If there existed a world championship for “convoluted, interminable conversations of no lasting consequence,” the American healthcare debate would medal right alongside Dostoyevsky’s “Crime and Punishment” and the exercises in the back of a Logic textbook. Ever since the Affordable Care Act was passed into law nine years ago, a particularly useless debate has set in over the domain of healthcare legislation, with constant tugs-of-war between Democrats and Republicans about the legality of the individual mandate or the act’s effects on the competitive market.
Yet now, with a recent court filing from the Justice Department arguing that the entire Affordable Care Act should be discarded, that idleness may have come to a crashing end. A series of tweets by U.S. President Donald Trump – confirming his concurrence with the actions of the Justice Department over objections from AG Barr and Health and Human Services Secretary Alex Azar – noted that “Everybody agrees that ObamaCare doesn’t work. Premiums & deductibles are far too high – Really bad HealthCare! Even the Dems want to replace it, but with Medicare for all, which would cause 180 million Americans to lose their beloved private health insurance.” Trump further promised that “The Republicans are developing a really great HealthCare Plan with far lower premiums (cost) & deductibles than Obamacare. In other words, it will be far less expensive & much more usable than ObamaCare,” not elaborating on any specifics of the purported Republican plan.
As of April 3, Trump has reneged on this initiative until after the 2020 general elections, thus sparing us the abject misery of a rehashed healthcare debate…for now. But this recent exploit by Trump speaks to the higher order of political discourse outlined above; the healthcare argument has, for whatever reason, lasted far longer in the United States than in almost any other industrialized country. I am not ready to argue that this longevity rests solely on the shoulders of Republicans, who, to their undying credit, have made every effort to obstruct the public option from gaining significant ground in Congress. Nor am I willing to argue that the Democrats’ impotent hesitation and pedantism have single-handedly lengthened the debate to quite this extent. But combine both tendencies in a legislature with an already-disturbing propensity for submission to moneyed interests, and voilà: our kids in the House and Senate take the gold.
Naturally, the most fitting solution in my mind is precisely what Trump has identified as the “Democratic” proposal – Medicare for All. Yet it would be a fundamental misunderstanding of the issue (an affliction to which Trump is proudly prone) to suggest that establishment Democrats are at all united on this solution. In fact, some can not even agree on the efficacy of ObamaCare, which – although it expanded coverage to 20 million more citizens than pre-2010 levels – left as many people uninsured as it left insured. Critics on both sides call Medicare for All and ObamaCare barriers against competition and the free market, evidently implying that what is economically true of diced tomatoes and phone cases is, mutatis mutandis, true of a kidney transplant or tracheostomy. This is obviously untrue; the mechanisms of competition are necessarily stunted in the healthcare industry because of the inherently non-competitive nature of human health – no rational individual suffering from a stroke or aneurysm would deliberate over whether this or that hospital was the cheapest.
Still others call a measure like Medicare for All too expensive, discounting studies by research groups like the conservative Mercatus Center which suggest that, over a 10-year period, a Medicare for All measure could actually save the United States as much as $2 trillion dollars in lower administrative costs, prescription drugs, and provider payments over our current system. (Furthermore, one should note that the question of “how we will pay for it” never once arose in discourse about wars in Iraq or Afghanistan.) Still more call Medicare for All “socialism,” a fear-mongering tactic in the foul strain of McCarthy, as a means of miring the conversation in historical stigma and atavistic flag-waving. None of these arguments have much in the way of merit, yet they have become so deeply entrenched in the conversation that little can be done to conclusively drive them from the debate. And so, armed with completely spurious talking-points made in nothing but bad faith, the discourse has languished like a stalled car in the summer heat, pushing slowly backwards down the hill we so recently surmounted, a metal-rubber prison creaking inevitably backward into the past, it never occurred to us that we may – and should – simply exit the car and walk.