Sen. Orrin Hatch, Republican of Utah, had a simple explanation for the lack of committee hearings in the Senate on a major bill to replace the Affordable Care Act, the “discussion draft” of which was finally revealed yesterday: “We have zero cooperation from the Democrats,” he said, according to the Los Angeles Times. “So getting it in public gives them a chance to get up and scream.”

Just about everyone is sick of the partisan rancor that radiates from Washington and now flares up in the most unwelcome places, from subway trains to church parking lots. But the chance to “get up and scream” is inseparable from the democratic process. Crafting legislation behind closed doors is admission not only that the legislative system is broken but that political leaders have no interest in repairing it.

Politics is the art of the possible—but on health care, our politicians keep settling for the possibility of narrow, partisan victories.

The Republican drive to replace the Affordable Care Act with a bill that the U.S. bishops say will “wreak havoc on low-income families and struggling communities” has been distinguished by an almost complete lack of public input from those with a working knowledge of health care—which means there has been almost no attempt to inform or educate the voters who will ostensibly pass a verdict on this Congress’s work next year. But this is not a sudden change in the way Washington works. Julie Rovner of Kaiser Health News, who has been covering the never-ending attempts to reform health care for more than 30 years, recently marveled at “Congress’s slow, stuttering retreat from…transparency.” And the Washington Post’s Glenn Kessler writes that Democrats’ push to pass Obamacare in 2009 featured a floor debate “mostly for show.” Like earlier efforts during the Clinton administration, the real crafting of the legislation was done behind closed doors. By this reasoning, Senate Majority Leader Mitch McConnell, who has been startlingly upfront about how everything has been pushed backstage this time around, has simply “skipped the preliminaries.”

Mr. McConnell’s stated intention to force a vote on the Senate bill only a few days after its unveiling—putting a maximum distance between the vote and next year’s congressional elections—only underscores the normalization of power politics as a substitute for public debate. By choking off adequate funding for Medicaid, which now serves about one-fifth of the U.S. population, the legislation would constitute “the largest single reduction in a social insurance program in our nation’s history,” as three health care experts recently wrote in The New York Times. Yet the wisdom of such a drastic move has barely been discussed in the halls of Congress, let alone in the increasingly scarce town meetings held by members in their home districts.

Politics is the art of the possible—but on health care, our politicians keep settling for the possibility of narrow, partisan victories in Congress rather than workable, long-range solutions to worsening problems such as rising costs and inadequate insurance coverage. Americans are united in dissatisfaction with our healthcare system but almost intractably divided over potential fixes. Both that level of division and the needs of the tens of millions whose access to health care is at stake demand that both legislators and voters struggle with this issue in public until we can achieve something much better, especially for the most vulnerable members of society.

Correction: An earlier version of this story referred to the American Health Care Act, which was the name of the bill passed by the U.S. House on May 4. The Senate version of this legislation is called the Better Care Reconciliation Act of 2017.

 

This article appears in July 10 2017.