One hot-button issue. Two opposing views. Three rounds of fiery debate updated in real time. This is Actually.
When the moment finally came to repeal Barack Obama's Affordable Care Act and replace it with the GOP's American Health Care Act, President Trump's unified government was anything but in harmony. On Friday, after more than 30 Republican members of congress publicly stated that they would vote against their party's own bill, the House declined to call a vote on the AHCA.
After years of fanfare, Republicans' first attempt at an Obamacare alternative was dead on arrival.
A group of progressives led by Sen. Bernie Sanders (I-Vt.) have already seized the opportunity to turn the national conversation around an ACA replacement toward "Medicare for all," a proposal that aims to create universal health care for all Americans regardless of age.
A December 2015 Kaiser poll showed nearly 58% of Americans in support of single-payer health care. But despite having the support of the majority of the nation, an attempt to pass single-payer in Vermont failed in 2014.
Mic asked two writers to argue whether the U.S. government should provide all Americans with free health care — or whether the government should step out of the equation entirely and allow market competition to keep health care affordable for consumers.
John Davidson is a senior correspondent at the Federalist. His writing has appeared in the Wall Street Journal, National Review, Texas Monthly, First Things, the Claremont Review of Books, the LA Review of Books, n+1 and elsewhere.
Maria Svart is the national director of the Democratic Socialists of America, "a member-funded organization with chapters in almost every state who fight for reforms that empower working people at the expense of the billionaire class."
This debate will have three rounds, no more than 200 words per writer per round — and all responses have to be made today. At the end, we'll include a poll so that readers can weigh in on whose argument is more convincing.
Davidson won the coin toss and will go first.
Round One — Opening Arguments
Davidson: For decades, government policies have made health care much more expensive that it should be — from tax exemption for employer-sponsored health insurance (a relic of WWII wage controls), to the creation of Medicare and Medicaid in 1965, to EMTALA in 1986 (which guaranteed emergency room care to everyone), to the Affordable Care Act today.
All these government interventions have driven up health care costs to the point where many Americans simply can’t afford basic coverage, even under the ACA, which did nothing to address underlying cost drivers but did plenty to drive up the price of premiums through heavy-handed regulations.
We’ve never really had a “free market” health care system in the modern era. What we’ve had is more like crony capitalism: We spend hundreds of billions every year subsidizing employer-sponsored coverage, which mostly benefits large employers, while also paying for a Medicare entitlement that includes every American over age 65 — even billionaires.
We could create a market-based system that subsidizes those who need it while driving down costs for everyone else. But it would mean disrupting the cronyism that has dominated American health care for 70 years. So far, neither party has been willing to do that.
Svart: The efficient public programs the left has fought for, like Medicare and Medicaid, have improved and saved the lives of millions, but these programs don't cover everyone.
The current mess not only excludes millions of people, but also provides care in tremendously wasteful way. The point of insurance is to have the largest possible pool, which distributes risk across the entire society. The point of making it public is we can then negotiate collectively with the insurance, hospital and pharma industries, which, after all, exist to make a profit. This not only drives down costs for patients, but also ensures that no one dies for lack of health care.
Aside from the moral argument against it, you cannot create a functional "market" in medical services and coverage. Consumers can't evaluate the product on offer without extensive research and the help of highly trained clinicians. In fact, many consumers enter the system on a stretcher, or even unconscious!
It's not like comparing two cheese sandwiches, where we can judge the quality of cheese and bread before we buy. Every other industrial country came to that conclusion long ago. We share your hatred of crony capitalism, but your solution won't solve anything.
Round Two — Rebuttals
Davidson: The real left-right debate in health care is whether or not you can have a functional "market" in health insurance and medical care. Svart insists you can't, because sometimes we need care in an emergency and we can't price-compare.
But this argument misunderstands how markets work, especially our distorted insurance market. The vast majority of medical care we can consume isn't in the ER, and we could easily shop around for the best deal — if we had prices to compare. As it is, the U.S. health care system disconnects patients from the cost of their care. How much is an MRI? Why can a single aspirin cost upwards of $25 in the hospital? Why does sinus surgery cost $5,885 in one facility and $33,505 in another?
You can't have a functioning market without clear price signals, and the way we treat health insurance prices and divorces us from the cost of care.
Think of it this way: If car insurance were like health insurance, premiums wouldn't just cover damage from accidents, they would cover gas, oil changes, tire replacement, windshield wipers and so on. No one would know what those things cost individually, but premiums would be very high.
Svart: Socialists understand all too well how markets work — or don't. It's absurd and cruel to insist that working people have the time, expertise and money to shop around for prices and providers while they are sick. Do you want the best trained surgeon, or the cheapest one?
And the same forces who drive up prices now will still be at play. Private insurers will continue to deny claims and give patients the runaround, while making profits and wasting billions on advertising and administration. They will continue to cherry pick and only “serve” the healthy. Private health insurance corporations and Big Pharma are the worst of all worlds: predatory, profit-seeking insulated bureaucracies with an interest in denying coverage because they are accountable to their shareholders, not their premium payers.
Health care is an intrinsically public good. Nobody should have to make income-based life-and-death decisions about health care that their doctors say the need, nor delay care and wade through paper work and red tape to access it. Our profit-driven sick care system is failing even the insured. The only way to provide actual health care is a universal program like "Medicare for all," wherein everyone is covered for everything and no one has to pay out of pocket.
Round Three — Closing Arguments
Davidson: The real cost drivers in health care aren't really insurance companies or Big Pharma, but the hospital systems that insurers have to have in their networks. Hospitals charge high prices because insurers will pay whatever they ask. Large employers divert employee compensation into tax-free health benefits, pay premiums to insurers who in turn pay hospitals and patients never know how much anything really costs.
We have to break this cycle. There's plenty of ways to do it that wouldntt leave working Americans without coverage or care. In fact, we could ensure every American had government-funded catastrophic coverage — for those times they unexpectedly end up in the ER — while shifting to a competitive market system for most everything else.
Prices for routine medical care would plummet, just like they have for cosmetic procedures not covered by insurance. Thanks to competition and technology, Lasik eye surgery cost $2,200 per eye in 1998 but only costs about $300 per eye today.
Svart says health care is a public good. Fine. So is water. We can make sure everyone has access to clean running water while also allowing the market to sell it anywhere from 99 cents to $100 a bottle.
Svart: Glad you acknowledge the value of a public system for emergencies. However, the idea is to keep people healthy and prevent catastrophic cases in the first case. High-risk pools isolate the very sick and are a proven failure. You would deepen the insecurity patients experience now, where they already set up GoFundMe accounts to beg.
You also presume that voters would find your leap into the void appealing. Who's truly comfortable with the idea of a competitive market for health care? You are again creating a fantasy world where buyers and sellers have perfect information.
Medical cost drivers now are profit, overhead, technology, employer efforts to shift costs onto employees, and medical empires cutting exclusive deals to attract affluent or group insured patients. Instead, we want to build on the efficient and popular Medicare system, without copays.
Medicare for all would be more efficient for the economy, be more equitable for patients and provide significantly better health outcomes. The only question is whether we can build a political movement strong enough to overcome the bloodsucking special interests.
Given that no other country in the industrial world has chosen DavidsonCare, and given the dysfunction of the U.S. system, I sincerely wish you the best of health!
This concludes the Actually health care debate. Cast your vote for the winner of the debate below — and check back soon to see who won.