Crawford headshot by William C. Crawford

Much has been said about the divisive partisan gridlock reaching back 15 years or more. However, close analysis reveals that Presidents George W. Bush and Barack Obama both successfully prodded Congress to enact compassionate, conservative health insurance legislation that vastly expanded coverage for millions of vulnerable Americans.

Our intransigent state leaders in North Carolina would do well today to emulate some largely disregarded initiatives undertaken by prominent Republicans. Such a change of course might finally bring healthcare insurance to nearly 500,000 mostly working citizens who, up to now, have been betrayed by their governor and elected representatives.

Political scientist Charles Lindbloom once described policy development as “the science of muddling through.” His seminal 1959 essay advanced “disjointed incrementalism” as a realistic approach to changing policy through small, gradual steps. His prescient paradigm captures the essence of recent efforts by two presidents — one Republican and the other a Democrat — to move US healthcare into a realistic, 21st Century posture. These often overlooked efforts also recognize that true economic prosperity requires that we take care of workers’ healthcare needs both before and after their retirement.

George W. Bush expanded Medicare to provide prescription drug coverage to millions of economically strapped seniors. The legislation was deeply flawed because of the much maligned “doughnut hole” as well as major indefensible concessions to Big Pharma. The insurance industry reaped a windfall in new business.

Ironically, Bush pushed this plan through Congress with no provision to pay for it. This seemingly reckless choice actually helped to assure Republican support. Like it or not, Medicare prescription drug coverage has been a godsend for millions of at-risk seniors.

The notion of universal healthcare coverage had been little more than a political football for decades. It took a Republican governor, Massachusetts’ Mitt Romney, to finally press for state legislation that offered affordable healthcare insurance for most of his constituency.

Later, Obama seized on this same conservative, market-based model as the basis for the Affordable Care Act. The resulting legislation was fraught with problems, but it nevertheless expanded healthcare insurance to millions of Americans, especially low-income workers.

Perhaps the biggest takeaway from this paradoxical, disjointed, series of incremental policy initiatives is that both political parties supported them in some fashion. They recognized on a bipartisan basis that healthy Americans are necessary components of a thriving economy. This is all to say that despite partisan bickering, political compromise helped to expand Medicare coverage; established Massachusetts healthcare as a successful model; and produced Obamacare with its many flaws but surprisingly effective increased coverage for the uninsured.

North Carolinians have a long history of overcoming their political differences to create a modestly progressive political economy. Pat McCrory ran for governor as a moderate, business-oriented candidate from economically booming Charlotte. It is high time for him to pick up the mantle of his Republican predecessors, George Bush and Mitt Romney, to propel North Carolina forward with a mature and compassionate 21st Century economy.

Maybe the governor and the General Assembly don’t really care much about the welfare of these thousands of uninsured, low-wage workers. However, they surely must have concerns about our still-struggling state economy.

Twenty-five thousand new healthcare jobs and billions of mostly federal dollars will flow into our state through the Medicaid expansion. If the loudly trumpeted Republican business ethos is to hold any real water, then McCrory and the General Assembly should step up now to enhance our still fragile economic situation.

Like Bush and Romney before them, state Republican leaders should recognize that healthcare expansion is just good business. Most other Republican-controlled states have found a way to expand Medicaid to cover the lowest-income workers. Our state leaders might also do well to carefully consider the words of Alexander Solzhenitsyn still echoing from the Gulag: “The line separating good and evil passes not through states, nor between classes, nor between political parties either, but right through every human heart.”

William C. Crawford is a social worker and health care administrator who worked for 35 years in Medicaid.

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