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Think you can force through a change as big as Obamacare? Think again.

18 November, 2013 - Source: The Gate

 Christy Stewart Smith, The Gate Managing Director, on Obamacare and forcing through change.

I want to talk about the controversial healthcare reforms that are causing such a kerfuffle on the other side of the pond.

“That’s rich”, I hear you snigger, “A Brit, with an opinion about US healthcare. Let’s see now…”

Well, it’s true that I barely understand it. So I’m certainly not going to try to explain it to you.

If you want a quick, bluffers’ guide to the “Affordable Care Act”, this is the best one I’ve found:

“It’s complicated”, as they say, even explained by the You Toons.

One joker has even tried to put into infographic form:

ObamacareInfoGraphic

And although people talk about the “closing wonk gap” (i.e. members of the general public figuring out facts about Obamacare that policy wonks on both sides of the debate have known for years), I guess you’d be prepared to agree with me that probably only a fraction of the people who need to understand the ins and outs of the proposed changes, actually properly do.

To give you some extra quick context, the video clip above has been viewed just 1.1 million times, which equates to it been seen by about 0.3% of the US population (Miley’s “Wrecking Ball” is on 327,294,077 views at the time of writing).

This hasn’t stopped anyone taking a position of course. And a strong one at that. There really aren’t very many ambivalent people in the US it seems, when it comes to this particular debate.

And it’s led to the fiercest, most destructive political brinksmanship and grandstanding in most of our living memories.

Why?

The concept is straightforward: Universal access to affordable healthcare ought to be the hallmark of a civilised well-developed society. Even at either extreme of the political spectrum, one ought to be able to get a nod on that, surely?

However even here in little Blighty, our precious NHS, providing care free at the point of use to all, is creaking and cracking as the apparently opposing forces of quality and affordability clash their irreconcilable heads. Even here it’s a nettle with a politically lethal sting.

The implications of realising a goal of this kind in a country (or more accurately countries) as huge and diverse as the United States go straight to the central ideological differences between the Elephant and the Donkey. And this is where the practicality of implementation simply falls apart.

Because democratic politics is really only successful when elected politicians of different persuasions propose, debate, negotiate, vote and repeat until a deal is brokered.

“Obamacare” is the first instance for 100 years where one party has simply steamrollered a bill with huge national implications without garnering any kind of even partial agreement from the opposing party.

To see this more clearly, look at the J. P. Morgan chart below, which shows that almost all the important and controversial bills in living memory were passed with at least some level of participation and consent from both parties in both chambers.

Now look at the bottom and contrast with Obamacare.

Obamacare JPM 1

The Democrats inability to empathise with their opponents implacable opposition to their solution has led to adopt a kind of “fuck you” politics, which can only provoke a “fuck you back, with knobs on” response. The Republicans, for their part, are now in the ludicrous position of proposing spoiling measures which may end up increasing the need for state intervention in the commercial supply of health insurance policies – one of the things they fundamentally oppose. The fight will go on, and the animosity between the two sides of legislators continues to grow.

And, just to remind you, 82% of Americans were perfectly happy with their health care system, before this all started (according to Gallup).

Now just 36% of voters support the bill.

And President Obama is now enjoying the worst popularity rating of any president except R. Nixon Esq.

A sharp reminder that big change needs broad consensus not just bright answers.

And establishing that broad consensus takes time, effort and excellent persuasion and communication skills – something noticeably lacking on both sides of the political divide in this instance.

It’s also a salutary reminder of another more important principle:

A democratic mandate gives you the right to try and govern. It doesn’t give you the right to get your own way.

That’s called something different.

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