Nothing lays bare the ideological divide between conservatives and liberals like a healthcare debate. We are now in the third major debate in my lifetime. The first happened when Bill and Hillary Clinton failed to implement healthcare reform in 1993. The second occurred just eight years ago when Barack Obama pushed through his Affordable Care Act. Now, we’re in another knock-down-drag-out over what to do with the program initiated by Obama.
Conservatives have argued that government should get out of the healthcare business altogether and let individuals decide whether they want to buy health insurance. They want the market to dictate the cost of care and insurance. For them, it’s a question of freedom of choice and keeping government out of our lives. Obama’s mandate was an anathema to them and the expansion of a big government program like Medicaid offended their small government sensibilities.
Liberals have argued that a minimum level of healthcare should be a right. Most support a Medicare-for-all type of single-payer system but have agreed to the compromise, free-market based system that defines Obamacare. They believe that eventually the country will adopt the single-payer system that they want and that, in the instance of healthcare, government can make people’s lives a little better.
In the middle are the American people–in particular, the mainly working-class families who have struggled to keep up with rising premiums and health care costs. Like conservatives, they instinctively don’t like the government mandate, but they also don’t mind government interference in the system. They just want health care that they can afford and coverage that doesn’t leave them deeply in debt. As the details of the GOP’s ACA repeal plan come into focus, Americans are realizing that they will pay more for care and many will lose coverage altogether.
Conservatives have lost the big argument. Most Americans aren’t willing to be left to the mercy of the free market when it comes to healthcare. Even the Republican standard bearer, President Trump, has advocated for government intervention. He’s promised universal coverage with lower premiums and better care. And what’s clear, his supporters believed him. That’s part of why they voted for him.
The argument has gone on for almost twenty-five years and a resolution is finally coming clear. In the 1990s, Republicans scared Americans into believing reform would cost them more and take away their care. But the problems that instigated the initial debate didn’t go away. An increasing number of people lacked adequate access to care and more people were going broke because they got sick or injured. Implementation of Obamacare over the past eight has given the American people insights into the complexity of the issue. People aren’t willing to give up what they’ve gained to satisfy the ideological impulses of conservative politicians.
The current debate over healthcare is doing more to make the Affordable Care Act popular than all of Obama’s promotion during his presidency. Despite Republican bluster, the program is not imploding. More people have care than ever before. While premiums went up for some people, the rate of increase overall is slower than predicted before the Affordable Care Act. There’s certainly work to be done, but the plan Paul Ryan and company are offering doesn’t look very good.
Americans know they don’t want to go back to the system we had and they’re now seeing what alternatives look like. They’re more concerned about having access to affordable healthcare than what Republicans call freedom. If the GOP doesn’t see that, they’re likely to suffer the same type of rebuke in the 2018 midterm elections that Democrats did in 2010.