COMMENTARY: What’s really stalling health care?

You might asking yourself why the Republican-controlled Senate is having such a hard time even bringing Trumpcare to a vote. Mitch McConnell postponed the vote once already and he may have to do it again. One reason is that Sen. John McCain had some pretty serious surgery and may by on the DL for a while. At least his craniotomy was fully covered by his health insurance.

After seven years of vowing to “repeal and replace,” Congressional Republicans had nothing to replace it with. They called their own bluff in 2017 and it turns out they weren’t even holding a pair of deuces. Just before the July 4th holiday Donald Trump suggested Congress ought to eliminate the Affordable Care Act now and find a replacement for it … later. Repeal and fuggedaboutit is apparently the new strategy.

As a piece of health care policy, the Senate bill is virtually as bad as the one the House rammed through as a political stunt some weeks ago. So what’s going on in Congress that the single-minded obsession with repealing the ACA has turned into such political quicksand?

Part of the problem is that health care is really complicated. Trump only discovered this, apparently, on Feb. 27 when he told CNN “nobody knew health care could be so complicated.” Trump doesn’t seem to have done any studying up since. After meeting with him about the health care bill late in June, several GOP Senators reported that Trump simply doesn’t know much about the issue and hasn’t bothered learning any of the details.

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Details, however, can be ironed out. The larger reason Congress has failed to come up with a bill that doesn’t take health insurance away from an estimated 22-24 million Americans is that many Republicans don’t think those people deserve health insurance in the first place. The sticking point here is one of cultural attitudes rather than insurance technicalities and it hinges on how you view the idea of responsibility.

Across the middle of the 20th century Americans shared a civic sense of responsibility that ran on a two-way street: the responsibilities that citizens had to the nation (as in John Kennedy's "ask not what your country can do for you, but what you can do for your country") and, in turn, the nation's responsibility to its citizens (embodied in Franklin Roosevelt's 1941 "Four Freedoms" speech).

By the 1970s, however, that civic sense of responsibility was eclipsed by one in which responsibility was seen as intensely individualistic. The nation owed you nothing, and you owed nothing in return. “There is no such thing as society,” Margaret Thatcher told an interviewer in 1987, only “individual men and women,” and her best political buddy Ronald Reagan wholeheartedly agreed.

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In this new cultural context, health insurance is no longer seen as a basic necessity that every American ought to have but as your individual responsibility. And thus if you don’t have coverage, that’s your own fault. That’s what House Oversight Committee Chair Jason Chaffetz (R-Utah) said back in March when he complained that “maybe rather than getting that new iPhone that they just love and they want to go spend hundreds of dollars on that, maybe they should invest in their own health care.”

Some Republicans think individual health outcomes are entirely a matter of personal responsibility, too. That’s what Rep. Mo Brooks (R-Ala.) meant when he told CNN that people without pre-existing medical conditions “have done things the right way,” implying that others had made bad personal choices and so don’t deserve health insurance.

Trump’s pre-holiday announcement was at least honest. Repealing ACA has always been the goal not because it has failed to provide access to health insurance to the previously uninsured but precisely because it has. In that sense, it violates the GOP’s sense of who deserves to be healthy and who doesn’t.

Steven Conn is the W. E. Smith Professor of History at Miami University.

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