A Dose of Reality: A Medicaid Status Report

Last night, I was able to attend an American Public Square conversation on Medicaid held at UMKC.  The panelists included Kathleen Sebelius, Daniel Landon, Tarren Bragdon, and Michael Cannon. American Public Square is an organization dedicated to promoting civil civic discourse on the important issues of our day. The emphasis throughout is on civility and open discourse (no clapping, no jeering, opportunities to call time outs for neutral fact checking, etc).

This was my first American Public Square Event so I don’t know if they always try to gin up extremes or whether the issue of Medicaid is particularly polarizing. It does mean that Medicaid was both demonized (forget expansion Medicaid, I’m talking original Medicaid) and extolled in somewhat inaccurate and unfair terms throughout the evening. Michael Cannon, for example, explained the very early results from the Oregon Medicaid Lottery to mean that Medicaid produced no better health outcomes, but when "fact checked" on this adopted a fallback position and began to argue that the studies interpreting the early results were methodologically flawed. Because it was all done in an earnest and calm manner, it apparently passed the American Public Square definition of civil discourse. 

Maybe it is just that I have a different idea of civility.  After all, the conduct of the members of the House of Commons has many of the characteristics American Public Square apparently considers uncivil. Yet, robust and even rowdy debate in the House of Commons seems to me to be exceedingly civil. Maybe true civility is not in the surface adornment of the event (no clapping, etc.) but in respecting the forum and the audience enough to not misrepresent, to not overstate, and — most of all — to concede that it is possible you could be wrong.

I'd say that is what was missing last night, a healthy respect for one's own fallibility and a generosity of spirit toward the fallibility of others.

The rare Medicaid expansion/original Medicaid discussion would be one where the parties had genuinely thoughtful and strong opinions yet admitted, “but, hey, I could be wrong.”  Who there had read Kathryn Schulz’s Being Wrong and taken it, even a little bit,  to heart?

 

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