Abbe Gluck (Professor of Health Law at Yale, and writing at Vox) says that our health care debates miss the point:
The fundamental question that every Congress from Truman’s to Trump’s has refused to answer is this: What is a health care system for?
Democrats and Republicans alike have always been disjointed about the basic purpose of a health care system. Whether we are talking about Obamacare or Ryancare, there is no overarching theory that sets out the fundamental values of American health care.
If two people are dying from the same disease, and require the same operation to survive, and one can pay and one cannot, is it okay for the poor person to die? After talking ourselves hoarse about health reform in this country for nearly a century, we still have no definitive answer to this question, because the main players in the debate keep dodging it.
What, many of us wonder, is so wrong, so un-American, about universal health care? Professor Gluck explains:
Part of the problem, believe it or not, is communism. Ronald Reagan, in his efforts to torpedo Medicare in the 1960s, proclaimed government support of health insurance “socialized medicine,” turning a big part of the health care debate into one about the American capitalist ethos and patriotism. (Even before Reagan, the American Medical Association had been sounding this particular alarm). The resonance of Reagan’s message is an important reason why the United States is highly unlikely to ever have a single-payer system, such as a Medicare for everyone. It’s why we keep hearing the term “liberty” to — ironically — justify massive cuts that will have terrible effects on people’s lives.
That is the continuing tension between “us versus me,” and between government and the market, in American health care. It’s our enduring question and it’s clear that this round of health care reform, like all those before it, is not going to debate it openly and honestly.
The real debate is not just about health care but, as Gluck indicates, about the boundaries between government and the market: we have to decide, that is, what we consider “public goods” and what we consider “private”. This is why the relatively small amounts of money that the federal government spends on things like Meals on Wheels, the Corporation for Public Broadcasting, and the National Endowment for the Arts are nonetheless significant: they signal a belief that such things serve a public purpose and are not to be left entirely to the market, even if the market were in fact providing them adequately.
The proposed Trump budget is not a serious fiscal document; its draconian cuts and wholesale elimination of entire programs and agencies will not pass muster even in a conservative Republican Congress. But the budget--which has been more accurately described as a “manifesto”--makes a serious statement, and the statement is this: Washington’s only legitimate purposes are to guard our national borders and, when necessary, to police the world and arrange it to our liking. Everything else--what the Constitution calls “the general welfare”--is the business of the states, and each state should be left alone by Washington to see to that as it pleases.
If you agree with that philosophy, then you will consider the Trump budget at least a step in the right direction. If you disagree, then you will consider the budget an unprecedented turning of the federal government’s back on the people of this nation.
Presented with the blueprint of Trump-ism, each of us has to answer: Which side are you on? In that sense (and in that sense only), the Trump budget document is praiseworthy: it has clarified what is at stake.