Mary Matalin & James Carville talk anger, politics and healthcare

Since the 2016 presidential election, Americans have watched politics unfold in excruciating detail. From the Mueller report to the Kavanaugh hearings to the ACA debates, each by-the-minute update garners an impassioned response from some corner of the electorate.

"Politics is infested into every corner of our lives," Republican political consultant Mary Matalin said in a discussion with James Carville, her spouse and Democratic counterpart, during an executive roundtable at the Becker's Hospital Review 10th Annual Meeting in Chicago. The discussion was spon-sored by Prism Healthcare Partners and moderated by Prism COO Brad Fetters.

While occasional moments offer a comedic break from our hyper focus on politics — think "covfefe" — by and large, Americans are riding a sociopolitical emotional rollercoaster.

"We are in a period of American politics where intensity is driving everything," said Mr. Carville. On the bright side, this means Americans are showing up to the polls more than they have been in years: The 2018 election generated the highest level of voter turnout for a midterm since 1914.

But Ms. Matalin tempered this: "This intensity — which is in some ways, but not completely, transfer-ring into voter turnout — is a product, not of choice and excitement, but anger," she said. She felt this anger could lead to voters making short-sighted decisions in 2020 based simply on who can beat the other party's candidate.

In a fast-paced and far-reaching discussion, the political duo delved further to discuss what Americans are so angry about, how we got to this point and where we can go from here.

Pulse check on party politics

The intensity of the moment has affected the political parties differently. Some Democrats are grow-ing more extreme, while Republicans are paralyzed.

Democrats appear to be flirting with socialism, much to Mr. Carville's dismay. He bemoaned the con-stant media coverage of Democratic Socialists like Rep. Alexandria Ocasio-Cortez, D-N.Y., and 2020 presidential candidate Bernie Sanders, who he believes are espousing unrealistic policies.

"The Democrats decided before 2018 that what we needed was serious grounded candidates who run on serious grounded platforms," Mr. Carville said. "As soon as the election was over, we just forgot what we were doing, and everybody is talking about crap that doesn't matter."

While Democratic Socialists capture headlines, Mr. Carville believes the Democratic Party is still more pragmatic than the media portrays. He cited the Democratic primaries in 2016, when a liberal won against a leftist in 50 of 53 instances. "Over a period of time, hopefully the party rights itself. Most of these people speaking are not Democrats. Bernie is not a Democrat," Mr. Carville said.

Meanwhile, Ms. Matalin feels Republicans have lost their mojo. "[Republicans] went through our tran-sition and sort of stabilized. Now we're just wimpy…wimpy versions of what we could be," she said. Republicans don't want to lose control in Congress, which translates into not getting a lot done. Ironi-cally, failing to make measurable changes, particularly in healthcare, caused them to lose seats in 2018, she said.

"Who wasn't shocked that the Republicans ran for six years on repeal and replace, and they get there, control everything and sit on their thumbs?" Ms. Matalin said.

Why Americans are angry

So how did we get here? Throughout the conversation, Ms. Matalin and Mr. Carville came back to four interrelated factors they believe led us to our current state:

1. Identity politics. More people are voting based on their racial, religious, ethnic, gender, social or cul-tural identity, and Ms. Matalin believes this is a major contributor to why Americans feel so divided right now. "A consequence of identity politics, writ large, in perpetuity, is it's divisive," Ms. Matalin said. "You start pitting your coalitions against each other. I mean who likes white men now? Who likes old white men now besides me?"

2. Media validation loops. Media, or media consumption, is deepening divides as people seek news sources that affirm rather than challenge their beliefs. "Everything is niche. Everyone is making money telling people what they already believe. There is more money in validation than enlightenment," Mr. Carville said. He noted the uptick in "super majority counties," or counties in which one party controls more than 50 percent of voters. In 1992, only 96 of more than 3,100 counties in the U.S. were super majority counties. In 2016, that number skyrocketed to over 1,200. "Not only do we not pay attention to what other people say on TV, we don't even live with people that disagree with us anymore," Mr. Carville said.

3. Rural-urban divide. Urban and rural America are growing apart, economically and politically. "[Dem-ocrats] got kicked in 2016 because we abandoned parts of the country," Mr. Carville said.
Mr. Carville also touched on the current struggle facing rural hospitals to stay open and retain physi-cians. Medicaid expansion saved rural healthcare, he said, but it may still need another lifeline. "I don't see us really trying to address this," he said. "Like everything else, healthcare reflects the de-mographics. Urban America is booming, and rural America is not."
"Right now, it looks like people are just paying attention to the urban politics. I think it will get back on track, but I am not pleased about what I've seen thus far because the conversation doesn't comport with what we see in everyday life."

4. Lack of political follow through. "Both parties have been detached," Ms. Matalin said. "They impose policies that they don't subject themselves to, healthcare being one of those."
Mr. Carville believes the problem is politicians overpromising and underdelivering. "In American poli-tics, they set expectations that are unfulfilling," he said. "Nobody wants to run and say if you elect me, I'll make things somewhat better. Voters start having that real expectation of politics, and people con-tinue to be disappointed."

Where can we go from here?

Both Mr. Carville and Ms. Matalin believe the natural order will restore itself. But to get there, Ameri-cans have to accept incremental change and be willing to build coalitions and compromise, according to Mr. Carville. "There are people that believe you want to have a smaller, purer revolution, but I think politics is a business of coalitions and compromise," Mr. Carville said. "I don't think Democrats are pay-ing much attention to what the American people are saying. I think they will. I am hopeful."

Ms. Matalin believes people can find common ground in data-based decision making. "Centrist and moderate is not a philosophy to me, it's a speed," she said. "When I say centrist, I mean … people who look at data and see if it's working. And if it's working, then [they say] let's expand on it. If it's not working, like the multitude of programs that do not work because they're not measured, there's not accountability for them, so you should stop them."

While the couple disagreed over whether Congress would touch healthcare before 2020, they re-mained optimistic that some issues with bipartisan support, like lowering drug costs, could be ad-dressed before the end of the year.

"Pharma is just kicking the crap out of everybody. They play the hardest level of politics that you can imagine," Mr. Carville said. "This is a group that has outsized influence and every person in this room knows that. The only answer I can give you, unfortunately, is dig in there and build coalitions to go against them."

To the healthcare leaders in the room, Ms. Matalin and Mr. Carville stressed the importance of work-ing with each other and other stakeholders, like payers. Ms. Matalin was optimistic, noting that previ-ously adversarial healthcare players were starting to come to the table together to address industry issues without government oversight.

But there is still work to be done.

"Washington is 90 percent lawyers and maybe two doctors. What do they know about how to deliver low-cost, high-performing healthcare?" Ms. Matalin said. "They don't. So it's very important for [healthcare executives] to continue sharing your ideas and get up, get at the table. If you don't have a seat at the table, you are going to be on the menu."


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