In Congress, and particularly in the Senate, successful legislating depends on dealing with the real concerns of individual legislators and the interests of their states. Theory is fine in colleges and think tanks, but when it’s time for a bill to become a law, practical considerations rule.
That’s why the current health care bill before Congress has been such a devilish thing to get done. In the end, as many as a dozen Republican senators expressed serious concerns about how the bill was coming together, especially as it related to Medicaid, the federal program that provides health care to millions of poorer Americans. Governors in many GOP-ruled states have expressed serious concerns about the possible shift of major health care costs to already straining state budgets.
Likewise, senators and governors are justifiably concerned that if as many as 20 million or more Americans lose health care coverage, they will end up flooding emergency rooms, hitting hospitals with billions of dollars in “uncompensated care.” These and other concerns about the impact of the bill on their constituents have led senators to drive a hard bargain with their leadership and the Trump administration.
To break this impasse, it will be necessary to get down to the real business of determining how to balance the imperative of containing health care costs with that of providing access to health care to as many Americans as possible. And underlying all of this is the fact that the American Care Act, or Obamacare, imposed a number of hefty taxes to pay for expanded care that now cannot be fully repealed without unraveling the entire system.
Senators must eventually come to terms with reforms to Obamacare and the nation’s private health insurance system that can help slow the upward spiral of premiums, deductibles and co-pays that are taking insurance out of the reach of many working-middle-class families. And lawmakers will eventually have to face the reality that they must slow the unsustainable cost growth in the nation’s other major health program, Medicare, which affects the elderly and disabled. Gradually raising the age at which Americans qualify for Medicare, and taking other modest steps to contain Medicare costs, must ultimately be part of any long-term health care reform.
Which leads to the next item that will need a dose of political and fiscal reality to get accomplished: tax reform. Twice while I served in the Senate, the nation’s income tax code was significantly overhauled. In each case, President Reagan — a master of understated negotiating — managed to thread the needle in Congress and get meaningful tax bills onto his desk. He did it with votes from both parties. The results unleashed sustained economic growth, lifting the economic conditions of all Americans.
And in another tax battle Reagan took on, New York state won a special benefit. He proposed a five-cent increase in the federal gas tax to provide more funding for infrastructure. Needless to say, most senators weren’t wild about raising any taxes, but Reagan and his team lobbied so effectively that they carried the day. But not without compromise. In the case of New York, that meant accepting my proposal to dedicate one penny of that tax (equal to $1 billion a year) to mass transit improvements, which provided the Metropolitan Transportation Authority with a major infusion of cash to improve its rail system.
President Trump and Congress should repeat those smart moves. Members of both parties agree that there is a need to reduce corporate taxes — which are among the highest in the world — and repatriate up to $2 trillion in stranded overseas capital, which could be dedicated to infrastructure, including desperately needed mass-transit improvements. Other tax relief, carefully targeted to business growth and middle-class taxpayers, could also be included in a truly bipartisan tax bill.
Some may say that coming up with bipartisan solutions on these tough issues is too much to expect from our polarized political system in Washington these days. My own instinct and experience tell me that the very fact that our national leaders are gridlocked requires a return to working across the political aisle to make progress for all Americans. It’s not impossible; it’s just a matter of getting back to the art of the real in D.C.
Al D’Amato, a former U.S. senator from New York, is the founder of Park Strategies LLC, a public policy and business development firm. Comments about this column? ADAmato@liherald.com.