by John Geyman, M.D.

The current debate over health care reform could not be more sharply divided and polarized along party lines. Republicans in Congress are mobilized to repeal or defund the Accountable Care Act (ACA) or Obamacare, while liberals on the left defend against further cuts in safety net programs and many in the political center are caught up in the details of the ACA’s difficulties in implementation as they wonder what its longer-term impact will be. Aside from polarization and gridlock over next steps toward health care reform, what debate we have is over details that completely miss the more fundamental questions. 

As one example, much debate continues over the roles and workings of Exchanges that will start operation in many states in just two months. It is still unclear how they will work, to what extent their offerings will be affordable,  what  levels of coverage can be provided, and how many Americans will benefit from this approach. The answers to these questions are still unknown as the debate swirls on. 

Meanwhile, there continues to be no consensus over much more important and basic issues, such as: should all Americans have access to health care?, have incremental “reforms” of past years worked to build access and contain costs of health care?, and are health care services just another commodity for sale on an open market or a service that should be available to all?

Regardless of our party affiliation, health care for each of us  and our families is an intensely personal issue. We all have accidents and illnesses along the way, and ultimately die. We all need access to affordable care as we encounter these challenges in our journeys through life. Why then can’t we focus our debate on how best to provide some level of health security for everyone in this country?

The Health Care Disconnects panel calls attention to many aspects that need to be discussed at all levels within the debate over where to go next toward a goal of universal health care. We need to ask whether our prevailing largely for-profit market-based system will ever attain that goal (the answer of the last 30 years until now has been No!), and what options we have going forward. As our blogs will make clear, the ACA tweaks the market at the margins, but can’t be expected to reach that goal, even as many millions of Americans find necessary health care both inaccessible and unaffordable. 

One might think that each of our major political parties might actually compete to be the first to answer our basic questions over health care. Parties can change greatly over any given issue over time; one example is the shift of the Republican leadership from isolationist views and against military action abroad in 1940 as FDR and some Democrats tried to build an internationalist role and become engaged in the war against Hitler. Today that same party is more hawkish and beholden to a vigorous role in international affairs. 

Many conservatives and libertarians reflexly believe that the free market, with little or no role of government, will fix our problems. But our track record over the years belies that possibility. Medicare, which just had its 48th birthday, has widespread political support in reliably providing access to health care for seniors over the years. It has become so much a part of the fabric of our society that many demonstrating against larger government say at the same time: “Keep your hands off my Medicare.!”.

A landmark 2006 article by Donald Light and his philosopher colleague Paul Menzel bears on this situation. They described striking differences between conservative thought overseas and in the U. S., with many conservatives in other advanced countries giving broad support to systems of universal health care on economic, political, pragmatic and moral grounds.  They see the advantages of universal coverage in saving costs, increasing worker productivity, and helping their business interests. Menzel and Light concluded: 

“It is time for American conservatives to add health care to fire and police services as minimum government services needed to enable individuals to thrive at minimal financial costs. The question for conservative leaders who deplore wasted potential, free-riding, financial waste, and inefficiency is not whether they can support universal access to needed health care. It is how they can not support universal access without betraying their own values.”

We tend to forget how radically different ideas and values have been across the political spectrum in our past when consensus was still reached to move forward. In his recent book, Republic, Lost: How Money Corrupts Congress—and a Plan to Stop It, Lawrence Lessig notes how our forebears two hundred-plus years ago put their differences aside and saved our country. Today we need to do that to give every American an opportunity to have essential health care that befits the country we want to be. 

It would seem that the first political party to solve our major health care questions will earn and receive enormous public support throughout the country for many decades to come.

Suggested Reading: 

1. Menzel, P, Light, DW. A conservative case for universal access to health care. Hastings Center Report, July-August 2006. p. 9.

2. Lessig, Lawrence, Republic, Lost: How Money Corrupts Congress—and a Plan to Stop It, New York. Twelve, 2011, p. 326.

TAGS: ACA access to care Accountable Care Act Accountable Care Act (ACA) Affordable Care Act Affordable Health Care Cost of Illegal Immigration David M. Gimlett Don McCanne M.D. Employee Medical Benefit Employers Medical Coverage employer-sponsored health insurance Fee-for-service (FFS)