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Rethinking healthcare

Last Friday, in a high stakes match of politic chicken that pitted President Donald Trump and Speaker of the House Paul Ryan against members of their own party, the Affordable Care Act was set to the guillotine. Repealing the act, colloquially known as Obamacare, had long been a goal of all three actors and groups, and each was eager to see to its demise. But the groups had different ideas about how that demise should look, and by mid-afternoon on Friday it became clear that those ideas could not be reconciled. After a short drama, Ryan’s repeal-and-replace bill was pulled from the House, and the Affordable Care Act was left, in the words of Paul Ryan, “the law of the land.” Today we explore what that means both for the country at large, and for us as students.

To springboard that discussion, it is worth observing some of the common reactions to Trump’s healthcare defeat. Broadly speaking, the reactions came in three major flavors. The first was that of the jubilation by Democrats who were thrilled that Obamacare, their previous president’s hallmark policy, had been upheld. The next was that of elation by conservative lawmakers who felt that “Trumpcare”, as they deemed it, was little more than Obamacare-lite. The last was that of disappointment by Ryan-Republicans who felt that by failing to move forward at all on repealing Obamacare, they had flunked their first big test as a party in power. All those reactions ought to be a bit more nuanced. Democrats must realize that the Affordable Care Act has not worked for many people; hardline conservatives need to realize that many of the tenets of Obamacare are here to stay; Paul Ryan’s clan must acknowledge that valuing Republican orthodoxy over people’s healthcare is unlikely to fly far. That everyone is somewhat in the wrong highlights the potential need for a shift in paradigm with regards to health care debates.

Perhaps now is the time to philosophically reground the ideas of insurance, medical care and universal coverage: to think outside of party confines and explore radical shifts in thought. Minced debates over lukewarm solutions like individual semi-mandates and public-private programs have not led us forward. The deeper debates we must have are not about plan deductibles, but are rather about deeper goals. Do we, as a country, believe that everyone ought to have access to health care they need? If so, then perhaps debates should begin over a single-payer system. But if not, and perhaps we decide that we value marginal individual liberty more highly, then we ought to seriously discuss what a free market healthcare system would look like.

For now, it seems unlikely that legitimate legislative debates over the philosophy of health care will become more than a rarity. But that does not preclude us, as citizens, from having such discussions. For Duke students about to graduate and leave the coverage of university health care, national healthcare philosophies and policies are about to become of great importance. It is easy to feel ambivalent about health care when Duke university insurance covers trips to Student Health, but less so when facing a serious illness as a freshly uninsured college graduate. To ensure that health care does not become a permanently problematic fixture in our futures, as well as those of our country’s, is it incumbent upon us to engage in the intellectual discussions about health care that are strangely absent from our Capitol building.


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