The missing debate about health care

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One sad legacy of the lead up to the election of a new President in 2016, and a new Congress this November, was the absence of a serious and sustained debate by candidates about health care. How do we increase access to affordable health care to more Americans and at the same time reduce its costs? The Republican focus on health care is almost entirely about repealing and replacing the Affordable Care Act (ACA) without offering a viable alternative. The Democrats alternatively believe in protecting the ACA but with improvements.

Unfortunately, the limited debate to date has focused almost exclusively on different health insurance options. It has largely overlooked the fact that health insurance is not the same as health care. The amount of care you receive is related to how much you can pay or your insurance is willing to cover. The fact is that millions of Americans are under insured Ė they have health insurance plans that barely cover their medical needs. So increasing the number of Americans who can get health insurance doesnít necessarily increase the number of Americans who have sufficient care.

A serious debate about fixing health care could start with a discussion about the ethics of health care. Should it be a right or a privilege? Sadly, we are the only country, in the developed world, unable to come to agreement on answers to critical questions.

Secondly, should it be based on maximizing coverage for everyone or limiting coverage to those who can afford it? The progressive health care notion is to maximize health care coverage. It is based on progressive morality Ė the morality of empathy and responsibility for oneself and for others. This requires that everyone has access to comprehensive, quality health care.

In contrast, the conservative notion of health care is of market principles that guarantee profits to private insurance and drug companies but limits coverage to only those who can afford its cost. Securing health insurance is thus a matter of individual responsibility. In this view, health care is simply a commodity to be bought and sold. If you want such a commodity, you need to work hard to afford it, and if you canít, itís because you didnít work hard enough and donít deserve it.

This difference between Progressives and Conservatives creates an inherent tension between the moral mission of government to provide for the protection of all its people and the profit-maximizing marketplace, which works only by limiting or denying care.

Unless we can resolve these fundamental differences on what the ethics of health care should be and whether it should be a right or not, itís hard to see how we can move forward to resolve the access and cost problems. Letís hope a reasonable and fact-based series of debates occur soon so that there is a resolution of these fundamental differences.

ó Beverly Tocci-Storer, Bigfork

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