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Posted on March 9, 2017 at 9:20 AM

From the 1940’s to the present, it’s hard to think of a
major topic on the American political agenda that has been subjected to more
tortured language and ideological extremism than healthcare. By no means am I
saying that healthcare proposals to expand access to healthcare over the years
should not have been subjected to rational scrutiny and disagreement. But it
seems, by and large, disagreement over healthcare policy proposals have always
been about the opponents of progressive options to expand insurance coverage
tapping into a certain segment of voters’ deepest fears and biases to
predispose them against any alternative for change.

All progressive leaders who have attempted reform in
healthcare, like Earl Warren (Governor of California from 1943-53) and
President Harry Truman (mid-late 1040’s), to President John Kennedy and Lyndon
Johnson in the 1960’s, to the Clintons in the 1990’s, to Barack Obama in 2009,
have been met with fierce opposition from lobbying groups representing big
business, including insurance and pharmaceutical companies, and often physicians
through the American Medical Association. The essential line of attack has been
that government would become overly involved in medical decision-making and
overshadow the influence and judgment of physicians in the care of patients.
But to win this argument decisively, the hired consultants
devised plans
to associate expanded healthcare coverage or universal
healthcare with “socialized medicine” and even the “red scare”—clear demeaning
associations with undemocratic countries, unlike the United States, that
quickly appeal to irrational sentiments and undermine any consensus for reform.
These basic underhand, scare tactics continued to be effective against the
failed Clinton proposal in 1993 and, later, President Obama’s signature
achievement—the Affordable Care Act—which currently in the process of being
repealed and radically scaled down in terms of benefits.

It is noteworthy that a trend developed during the Reagan
administration in the 1980’s that added ideological vitality to arguments
against expanded access to healthcare: not only was any move toward expanded
healthcare a move toward socialism, something assumed to be inherently
repugnant, but also, that government, compared to free market mechanisms, was
particularly inept to bring about any desire change—as Reagan stated in his 1981
inaugural speech. Just as it is not unreasonable to question the viability of
various healthcare proposals, it is not unreasonable to question the legitimate
and reasonable extent government should be involved in providing public goods
and services. But from the outset, Reagan’s critique of government was
simultaneously an outcry of how government was providing benefits to
undeserving people, like the infamous “welfare queen” who was abusing the
system. It’s hard not to discern from his message clear racial overtones that
were meant to appeal to crass biases and prejudices of White working people. It
became easy to see government services and benefits as “free stuff” that
undeserving people received because those who worked were being coerced to
support with their tax dollars.

By the 1990’s government was under attack by the political
right and when the Clinton healthcare reform effort began to crack in 1993, the
opponents pounced. Healthcare reform was not on the public agenda during the
Bush administration and many of thought it was a dead issue for at least
another generation. However, the election of President Obama revived interest
in healthcare reform, which resulted in the passage of the Patient Protection
and Affordable
Care Act
(ACA). In spite of the fact that this bill was developed by
Heritage Foundation, a conservative, pro-free market think tank, and
implemented rather successfully in Massachusetts by a Republican governor and
future Presidential candidate, the political right attacked it from the outset.
The passage of the ACA gave right wing media handlers all the talking points
they needed to incite public outrage on the part of many White, working
Americans, most in need of healthcare coverage, not less.

The ACA was adopted and pushed through by our country’s first
African American president, whose success his opponents wanted to subvert, even
if they agreed with him. The ACA was predicated on the use of mandates and
expanded a Medicaid program, and provided healthcare coverage for many millions
of more Americans. Though it used the private insurance market, the ACA was
viewed by its strongest opponents, viz. Republicans in the House of
Representatives, as a new government, welfare program that provided more free
stuff to non-working people on Medicaid; was paid for by those who chose to
work; and interfered in the physician-patient relationship, as critic Dr. Tom
Price, the new Secretary of Health and Human Services, was wont to say. There
were many ways that reasonable people could have made their critiques, but for
the Republican Congressional Representatives, the ACA became a bizarre
obsession, attempting to repeal without success 60 times. That is, until the
unexpected outcome of the 2016 presidential election. Since then, they have
been somewhat like the proverbial dog who finally caught the car he had been

Now the Republicans are in control of the White House and
both houses of Congress, and are unwinding of the ACA. Many on the extreme
right are eager to see its full repeal in spite of the lack of any clear
consensus on the plan for what will replace it and the consequences that will
ensue. All along, we have heard promises that the replacement will provide healthcare
that is cheaper and better quality care – but so far those promises seem to
ring hollow.

At this point the Republican proposal repeals the individual
and employer mandates as well as the subsidies based on a sliding scale
according to income; the replacement
would distribute subsidies based on age, not income, which in effect greatly
benefits those in higher income brackets and harms those in lower brackets.

States would allow to cover Medicaid patients using block
grants, which would give states broad discretion over how care is provided and
greater emphasis would be placed on health savings accounts (which presupposes
people have money to save and would only affect the fairly well-off) The new
proposal would continue to guarantee that patients with preexisting conditions
will not be denied access to healthcare coverage and that children can remain
on their parents’ healthcare insurance until age 26.

This proposal will cause many millions of people—ironically
many poor people in states that supported the current president like Kentucky
and West Virginia—to lose
their healthcare coverage. Moreover, with the demise of the ACA there is the
real risk that millions of Americans will not only be without healthcare, many
more will die

Let me say again, I fully realize that rational people could
disagree about the wisdom of the ACA and which healthcare policy makes the most
sense. But attack on the ACA and the insistence on its repeal have been
irrational. It is only in the context of a tradition of distorted information,
hype, and ideological zealotry that Speaker Paul Ryan could make statements
like he did on Twitter on February 21:

Freedom is the ability to buy what you want to fit what you
need. Obamacare is Washington telling you what to buy regardless of your needs.”

 It is a moral tragedy that such
statements about an essential human service, like healthcare, is even taken
seriously by anyone who knows anything about healthcare. All human beings are
vulnerable to illness and accidents and when their bodies, or the bodies of
those we are caring for, fail acutely, we seek and expect help in hospital
emergency rooms.  This expectation will
continue and the result will be greatly increased healthcare costs and human
suffering, since more people will lose access to primary care and be forced to
enter the healthcare system at the acute stage with no insurance, rather than
earlier on with medical problems can be more easily managed.

But Ryan’s words also offer a distorted,
truncated view of freedom that likely only appeals to the well off with
blinkered moral concerns about their fellow human travelers. Freedom for him
and his ilk is like saying, “I got mine, let those without fend for themselves;
after all, they are free.”  This is a
hollow, simplistic
view of freedom and our society is paying the price for decades of distorted
information about healthcare policy.

We can only hope the fight for
universal healthcare continues and eventually a consensus emerges to do the
right thing.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI’s online graduate programs, please visit our website.



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