Monday, March 06, 2017

US v. Me: The Real Fight in American Health Care that this Debate, like all the Earlier Ones, Won't Resolve

Abbe Gluck

The GOP ACA “replacement” draft is expected today. Chances are it will look much more like Obamacare than people might expect.  It also isn’t going to answer the biggest question in health policy-- a question every Congress that has attempted health care reform from FDR’s to Trump’s has steadfastedly avoided.  What is a health care system for?

If two people are dying from the same disease, and require the same operation to survive, and one can pay and one cannot, is it OK for the poor person to die? This is the central question in health policy-- the tension between “social solidarity” and “personal responsibility” (terms popularized in this context by Wendy Mariner of Boston University), and it poses a particular problem for American politics, because it sets up  a debate between our American capitalist ethos and our norms of equality that we all share to some extent (even the Republican plans keep Medicaid and the ACA’s generous insurance reforms, and Trump himself has repeatedly claimed no one is going to lose their care), but that raise entrenched concerns about socialism.

Our collective unwillingness to confront this question also has resulted in a American health care system that is a hodgepodge of layered programs that mix public and private regulation and that does everything in its power to hide the government’s role in health policy. We do this-- Obamacare did this, and the current GOP plan is expected to do this, too--by running our much of our national health policy and federal assistance through insurance regulation and tax policy, so it seems private and so remains palatable to our capitalist ethos. But make no mistake: the government is helping most of us. Not just the poor and the elderly: anyone who gets their health insurance from work is getting a “handout” too.

For a lot more, please see my piece out today on Vox’s The Big Idea section.

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