Imagine The Hospital.
It has everything. Not sorcery, miracles, or not-yet-discovered technological wonders, but all the stuff we really have right now, the sum of human medical achievement.
It is fully staffed. Again, not by a race of super beings who work without rest, who never make mistakes, and who understand patient needs with perfect intuition. It’s staffed by a diverse assortment of contemporary medical professionals: doctors, nurses, specialists, technicians, therapists, and basically anyone else you might need to consult with about your health.
Every door in The Hospital is unlocked and open. You have 24/7 access to the people and services you need. It might not be perfectly convenient, and you might not find exactly who or what you’re looking for at all times. For most intents and purposes, though, you have the run of the place.
But. Buuuuuuuuuuuut. The Hospital’s floor is extremely dangerous. Every square inch of walking surface is covered in hazardous detritus: broken glass, caltrops, lit firecrackers, Christmas tree ornaments, rusty nails, tiny lightsabers, and those steel origami cranes I saw in some bad ninja movie.
Of course, if you’re wealthy enough, you can buy some big-ass, adamantium boots and walk wherever you want, easily accessing the people and services you need. Everyone else has try their luck without protective footwear or, if they have a bit more financial wherewithal, haggle with the cobblers over the nuances of foot protection and which toes they care the least about losing.
The Republican approach to healthcare, as far as I can tell, is to assume that, as long as The Hospital’s doors are open, The Holy Market will somehow provide everyone with appropriate footwear. Not equally good footwear, obviously, but footwear appropriate to one’s class and in alignment with acceptable profit margins.
The Democratic approach to healthcare, as expressed in the Affordable Care Act, is to establish legal frameworks which control the cost of foot protection while also maintaining and encouraging a profitable market for cobblers. Ideally, then, cobblers will make worthwhile footwear at a price most of us can reasonably afford.
And, sure, I guess it’d be nice if we could figure out a system whereby everyone can have the boots they need to get where they want to go, to see all the doctors they need to see. BUT WHY DON’T WE JUST CLEAN THE FUCKING FLOOR?! Why don’t we put effort into eliminating the thing that actually stops people from getting healthcare?
But, back in 2009 and 2010, when the Democrats were putting all their eggs into the ACA basket, they barely glanced at the idea of a public healthcare plan. They took it for granted that any system worth talking about had to be grounded in the private insurance market.
The ACA does some undeniably good things, but it’s built on festering, gangrenous foundations. Private health insurance is the problem, and there’s no magical arrangement under which private health insurance will actually lead to effective, efficient healthcare. Under a system of for-profit health insurance, our health, our inevitable need for healthcare, becomes a financial asset for private interests, an asset which those interests will fight tooth and nail to maintain control of.
This system is most of the way to being a protection racket. “Nice health you’ve got there. It’d be a shame if you didn’t have access to medical care to maintain it. Nice finances you’ve got there. It’d be a shame if sudden medical expenses were to ruin them.”
To my mind, a public healthcare system is the only coherent way forward. It’s a public need, so we ought to guarantee it to the entirety of the public through use of public funds. If someone wants to have their own private insurance for their own private medical care outside that system, that’s fine. They can have fun doing whatever. But we meet the public need first. Everything beyond that is gravy.
We don’t need better boots. We don’t need better insurance. We need reliable access to medical professionals and medical facilities. Anything less than that is just playing pretend. No amount of or quality of insurance will improve anyone’s health or save anyone’s life. But actually getting to see your fucking doctor just might.