One of the annoying blessings of a democracy is how we can decide to build something, agree on the plans, build it, move in to what we’ve built, live in for a few years, then decide it’s no good after all and blow the whole thing up. Take medical care in America—an issue and industry we’ve been trying without much success to feel good about for as long as I can remember, and I can remember the last five decades. Through the years we’ve tinkered, tweaked, and tweaked some more. Mostly, we held our noses.
And now, 52 years after the creation of Medicare and seven years after passing Obamacare, we’re right back to where we started, trying all over again to figure out what to do about health insurance in the United States of America, the only industrialized nation on Earth that doesn’t routinely provide paid maternity leave and some form of accessible medical care for all its citizens.
Why can’t we get our act together on this issue?
It’s because here in America we can’t, or won’t, answer one central question, and until its answered our nation’s healthcare system will continue to flounder and stagnate.
It’s this simple: Is access to medical care a right that should be guaranteed to all citizens in an economically developed nation like ours? Or is medical coverage just another product, like a new coat or a gallon of milk, that you can buy if you have the money, and if not then you do without?
The recent failed attempt to generate a replacement for the Affordable Care Act has demonstrated the extent to which the majority-Republican government is divided on this question. The result is the mess we witnessed a few weeks ago in Washington.
No effective solution is likely until we pick a path and pursue it. If access to medical care is a right for citizens, then let’s get on with it and make it a reality. Many, many other nations have accepted the care of their citizens as a moral necessity, and from that starting point have put plans in place to make it happen. Some plans work better than others. But they’ve acted.
But if the availability of health care is not a basic right of citizenship, then let’s stop pretending that it is. Junk Medicare and Medicaid. If you can get insurance through your job, great. If not, it’s your problem, not the government’s. Go find an individual policy somewhere else. There will be many waiting to sell you something.
It’s the back and forth, the government’s are-we-in-it-or-not approach that’s driving everyone to distraction. Washington has been trying to have it both ways for years as it promotes—or forces, depending on your point of view—mandatory coverage provided by grumbling free markets to a less than committed customer base.
Remember how our president promised us before Election Day that we’d all soon be enjoying “big, beautiful insurance with more coverage for less money?” Now it’s all a house of cards flat on the table, because neither the Senate nor the House nor the White House have the courage to (1) answer the simple question of whether we have a right to health care or not, and then (2) design a strategy to get us from where we are to where we’ve decided to go.
Until our friends in Washington can actually decide what kind of health care we’re entitled to, we will be forever cobbling shoes with construction nails, and framing buildings with duct tape. And the architects of whatever patchwork plan they come up with next will look at the final sloppy masterpiece they’ve created and declare it’s good enough.
Except that it won’t be good enough. We all know it won’t be good enough. Nor will it be until we demand of our government that they make up their minds, and decide if health care is a right, or just another product on the shelf. Then at least we’ll know where we stand in this country. Then at last we can get on with it.