It’s about as clean a political debate as you’re going to find. When you break it down as simply as you can, the healthcare fight is drawn up so tightly that it may as well be a Poli-sci 101 case study. It seems messy and complicated, with bills in the thousands of pages and votes that happen without the Congressional Budget Office actually being able to assess the overall impact. But it’s really not. Because no one really needs to know the details to choose what side of the debate they’re on. The line is that bright.
The Affordable Care Act, Obamacare if you will, was 11.5 million words. If it were a book, it would be 40,000 pages. Which means it would literally take years for any one person to read it end to end. So, no one did. And that’s not that uncommon or even wrong in Congress. Because when you take a look at what Obamacare did, all you really had to know to understand if you supported it was whether you were a Democrat, or a Republican.
Obamacare did lots of things. Materially though, the most important of those things can be described pretty simply. Obamacare forced the inclusion of sick people into the healthcare insurance pool. In order to keep that from causing premiums to skyrocket, the act forced everyone to have health insurance or to pay a penalty. It also expanded the definition of poor people eligible for government provided care. Which was pretty expensive. In order to help those who couldn’t afford the new burden of the care they now had to get, and pay for the newly defined poor, Obamacare paid for it by taxing corporations and people that made lots of money.
Which means that the Straussian distillation of Obamacare is that it helped the American poor and disadvantaged by growing the reach of government to force the removal of choice and money from other Americans that had choice or money. You either believe that’s a good idea. Or you don’t. And if you are a political animal, you know exactly what side you’re on.
Conversely, it’s not particularly difficult to track the changes the American Healthcare Act (Trumpcare) will have on the existing American healthcare landscape. Trumpcare is going to give states the choice to opt out of the Obamacare restrictions on things like pre-existing conditions. It’s going to reduce the amount of poor people who have access to coverage through repealing the expansion of Medicaid. And as a result, the reduction in cost will be paid back to rich people and corporations, as it was them who were originally taxed to pay for the original increase. As a result, people who can afford to, can choose to opt into lower cost plans that provide less than the basement plans in Obamacare.
Which means that the Straussian distillation of the AHCA is that we give back choice and money to those Americans who have it, and we hurt the poor and disadvantaged to do it. Again, you either believe that’s a good idea or you don’t. And again, if you are a political animal, you know exactly what side of that debate you stand on.
You can save yourself 40,000 pages of words now.
Healthcare in America is the defining political debate of our time. When you strip the two arguments above down to core principles, you could argue until you’re blue in the face which is right and not change many minds. Do we push choice down to the lowest possible level, the states and the individuals? Or do we take it away and allow the government to force us to help those in need in exchange? It’s the same debate we’ve been having with different words since we were arguing about a Constitution or a Confederacy. And it’s not sorting itself out any time soon.
But what if I told you that neither of those arguments matter? Because very shortly, almost no one is getting the healthcare they get today. Not the poor and sick. Not the struggling middle who values choice above all things. Not the well off. Not even the rich. None of them are going to get the care they get today, no matter what side of this debate we land on. Would you feel different?
I know I would.
Here’s the cold and bitter reality. 42% of all government spending goes to healthcare and retirement in America. In 1962, it was 13%. One out of every six dollars in America is spent on healthcare. The Federal budget at present day is 80% locked in before the year starts. By 2022, it will be 90% predetermined. The average American is 36 years old. In 1960, he was 29. We live to be 82. In 1960 we lived to be 71. Our state and municipal pension plans nationally are only 80% funded. Social Security is 68% funded. Healthcare costs increase at two to three times the rate of inflation every year (it was actually worse before Obamacare). The United States of America spent 580 billion dollars more than it made in 2016. And our collective governments are in debt 29 trillion dollars.
Those are all daunting numbers that represent a hard reality. Neither Obamacare nor Trumpcare address the spiraling cost of healthcare or the ever shrinking amount of resources we will have in the future to try to keep pace with it. They simply change who has choice. They are two buses full of very different looking people. But they’re both going to drive off the same cliff.
That course is set until we do something that no one really feels like we have the political stones to do—fundamentally change the market forces in play for medical care. That’s going take messy government intervention in one way or another. Because left to our own devices, America spends more on low value care treatments and services that don’t make us healthier—scans, just in case antibiotics, end of life care— than we do on education in America for grades K-12. And we sling more drugs than any place on the planet, many of which are just making us sicker. Watching football used to mean funny beer commercials. Now it’s drugs. Because drugs in America are consumer goods. And that’s a problem to solve.
So where do I stand on this choice? Trumpcare or Obamacare? Well, Trumpcare isn’t a better plan. It’s just different. It helps some people and it hurts others. But the one moral good that Obamacare does do, that I can’t say that I see has an equal on the other side, is that it gives people health coverage that otherwise would not have it. And from where I sit, having lived with long term family illness and disabled children, I can’t justify giving that up without significantly more societal benefit than I see in the new plan. I say that as one of the fortunate being taxed to pay for Obamacare. And until we finally go off that cliff, or find the courage to change course, I’d rather help those that need it most.
And one other thing. This truly hard debate gets even harder when one side of the party is led by someone who is or pretends to be a bully. Because no one believes him when he says he’s just trying to do what’s good for us. Even if he is. Whoever is going to turn that wheel, needs to have a hell of a lot more trust than what we’re willing to give to the man at the top right now. And that’s another problem to solve.