• Focusing on Single Issue Guarantees Inaction on Others

    "He had a nasty reputation as a cruel dude. They said he was ruthless, said he was crude."
    -- Eagles

    I was extremely hesitant to write this post. Although starting a conversation about the current political climate might be a poor decision, I think it is an important discussion we need to have as an organization.

    During the past several years, I have witnessed a dangerous trend in our public policy and political discourse. That trend is the increasing willingness to develop views about elected officials based on a single vote or their position on a small subset of issues. I refer to this approach as the "one-dimensional politician," and it is becoming extremely common.

    To be blunt, I am concerned (and a little scared) that we are normalizing an expectation that the AAFP should never work with politicians or support policy they introduce solely because we disagree with a position that they have, or had, on an unrelated issue.

    I understand that many people, individually, vote based on a candidate's alignment with their personal political or governing philosophy. Sometimes we vote for elected officials based entirely on their position on a single issue of great importance to us as individuals. You should always vote for those individuals who reflect your values and priorities.

    My concerns are with my observation of a growing expectation that organizations such as the AAFP should view elected officials entirely based on their position on a single issue or a small subset of issues rather than on the comprehensive, complex set of issues considered by Congress. There are expectations that we should view politicians as one-dimensional, not as multidimensional individuals.

    This, in my opinion, is inappropriate, and here is why.

    According to the Brookings Institution's Vital Statistics on Congress, the U.S. House recorded, on average, 699 votes per year from 2008 to 2018. The Senate averaged 261 per year. Now, consider that, according to GovTrack, during the past five Congresses -- the 111th, 112th, 113th, 114th and 115th -- more than 10,000 bills were introduced in each Congress. (As an aside, Congress has gotten lazy. The 93rd Congress -- 1973-74 -- introduced more than 26,000 bills.) These numbers illustrate the depth of legislation that is introduced and considered in each session of Congress. It also shows that there are literally hundreds of opportunities to align with or against any elected official. I can tell you from personal experience that it is not uncommon for the AAFP to support and oppose different proposals from the same lawmaker in the same week.

    I am not a political scientist, so I will not render an opinion on what has spawned this new expectation in our political system. However, I have worked inside and alongside the political system for more than two decades, and I have witnessed firsthand the consequences of polarization. It is having a profoundly negative impact on policymaking and the legislative process.

    I believe that 90% of people who put their name on a ballot do so with the best of intentions. They are committed to service that makes our communities, our country and our world a better place. Now, you may be asking yourself why only 90%? Well, there are people who run for public office simply to advance selfish individual goals. They are not public servants -- they are parasites on public service. But there are few of them. Thankfully, our system has a way of identifying and weeding out selfishness.

    In my early days in Washington, D.C., the philosophy among elected officials was always, "We will work with anyone, when and where we can." Interestingly, they not only meant it, they actually executed against this philosophy. I believe that generations of politicians were rewarded for this pragmatic approach to legislating. Of course, this was before 24-hour cable news, Facebook and Twitter. Today, elected officials are graded in real time and are more concerned about their left or right flank than they are the middle.

    The U.S. Congress, state legislatures, city councils, school boards and many other governing bodies comprise individuals who bring a multitude of experiences, views and opinions to their roles. There are issues they care deeply about, and there are things that they don't have a strong emotional connection to. There are issues that make them want to work all night, and there are issues that make them want to take a nap. They are human. We must accept this.

    We must accept that 100% alignment is a fantasy promoted by bloggers and movies. In the real world, you just hope that you can get alignment on some key priority issues.

    The AAFP is committed to a vision and mission grounded in member-established policy and guided by a clear set of strategic objectives. We are not an advocacy organization committed to a single issue, and we are not a think tank simply providing ideas and hoping for the best. We are an active participant in the legislative, regulatory and political process, but we are a participant committed to a set of policies and strategic objectives, not a political ideology.

    For the past several years, we have engaged with Ballast Research to evaluate the performance and efficacy of our advocacy and political engagements. I previously wrote a detailed post about this evaluation. Here are a few key points from Ballast's research that I would like to reiterate:

    • Of the top 50 trade or professional associations across all industries who have a presence in Washington, D.C., the AAFP is ranked as the second-most effective organization.
    • The AAFP is ranked as the most trusted organization and is widely praised for our contributions to policy and our approach to identifying achievable solutions.
    • The AAFP also is recognized as one of the most bipartisan organizations in Washington, with approval ratings from both parties that exceed 60%. This is an important accomplishment, and it takes effort to remain bipartisan in our current political climate, but it is essential to our members, the discipline of family medicine and the AAFP as an organization that we do so.

    Contrary to popular belief, D.C. is a small-ball town. Yes, big things happen, but the legislative and regulatory process feeds on small plates, not buffets. This means that effective organizations are constantly attempting to position themselves to achieve incremental changes. To do so, you must be trusted, and you must be well-positioned with the largest, most diverse group of collaborating lawmakers possible. Organizations such as the AAFP should be encouraged to be bipartisan, and you should be proud that we are one of the most bipartisan organizations. You also should be proud that people see us an organization committed to solving problems.

    It is true that many elected officials may support policies that are inconsistent with our worldview, and there always will be some votes that matter more than others. However, there also will always be issues where alignment and collaboration are possible.

    Baseball teaches us many things, but none is more important than patience and persistence. A strikeout in the second inning is quickly erased by a double in the seventh. A long 0-for-20 stretch fades with a three-hit game. The key to success is not leaving the field of play, it is getting in the batter's box over and over again.


    Stephanie Quinn, AAFP Senior Vice President of Advocacy, Practice Advancement and Policy.  Read author bio »


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