Over the past several months, I have tried to bring to the Valley Patriot readers a mix of what’s new in medicine, and what is happening in the world of healthcare from the perspectives of patient access, business and politics. Since this edition of the Valley Patriot is focusing on the upcoming local, state, and national November elections, I am going to veer off my usual topics and take the risk of challenging the way you may be thinking about your vote and how it may relate to your health.
Politics is a process whereby we decide, as a community, simply what our priorities are. In the political process, for an idea to make it from a concept to actual legislation and be passed into law, there are many levels along the way where those with influence and power can mold and shape that idea. The priority can be simple or complex, but in a democracy, it is always best for all sides to be heard before a decision is made. For the best outcome, and even though one side may have numerical superiority, the process should include consideration of minority viewpoints in an effort to achieve consensus, so that there is a shared stake in the consequences.
The Affordable Care Act of 2010, also known as “Obamacare,’ is a great example of the result of consensus abandoned. What was supposed to be healthcare reform ultimately morphed into a monstrously complex and poorly vetted piece of legislation designed by a small elite in the Senate coached by self-interested industry insiders. The work product that was passed under special rules forced the House of Representatives to vote up or down, offer no amendments, or get nothing at all. Vote buying, special deals, corruption of any concept of equality before the law was on full display in this shameless affront to the democratic process. So, the bill that neither Republicans nor liberal Democrats really wanted got passed by both chambers, was signed into law by our President, and once the actual implementation and Healthcare.gov website crashed, there was practically no one other than the President himself who wanted to own it or take any political risk to fix it. I think the lesson here is that leadership matters, elections matter, and if you care about your access to healthcare and everything else that politics prioritizes, then you must think about how you vote in a way that is strategic.
Unlike many countries with multiple viable political parties, in the United States, we have a binary (two party) political system. Within each political party, there are subgroups that vie for influence. This is true of both Republican and Democrat parties. Party primaries, conventions, and grass roots organizing are where parties work out their differences and arrive at consensus. Parties do change over time and evolve, and history is full of examples where the old consensus changes.
In Massachusetts, I would argue that our one party state government has undermined the political process on both sides. Clearly the Republicans are disadvantaged by being in the minority, but the Democrats who are not in the leadership are also marginalized as well. You may have noticed the mainstream press reporting how the state house was only in session a small number of days last year. The main reason for this is that they do not have that much to do. The leadership determines what gets voted on, and determines what the rules are, and whether there will be debate or amendments allowed. A lopsided majority in the legislature empowers the State House and Senate leadership, and actually disenfranchises the regular members of both parties. It also leads to little input from the rank and file, and we all lose when political topics are decided without all sides having been heard.
So my challenge on the eve of what I believe will be a consequential election, is to get out and vote, and use your vote strategically to rebalance a broken system. Whether local, state or national, support the candidate who brings balance to the process. Support the grown up. You will never get a candidate with whom you agree with on every issue, or all the time. Work on your ideal candidate at the grass roots, and at the convention and primary the next time around. What we have to choose from now is what’s here on the ballot today. It’s a binary choice, and a protest vote for a third party candidate may be your right, but it is not strategic. Healthcare policy at the state and national levels needs your attention, and there has been a lot of mischief resulting from one party rule. Be thoughtful, be strategic, and get out there on Tuesday November 4th and vote!
Frank MacMillan, Jr, MD, FACG specializes in Gastroenterology and Liver disease. He is President of the Massachusetts Gastroenterology Association, a Fellow of the American College of Gastroenterology and it’s Massachusetts Governor. Dr MacMillan is a native of North Andover and practices Gastroenterology at Holy Family Hospital. He has also been a member of the North Andover Board of Health since 2007.