Thursday, May 4, 2017


In the end, I think the problem with the Patient Protection and Affordable Care Act is wrapped up in the nickname "Obamacare," in that is has become much more about people's opinions of President Obama than it ever was about the processes and finances of health care.

And in a lot of ways, people's opinions of President Obama weren't even about the person of Barack Obama. Instead, they were about an understanding of political philosophy and ideology. To the degree that President Obama was a symbol of a certain type of progressivism and social consciousness to people who supported him, he was some mix of a caricature and nightmare vision of the same to his detractors. And whatever the views were, they were buttressed by a combination of confirmation bias, cherry-picking and, when needed, outright fabrication.

As a partisan matter, the debate about "Obamacare" never had anything to do with health care in the United States. Instead, it was about the interlocutors' competing visions of right and wrong. And perhaps that explains both the flaws of the Patient Protection and Affordable Care Act and the American Health Care Act - vision statements rarely have to line up with the reality on the ground.

As I see it, the vision put forward by the Patient Protection and Affordable Care Act is one of shared responsibility. People, by virtue of being people, have value and worth, and a responsibility to help each other recognize that value and worth through staying healthy. This is more or less in line with how I understand the Liberal worldview more broadly. Life, when left to it's own devices aims its slings and arrows with abandon, striking some down while sparing others and the role of the collective society is to mitigate against that randomness - not for the sole benefit of those who receive aid, but for the greater benefit of the whole. On the other side of the coin, the vision of the American Health Care Act is...

Hmm. Maybe it's too early to say. On its face, it seems like a repudiation of the ACA's shared responsibility vision. Which would make sense, as the American Conservative worldview tends to see itself as an antithesis of American Liberalism. From where I sit, it postulates that life's slings and arrows are predictable in that they are earned - they are the results of choices that people make for their own benefit, and those self-serving choices should not be financed by involuntary donations from the public at large. Mitigating against those effects encourages moral hazard, as losses are socialized, yet gains are hoarded. Letting the world work as it does is not for the sole benefit of those who do well, but for the greater benefit of the whole... Sound familiar?

But here's the thing. Neither side is willing to credit the other with looking out for the greater good. Rather, each sees the other as cynically invoking the public's welfare, while seeking to enrich their friends and favored benefactors. (I, anecdotally, blame the abortion debate, which strikes me as one of the first controversies to directly insert the concept of "evil" into a policy debate.)

For Republicans, President Obama, from the outset, was a figure to be distrusted. Not because he was secretly a Manchurian Candidate - a Kenyan-born Moslem who sought to undermine the United States to honor African anti-colonialist sentiment, but simply because he was a Democrat who ascended to the White House after the disastrous onset of the "Great Recession," something that Republicans at the federal level were mostly unwilling to accept responsibility for. They feared a hard left turn in American politics, driven by a crisis that they felt must have been brought on bad acts by government.

Primed to distrust "big-government" solutions to problems, especially those they felt were caused by government in the first place, Republicans in Congress were perhaps also primed to see the concessions that President Obama offered to their sensibilities as a trap. And so, while many people noted the similarities between the Affordable Care Act and a plan pushed by Governor (and candidate for President) Mitt Romney, it can be argued that the American Right smelled a Trojan Horse.

In the end, many critics of the Affordable Care Act wanted it to fail. Not because they wanted people to suffer without health care, or even that they felt the price was too high; but because they saw it as intentionally bad for the very people it claimed to protect - not to mention their constituents, in whom they'd stoked distrust and motivated skepticism.

I will be unsurprised if, regardless of how it turns out, the American Health Care Act doesn't meet the same fate. For all that it's Republican boosters will enthusiastically tout it as a cure all to everything that ails American health care, the fact remains that it's unlikely to tackle the difficult economics, perverse incentives and slapdash legislating that created the system we have now. A dedicated refactoring of the system, and the laws regarding it, would be a difficult undertaking and likely a thankless one at that, as change creates losers, and losers birth opposition.

As long as American politics consists mainly of mutually antagonistic factions who see each other a moral and mortal enemies, the animosities stoked will become an impediment to lasting progress. There will be change, and counter-change, as each side seeks to undo what the other has done and replace it with something more to their liking, but that's a different beast than actually creating solutions.

No comments: