I watched the Republican train wreck of “repeal and replace” while figuratively holding my breath. Full disclosure – I buy my health insurance on the “Obamacare” exchange, am relieved that the ACA will remain intact, and can only hope the Congress won’t commit too much sabotage in the coming months.
But I think we’re asking the wrong questions and having the wrong discussion. We shouldn’t be talking about insurance but about health care. There’s no way to agree on “how” or “to what extent” until we agree on “what.”
Do all Americans deserve health care? (I’ll leave aside the politically-laden word “entitlement.”)
- I thought we’d reached a lasting consensus on health care for those over 65, but various proposals to replace Medicare with vouchers makes me wonder.
- I thought we’d agreed children deserve health care, though not with methods as well settled as Medicare.
- There’s less agreement on health care for the disabled since suspicion of fraud seems to be a big worry, and there’s a lot of downright skepticism on health care for addiction and other mental health illnesses – at least in part because we don’t seem to believe anyone knows how to treat these illnesses. (Many professionals will disagree with that last bit, but I think a lot of people feel that way.)
- That leaves the rest of working age adults. There is some support for the idea that anyone who has a job should not have to live in poverty – and I’ve read that most Medicaid recipients in this category are working. But again the fear of fraud and anger at the notion that someone is getting away with something seems to overwhelm the issue.
Surely we’re all opposed to fraud, and there should be ways to guard against it. And evidence-based research should be able to prove which treatments work, even if they may run counter to some social tropes. May I assume those problems are solvable?
It leaves the core question: Do all Americans deserve health care?
Until we arrive at a generally accepted consensus, we’ll never figure out what to do about it.