As the 115th Congress gets underway, the Patient Protection and Affordable Care Act is set to be among the first casualties of rambunctious Republicans who have been clamoring for its beheading since the day it was born.
Now that they have full control of federal government — thanks to their singularly improbable candidate winning the presidency — there is nothing standing in the way of a swift execution, except maybe cautious concern over how much blood might get splattered on the executioners.
While the ACA has not quite been the success its supporters had hoped for, it has provided health insurance for tens of millions of Americans who would not have had it otherwise.
Now, either out of compassion or fear of voter reprisals, many Republicans have become squeamish about slaying a benefit as crucial as health-care coverage for that many Americans.
As with most issues in America, health care is mired in the ideological mud pit where liberals and conservatives wrestle over just about everything while accomplishing very little — except to get filthy. Their fundamental disagreement is over the most effective way to organize society — free-market capitalism with minimal government versus community capitalism in which government ensures a certain basic level of well-being for all citizens.
Ideology aside, ultimately politics is mostly about personal economics.
The American Dream promises a certain level of affluence commonly identified as middle class, and it includes quality health care.
When that dream becomes elusive, affected Americans become agitated, angry and afraid. In desperation, they move back and forth between the two entrenched political parties in the hope of improving their economic conditions.
President Donald Trump successfully convinced enough Americans that he could do that for them. Hillary Clinton did not.
However, the realities of the American economic system make it highly unlikely that any president can ensure the American Dream.
The primary reality is that America’s version of capitalism is pervasively infected with pathological avarice. Every industry, every institution has become first and foremost a profit center, typically with short-term earnings goals, and run by incentivized executives or administrators whose personal greed often results in injury to the broader population.
Every week reveals another egregious predatory transgression by a big corporation. Big banks engage in systematic cheating of their customers. Western Union knowingly conducts money laundering. Car manufacturers connive to circumvent environmental laws, and worse, continue to sell cars they know are lethally defective.
ExxonMobil conceals its own findings that its products cause global warming while mounting a campaign to discredit such findings by others. Big pharmaceutical corporations facilitate misuse of their addictive drugs, conduct misleading promotions and mercilessly raise drug prices to levels that impoverish customers.
Not only has Trump no magic wand to undo this, he has engaged in such predatory greed himself and is packing his cabinet with suspect corporate creatures. Maybe his strategy is “it takes a thief to catch a thief,” or maybe it is business as usual in Washington, D.C., with the same forces of greed continuing to be in charge.
Health care is among the very largest profit centers in the American economy and with some of the most rapacious forces of greed. Access to health care is mostly administered by insurance corporations. If Sarah Palin was looking for death panels, she was more likely to find them in insurance companies than in Obamacare. Before the ACA, millions of Americans were subject to the mercy — or lack of it — of the health insurance industry.
The essential question about health care in America is a simple one, but with difficult answers: is health care to be considered a market commodity reserved for those who can afford it, or a universal right?
If it’s to be a commodity, the difficulty is that the forces of greed infesting America’s health-care industries push the cost of health care significantly higher than it is in other advanced nations (with no better results). If health care is just another free-market commodity, then we must accept that people will be allowed to suffer, even die, so that others can profit.
If the answer is that health care is a universal right, then we must address the cost issue and eliminate as much greed as possible. Single-payer health-care systems work in many advanced western nations, but that approach eliminates much of the for-profit health insurance industry and weakens the cartel-like pricing power of big pharma and various providers.
Republicans have had years to come up with a viable alternative to Obamacare, but I suspect that they struggle to devise an alternative that would benefit most Americans without upsetting the health-care industry’s gravy train.
In a capitalist economy, the American Dream is earned by individual effort. The fittest, or luckiest, will realize that dream. Health care, however, is not a market commodity in the way that a smart phone or a pickup truck is. Should the less fit and the unfortunate just do without?
Risking life and limb for one’s county is considered nobly patriotic, but doing so for corporate capitalism — maybe not. What is noble about suffering and dying for shareholder value and someone’s annual bonus?
— Randy Alcorn is a Santa Barbara political observer. Contact him at randyalcorn@cox.net, or click here to read previous columns. The opinions expressed are his own.