Spotlight: Health 2014

Want to Fix Health Care, Congress? Try Talking to Each Other First

Three former congressional leaders examine the barriers to consensus on health policy—and point to some reasons for optimism.

(kmf164 / Flickr)

It’s a tired lament: Congress is so dysfunctional it probably couldn’t agree on a pizza order, much less on major domestic legislation like the Affordable Care Act. The controversy following the passage of that billafter months of tortured negotiations and vitriolis emblematic of the country's ever deepening partisan divide.

At the Aspen Ideas Festival’s Spotlight: Health, a morning panel braved the question: “Can Congress Come Together to Build a Healthier Nation?” On stage to rise to the challenge were Tom Daschle, former Senate Majority Leader; Bill Frist, another former Senate Majority Leader; and Mickey Edwards, former Congressman and Chairman of the House Republican Policy Committee. The three speakers analyzed the roots of the current congressional gridlock and offered measured optimism for the future of legislative action on health care.

Calling the ideological disputes between Republicans and Democrats today “the noise of democracy,” Daschle argued that the “culture of the Congress” is at fault for the discord. “I blame the airplane,” he said, “because the airplane now has allowed members of Congress to leave on Thursdays, come back on Tuesdays, and try to govern on Wednesdays.” The result? A Congress made up of people who don't know each other on a personal level—making members prone to seeing each other as ideological enemies and nothing more. Edwards summed it up: “There’s less opportunity for them to get to know each other as human beings.”

The panelists also emphasized the importance of the relationship between legislators and their constituents—and the ways that the current political primary system works to marginalize voters not at the fringe. “What’s happened is that you have a Congress that is representative, but it’s representative of the people who participate in their party primaries, and they’re busy looking over their shoulder, not at the general electorate,” Edwards said, citing the fact that 46 states don’t allow candidates who lose their primaries or state party nominations to appear on the ballot in the general election. Consequently, more extreme partisans—those who actually vote in primaries—are disproportionately influential.

Tearing down the partisan political primary system is a massive undertaking, and perhaps unrealistic in the short term. But despite the scale of congressional dysfunction--and its deeply entrenched systemic roots—the panelists found some cause for optimism, however limited, when it comes to health care legislation, saying they believe the parties share common goals. “There’s general agreement," Daschle said. "We want to build a high-performance, high-value health care marketplace with better access, better quality and lower cost."

Moderator Julie Rovner agreed, saying she has been heartened by a recent attempted fix to Medicare—a deal which was hammered out behind closed doors even as party members publicly bickered. The fix—designed to ensure that doctors paid for Medicare services are compensated based on quality, not quantity, of care—passed the Energy and Commerce Committee unanimously before ultimately failing when the larger Congress couldn't agree on funding. "Everybody basically came to the table," Rovner recounted, "and said ‘yes, let’s do this.'"

And yet for all their supposed agreement on the overall goals of healthcare reform—and for all their lofty talk of personal connection over ideological division—the panelists didn't shy away from partisan rhetoric. Frist, for example, asserted that the Affordable Care Act was “a dirty bill,” since it passed without Republican support. Edwards accused Obama of overstepping the boundaries of his office in making revisions to the Affordable Care Act, to which Daschle replied that Congress had delegated the extra responsibilities in question to the President. But on the surface, at least, the panelists seemed to want to avoid overt conflict and instead focus on bipartisan leadership solutions.

Of course, back in Washington, discord is harder to avoid—a reality all of the panelists admitted is problematic. "Without communication, there can’t be coordination," Daschle said, "and without coordination, there’s no trust and there’s no opportunity to govern." The American people couldn't have said it any better.