The 2020 election results are in. What can they tell us about prospects for healthcare reform? Let’s dive in, using Pennsylvania’s Congressional races as a bellwether.
- Healthcare was a mid-priority issue both for voters and for candidates in Pennsylvania’s 2020 Congressional races. Healthcare ranked fourth after the economy, the pandemic, and racial inequality.
- Candidates from both parties in Pennsylvania agreed on the goals of covering pre-existing conditions, addressing the opioid crisis, and lowering drug costs, but the two sides disagreed on whether to fix or to scrap the ACA (Obamacare)
- Voters in both parties reported that they disagree with each other not just on policies but more fundamentally on core values.
- Despite these deep disagreements, this blog is optimistic on the possibility of compromise on healthcare reform. Hear me out. . .
Healthcare Is a Mid-Priority Issue
In an exit poll conducted November 3 by Edison Research, eleven percent of voters identified healthcare as the top issue determining their vote. Healthcare was outranked by the economy (34%), racial inequality (21%) and the coronavirus (18%).
Pennsylvania candidates for Congress acknowledged that healthcare remains a key long-range issue, even though overshadowed by crises of the moment. Among candidates for the state’s 18 Congressional seats, all Democrats and all but 2 Republicans included healthcare in their platforms, according to my own survey of Google and Ballotpedia.
Republican and Democrats Strongly Disagree over Obamacare, but Do Agree on a Lot
Perhaps not surprisingly, fourteen Republican candidates – including all but one incumbent – pledged to repeal Obamacare. By contrast, also not surprisingly, twelve Democratic candidates – including all but one incumbent – pledged to expand Obamacare. That said, perhaps surprisingly, candidates from both parties displayed agreement over covering pre-existing conditions (28 of 36), lowering drug costs (also 28 of 36) and addressing the opioid crisis (20 of 36).
Voters Love to Hate Each Other
Given this unexpected consensus in at least these several areas of the healthcare debate, why has compromise been so elusive for the last four years? Perhaps Pew Research has an answer. Only about one-in-five Trump and Biden supporters say they share even the same core American values with each other.
But the Other Side Isn’t Going Anywhere Anytime Soon
Each side was hoping to overwhelm the other in this election, either by persuading each other to “come to their senses” or by sheer force of turnout numbers. And indeed, this election numerically had the largest voter showing in history in the U.S. overall (156.8 million) and in Pennsylvania (6.9 million), and also the highest percent voter turnout for the state (70.93%) ever recorded.
But neither side got the blowout it hoped for. Biden beat Trump in Pennsylvania’s popular vote by just 81,000 votes (1.2%). Down ballot incumbents all held their seats in their Congressional races, keeping the nine-to-nine split. In the state’s General Assembly, Republicans slightly expanded their majority in the House and maintained their comfortable majority in the Senate.
That means that both sides will need to face the fact that the other side is here to stay. The only recourse is to re-engage with each other. Serious politicians already seem to sense this. At least on healthcare reform, both sides have already identified common ground, even before opening any negotiation, whether they realized it or not. But it is also clear that pat solutions like “Medicare for all” or “let market competition solve the problem” are just too simplistic for the massive healthcare reform challenge.
A key element in the feud of perpetual antipathy between the sides has been the news media. As Barack Obama put it in a recent interview, media has created “kind of reality TV phony controversies [that sees] these big issues as just a matter of sport . . . And we’ve got one team and the other team, and they hate each other, and we’re just going to go at it. And it becomes a spectacle.” These media companies have seemingly divided Americans into separate ecospheres, which commentator Jon Fasman labeled as “seeing the world through red or blue glasses.”
Some expect this dynamic to subside at least a bit once Donald Trump leaves office. And indeed conservative cable news media is already beginning to splinter. Time Magazine columnist David French envisions a path toward constructive civic engagement that necessarily must “travel at least partway through the very loud voices of the vast right-wing media-entertainment complex.” Meanwhile social media companies also are coming under scrutiny for their role in amplifying disinformation and distrust.
Forty years ago law professor Roger Fisher and anthropologist William Ury published their handbook on negotiating agreement without giving in, entitled Getting to Yes. They called their method principled negotiation to contrast it with positional bargaining. Its goal is to produce wise agreement, that is, one which meets the legitimate interests of each side to the greatest extent possible, resolves competitive interests fairly and efficiently, is durable, and takes community interests into account. This approach could be a model for negotiating healthcare reform.
Fisher and Ury noted that principled negotiation is best conducted after groundwork has been laid to foster mutual trust and understanding. Thus, before the first fact-finding report is issued or the first list of agenda items is drafted, negotiators must spend time building a constructive relationship. Here are some trust-building steps recommended by Fisher and Ury:
- Put yourself in their shoes
- Don’t mind-read their intentions based on your fears
- Don’t blame them for your problem
- Discuss each other’s perceptions
- Look for opportunities to act inconsistently with their perceptions
- Give them a stake in the outcome by making sure they participate in the process
- Make your proposals consistent with their values (and let them take credit)
- Recognize and understand emotions, both theirs and yours
- Make emotions explicit and acknowledge them as legitimate
- Allow the other side to let off steam
- Don’t react to emotional outbursts
- Use symbolic gestures
So, this is what it will take for Americans to come together to reform healthcare: First, rebuild our mutual relationships, understanding, respect, and trust. We must take off our “red and blue glasses” and see each other just as fellow citizens and neighbors. Once we do that, we might just find from there that the path to Yes is a little clearer. Nursing grievances and stoking hate, in the end, takes just too much energy, and doesn’t get us anywhere.
Now, take action.
Only about one-in-five Trump and Biden supporters say they share the same American values and goals, excerpted from “2020 election reveals two broad voting coalitions fundamentally at odds” by Claudia Deane and John Gramlich. Pew Research Center, Washington, D.C. (November 6, 2020). URL: https://www.pewresearch.org/fact-tank/2020/11/06/2020-election-reveals-two-broad-voting-coalitions-fundamentally-at-odds/ Copyright 2020 Pew Research Center. Used under Terms and Conditions.
Title: County map of 2020 Pennsylvania Election.
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