U.S. law forcing cigarette packaging and advertisements to display images such as diseased lungs, persuading a federal appeals court that the requirements violate their free speech rights The D.C.Appeals Court ruled 2:1 in the industry’s favor. Wonder who appointed those two judges, and who funded his campaigns?
      Canada has had rules requiring that such images be on cigarette packs for at least 10 years.

      Run–Thanks– and yes and there are a great many provisions in the PPACA that people rarely talk about.
      I’m particularly concerned that the children of illegal immigrants are not protected. The kids did not break a law. . ..

  5. Hi Maggie:

    Nice article and it gets right to the point. So much about the PPACA is unknown including the parts about insuring illegal aliens, letting the gov have direct access to your banks and lines of credit, not allowing us to build more McMedical Centers where ever we wish, etc. What they do not know they make up and it becomes more real than the truth. Didn’t you know, the 2nd amendment prevents gun control laws; except, it was never used to overturn gun control laws. Other rulings such as Cruickshank and Miller are cited to over laws on guns. We live in a strange world.

    Thanks for the help the other night. Mine should appear tomorrow.

  6. .
    Thanks for your persistence Maggie.

    There can be no seeking of middle ground when it comes to the ACA.

    When it comes down to the well-being of all and the health of the nation, there can be no backing off.

    Recall Mitch McConnell’s words: “The single most important thing we want to achieve is for President Obama to be a one-term president.”

    That myopic attitude of party over country be damned.


  7. Larry–

    Yes, and I’m afraid Mitch’s words tell us exactly why the
    Republicans want to obstruct the Affordable Care Act in any way possible–for instance, by refusing to expand Medicaid,
    even though many states would actually save money if they did that.

    The fight against health care reform is less aboutt what is actually in the bill–many of these were originally Republican ideas–but rather, about making Obama a “one-term president.”