Particularities & Generalities about Ryancare

Trump is settling into the background noise (as we can only hope), while the real players are in the Congress and the Cabinet. Trump may hold a triumphal self-promotion event in the Rose Garden to celebrate getting an Obamacare repeal bill through the House of Representatives, but that is only a stunt because a new bill will be crafted in the Senate that may look very different from the bill Speaker Ryan got through the House. Remember that Trump’s election was itself a fluke, not a trend, much less “a movement”, as he likes to put it. Journalists like to tie his election to Brexit, which had its distinct sources in the failures of the European Union, and to tie it to Marine Le Pen, but look what happened to her.

So we have to look elsewhere than to Trump to find out what is happening in government, and an insight into, at least, how politicians argue about health care policy was available yesterday at, among other places, George Stephanopoulos’ Sunday talk show on ABC. Politicians and journalists, first of all, when they talk about policy issues, by and large do not these days begin with axiomatic statements that they then apply to the particulars of Ryancare. They do not argue about whether people do or do not have a right to health care, even though, by the way, Ryan made it clear that if people don’t want insurance, they shouldn’t be forced to get it, and so people have no right of coverage, even if they do have a right of care, which means that they can always go to emergency rooms where the costs will be picked up by insurance companies and state governments. But Ryan does not too much refer to first principles because outright saying that healthcare is a luxury purchase rather than a right might make him seem hard hearted. So he prefers to appear as someone who is just making health insurance better.

And, second, politicians and journalists, by and large, do not argue dialectically, which means addressing an assertion with an argument or a fact that is relevant to countering that assertion, as people are taught to do when engaged in debates. Senator Susan Collins, on George Stephanopoulos’ program yesterday, did counter what Paul Ryan, who had appeared just before her, had to say about Maine’s pool of money for high risk people, by saying that there was a stream of money dedicated to it, and that was not available under Ryancare, where states might or might not fund a high risk pool, but interlocutors mainly do their thing not by responding to one another but by stating some bottom line that seems obvious to them as a general critique of the opposition point of view, that point of entry in the debate capable of being treated as either a particularity or a generality about the subject being debated, in this case Ryancare.

So Ryan offers up a standard Conservative platitude as if it were a gilt edged fact: one kind of program, dictated by Washington, doesn’t fit all sizes. Every state is different in its health care needs. This statement seems so obvious that it doesn’t need proof, just application, and yet a moment’s consideration tells the viewer that there are a lot of programs that are very successful and administered by Washington without attention to local conditions. Social Security does not vary its checks based on state or region, only on the basis of how much an individual retiree has contributed to the program over the course of a work life. And while it is true, as Ryan claims, that many states and counties are down to only a few insurers willing to offer plans under Obamacare, Ryan is not proposing to change Obamacare only for the districts where it is not working while retaining in for the areas in which it is working; he is out to repeal it for everyone. What Ryan says about one size fits all is therefore without bite; it doesn’t work except in the way he wants it to, the generalization no more than a particular about what is wrong with Obamacare.

Stephanopoulos did not engage Ryan on this point, even though he had set aside a considerable amount of air time for the interview. Instead, he went on to a different insight into the health care debate, his own way of being incisive about the debate. He asked Ryan rhetorically whether he thought that cutting a trillion dollars from the health care budget wasn’t going to hurt anyone. Obviously, so Stephanopoulos thought, it was going to. That was a particularity, a point of fact, that there was no getting round, as well as an appeal to the general point that the real measure of a policy was the size of its budget. Cut the budget and you cut the program. That was when Ryan pulled out the idea that fewer people covered is not so bad if they don’t want to be covered, which is not to the point of whether sufficient investment was being made to cover all the ways in which care might be provided--through insurance that is at least partly subsidized or through emergency room care paid for otherwise. It is easy for a skilled debater to move aside what seems a cutting insight by referring to another generality entirely.  

It would be easy enough to conclude that debating policy is pointless. Everyone can always defend their side and put out both factoids and generalities to suit their case, leaving the voter or observer to say no more than that both sides seem to have a point on the merits. That is certainly the position taken by the panel of journalists and political operatives who commented on what Ryan and Collins had had to say. They just shifted to a discussion of the politics of health care, what was going to happen down the road in the Senate, rather than take a stand on who had scored the most points in the debate. But, in fact, if you had paid attention, you could have scored the debate. Ryan’s cliches or bedrock convictions, whichever you call them, did not stand up to either analysis or to what Collins or Stephanopoulos had said. His policy is bankrupt, even though you have to give him credit for standing up there and not running out of things to say or rejoinders to make.

It should be remembered that most great and near-great Presidents cited first principles. Ronald Reagan insisted that Gorbachev bring down that wall; FDR listed Four Freedoms that nations should be guided by after the war ended. But John Bonier is notable for having criticized President Obama for having wasted their meetings by insisting on talking policy rather than votes. And Elizabeth Warren and Bernie Sanders regularly enunciate their own first principle, both a generality and a particular, that the cause of the nation’s problems is income inequality. Trump, for his part, having no ideology, enunciates opposite principles all the time, rendering the discussion of first principles moot. So we are in for a time where Republicans engage in point making rather than explanation.