The Ideology of Healthcare Reform

Back in 2009, when the Affordable Care Act (also known as Obamacare) was making its way through Congress, a debate was making its rounds amongst the American populace: “Is healthcare a right, or a privilege?”

This seemingly simple question spread through social media like wildfire at the time; today, it’s still around in some circles, but doesn’t seem nearly as prevalent as it was 8 years ago. The reason for this, I would suggest, is that the adoption of the ACA also ushered with it an implicit acceptance among the populace of its logical basis: that healthcare is indeed a basic human right, and that people of all income levels deserve to have it.

Unfortunately for most Americans, this premise of healthcare as a basic human right is not one that is yet ingrained in the dogma of the Republican Party. Healthcare as a privilege – or as Republicans frame it, as a market-based commodity – is still the reigning ideology of the right. The clash of ideology here, then – in viewing healthcare as a privilege as opposed to a right, described in operational terms as a market-based commodity as opposed to a social good – serves as the fundamental difference between Republican and Democratic visions for healthcare reform.   And now, with the slow-creeping acceptance throughout society of the view that healthcare does serve as a social good, Republicans find themselves faced with a conundrum: either they accept and adopt this mentality (or pretend to) and work towards a revision of the ACA that uses this as its framework, or they continue to push aside this view and present their entirely market-driven (if morally bankrupt) position that healthcare should be available to those who can pay for it.

This problem is highlighted when Donald Trump promises things, as he did on the campaign trail, that align with the Democratic vision of healthcare in America – universal coverage, low premiums and deductibles, minimum standards for what coverage plans must include. When he pledged, prior to taking office, that his vision for healthcare would lead to “…insurance for everybody,” that will be “much less expensive and much better,”  these talking points likely struck a dissonant chord with his Republican colleagues in Congress.

The ideological schism in the healthcare debate is on public display in the proposed ‘repeal and replace’ plan put forth by House Republicans earlier this week.   The proposal essentially serves up a massive tax cut for the wealthiest Americans (and donors) upon whom Obamacare relies to fund its keystone provisions, removes ACA protections for lower-income and elderly Americans, requires these same vulnerable populations to pay a significantly higher cost for less care, and spins this as some kind of a positive by alleging that the plan will increase “access to” care — giving that ever so slight nod of acknowledgement to the moral implications of recognizing healthcare as a social good (while still refusing, counterintuitively, to formulate a proposal that takes this into any kind of serious account). If these Americans can no longer afford health insurance or out of pocket healthcare costs, having access to such care is entirely meaningless.

If the GOP actually wants to fix the problems with Obamacare (which are plentiful), it must first accept the premise of its passage: that every American, and indeed every person, deserves healthcare – and that affordable health coverage is essential to attaining this end. If it accepts this, as well as government’s role in procuring it, then it can begin to work with Democrats toward a bipartisan solution to fix the ACA. If it does not accept this premise and remains unwilling to budge in its commitment to free market principles alone in the consideration of healthcare, then this “survival of the fittest” worldview will be entirely out of step with what most Americans want in terms of healthcare reform.

Healthcare is a social good. It coincides with the ideology enshrined in our Declaration of Independence, where “life, liberty, and the pursuit of happiness” are affirmed as our “unalienable rights,” which governments are instituted to secure. There is no right to life without healthcare. Any ideology which denies this fundamental truth is, quite simply, wrong. Now is the time for Republicans in Congress and the White House to work for the good of the people – their people – instead of continuing to push for the interests of big donors and insurance executives. For them to remain on the current path will lead almost certainly to the severe detriment (and likely death) of many vulnerable Americans.