When we hear of the Trump administration’s effort to repeal the Affordable Care Act (ACA – also known as Obama Care), most people have strong opinions which are generally aligned with one’s ideological views. I doubt, however, that most of us truly understand the complexities of the subject beyond our political associations.
Regardless of one’s strong position either in defending the rights of Americans to have affordable care or in advocating for the need to curb the cost for such programs, we need to understand that ideology alone cannot solve these issues. Rather, it takes time and patience to understand market forces and their influence on the future of any program. Despite the intricacies in the intersection of the medical field and its economics, it seems prudent to take a fresh look at the available choices that involve such policies.
A quick review of the concerns which occurred when FDR created Social Security back in the mid-1930s or when Johnson established Medicare in the mid-1960s, reminds one of how fear mongering some ideologists were about these social programs – intimating that big government would bankrupt our country, but which today are part of the fabric of our American democracy. Today, we cannot imagine our society without FDR’s New Deal or Johnson’s Great Society ideas, allowing millions of Americans to retire and live proudly in dignity and security, rather than ending up destitute.
On the other hand, this doesn’t mean that every social program is automatically great. We have seen the decline of the Affordable Care Act due to its becoming unaffordable for individuals and possibly for the country.
In reviewing the message in FDR’s March 1937 radio address,“… [the New Deal] is not for a day or for a year, but for an age. It must be worked out through time…” I wonder how the Republicans, who chanted “repeal, repeal” for two Obama terms, would wait for the ACA to be worked over time.While David McCullough argues that it takes 50 years to appreciate history, conflicts are often resolved, less by improvements than by political expediency, and eight years later, we embark on yet another experiment in social welfare.
At the root of either approach lies the question of what to do with the uninsured and with pre-existing conditions. They are at the center of the debate because it is estimated that tens of millions of American lives will be affected, the cost of whose insurance coverage cannot be overlooked.
A person’s right to affordable health care and education are at the center of any progressive society, and the debate is in how to provide these without overwhelming our economy. When we talk about helping a large part of our American population, it is imperative to understand both, the risk and the financial and human cost to our socioeconomics. Mainly, the big questions are whether it is feasible and whether the cost of implementation comes at the expense of other priorities.
I have no sympathy for Trump’s rush to repeal the ACA; yet, I have little empathy for Obama’s method of muscling his majority in the House, not much differently than the Republicans are doing now.
In her book “Fear City: New York’s Fiscal Crisis and the Rise of Austerity Politics” about the financial crisis in NYC in the 1970s, Kim Phillips-Fein writes, “austerity remains a political choice… Did [the city’s] responsibility lie in providing extensive social services and guaranteeing a set of social rights to all?” she asks, “Or should its main commitment be to make the city an attractive place for businesses and corporations by lowering taxes, relaxing regulations and fostering economic development?”
This fundamental question is exactly what we are debating today, beyond all the rhetoric on each side in appealing to the public. Do we provide more services or lower taxes for the rich?
Despite our desire for simplicity and wanting to appear progressive, it is not as simple as either side wishes it to appear. It is said that in a society on the rise, the benefits of the many come at the expense of the few, while in a society on the decline, it is the opposite, and the few benefit at the expense of the many. So, this begs the question, Can we afford all the benefits we try to give our citizens and at what cost?
With half a trillion dollars in the annual deficit, and almost $20 trillion in debt, we have to determine our priorities. While a progressive society must afford its citizens basic rights, we also need to maintain a military, fix our dilapidating infrastructure, and preserve a strong society.
But these economic factors pierce two bigger assumptions:
- The presumption that life is safe place, where the parents (government) care for the children (all of us), and tomorrow will be a better day.
- The presumption that everybody has equal access to services.
But is safety a guarantee or is it just an illusion? In a complex economy, there are far too many competing causes to be able to cover you or your loved ones – at any cost. Governments can do some things, but not everything, and demanding that it fixes everything for everybody is foolish, if not irresponsible. There is saying, “If you wait till you can do everything for everybody, instead of something for somebody, you’ll end up doing nothing for nobody.”
The answer as I see it, is that society tries to afford its citizens equal access and protection, in maneuvering the often-difficult ride and bumps along the road. However, the truth is that there are many for whom help will arrive too late and often not at all.
More importantly, we need to accept the fact that these complex issues do not have simple answers. We need to be humble in the face of the facts and understand that life is one long experiment in testing, tweaking, and retesting different answers until we get it right, for a short while and then we need to tweak it again. Just as our Social Security and Medicare programs have helped sustain retired Americans for more than half a century, yet they need to be revamped in the face of changing demographics and economic realities.
When children grow up, parents often share with them the difficulties they encountered, and the truths they discovered along the way. Challenging them for the steps they took to solve their problems is not the solution. As adults, we must unite and try to work together to arrive at a better tomorrow and the day after tomorrow – one day at the time.
The cynics tend to believe that everything is a sham, and that by lowering taxes for the rich, which will increase the gap between the rich and the poor even further and deprive the poor from critically needed medical care, making it be akin to slavery, but with a different name. Maybe for this reason, Thomas Jefferson changed the wording in an early draft of the Declaration of Independence from, “Life, Liberty, and Property” to “Life, Liberty and the Pursuit of Happiness.” Happiness can be sold to the masses as a religious concept while Life, Liberty and Property are sold to the highest bidder.
However, since we have no evidence for that being the case and since we have no choice but to move forward, the only constructive path is that of responsible citizenship. Get involved and lend your civil voice to those who want to help our country reach its apex.