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Saturday, December 3, 2016

When the Obama administration drove the Affordable Care Act thru Congress in 2010, its advocates made plenty of calm, sober, technocratic arguments. There was a lot of talk about “don’t worry, you’ll keep the insurance you have”, and many assurances that health care reform would reduce future budget deficits, and “bend the cost curve” of medicine downward. In their understandable haste to pass some kind of universal health care law, however imperfect, liberals, Democrats, and President Obama himself missed the fundamental first step: They failed to clinch the moral argument that — unlike iPads or Toyotas — health insurance is a right, an essential element for both physical health and economic well-being.

Now even if the Supreme Court sustains some or all of the law, conservatives at the federal and state level will do everything they can to delay and disrupt it — at least until the moral argument is as unassailable as stop signs on our streets.

Conservatives and Republicans do not concede the moral imperative of universal health care — although that leaves them isolated in the entire advanced democratic world. There is no other country among our allies in Western Europe, Canada, Japan, and Australia that does not stipulate every citizen will have health insurance from birth as a matter of course. In all those countries, the center-right parties have long accepted the moral imperative, whatever initial misgivings they may once have voiced. So do the medical- industrial complexes of every nation but ours.

Across the developed world, there are variations on how universal health insurance provision is reached—from a truly socialized system in Britain to single payer government administrated health insurance in Canada, to hybrid public/private systems in Germany and France (and it is amusing to read American conservatives praising the German “social market” state these days—yeah, they were in favor of those unions and universal health insurance all along!), to mandated, subsidized, and regulated systems in the Netherlands and Switzerland. All of these plans, however, start with the predicate of health coverage for all — and the details are worked out from there.

So the moral issue must be joined in the most aggressive fashion possible. Not so much by showing empathy for the uninsured—liberals are always wonderful at showing empathy. No, by belligerently challenging conservative pundits and Republican politicians at every opportunity, reminding them how lucky they are to have health care themselves. Just imagine what would happen if, during one of those mildly energized discussions on ABC’s This Week, the liberal interlocutor of the week said something like this to George Will:

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