With the passage of the AHCA in the House, Washington D.C. retains its place as one of the most violent cities in America. It earns this distinction not because a certain number of robberies or other felonies carried out by individuals there, but because of the action done by men and women wearing suits and ties and endowed with the veneer of respectability. The real violence in D.C. is carried out by budget committees giving millions of dollars to build newer and better drones that make children the world over afraid of blue skies. Violence occurs when senators sit idly by while American infrastructure collapses and cities left behind by deindustrialization are left drinking lead, all while claiming nothing can be done and there’s no one to blame.
When it comes to healthcare policy, this too is a kind of violence. The legislative branch draws circles around who it decides is or is not deserving of healthcare and will inevitably cosign millions of people to the whims of a market that is punitive towards the physically and mentally ill. Sometimes this number is better than others—the period after the implementation of the ACA saw more coverage than the period before it. It saved many lives, but left many others behind—around 27 million people are still uninsured under the ACA and others are covered in name only, unable to use their plans because of high deductibles, pharmaceutical costs, or other obstacles that provide profits for corporations and bills for the rest of us.
Still, it makes the cruelty of the AHCA no less shocking. The Republican party will render millions untreatable. The grim reality is that a party now led by a man who bragged about sexual assault has decided that, once again, the victims of domestic violence or rape should not have access to healthcare. We know that life expectancy in the US is already on the decline—the AHCA ensures this trend will only accelerate. The AHCA kills people to benefit the wealthy, and nothing less.
While Republicans were celebrating their vote, Nancy Pelosi made the position of the Democratic party clear—universal healthcare was off the national agenda. If institutional support for this effort is off the table, it’s hard to see how the Democratic party leadership views efforts to establish a Medicare-for-All program as anything but empty political theatre.
For the Democrats, the calculus is straightforward—the AHCA is bad enough that fighting for keeping the ACA alone is all they have to do. This has the dual benefit of freeing the party from having to placate their left-wing critics and maintains the hegemony of private insurance aligning with their own class interests. Critics are purists and compared to the AHCA, the ACA looks better even with its faults.
But this strategy is bad not only because it ignores that there is now a majority that wants universal healthcare—it undercuts any moral arguments made against the AHCA.
Leaving the decision of who deserves coverage up to the profit-motive makes healthcare a privilege, even if it is done in the name of declaring healthcare a right. What makes the uninsured under the ACA unworthy? How many millions of people need to be denied healthcare before the underlying system is considered inhumane? By defending the ACA and going no further, the Democratic party concedes that some people will have to die for insurers to make money. Private insurers have no desire to achieve universal coverage nor do they want to cover those who need healthcare services the most. Any opposition to the AHCA that does not acknowledge this cannot provide a morally coherent or meaningful critique of the Republican bill. An opposition that still defends a system of healthcare as a privilege cannot claim healthcare as a right.
It’s telling that the material produced by the party isn’t echoing the calls among grassroots activists for a Medicare-For-All system or highlighting the existing Medicare-For-All bill in the House—it stops at defending the ACA. One defense for this strategy is that the ACA was a step on the road to universal coverage and can still bring it about. But by its very structure, the ACA cannot do this. It is a piece of legislation that explicitly protects private insurance’s monopoly on healthcare coverage—a goal that is in direct conflict with establishing universal healthcare.
One of the basics of neoliberalism is a belief in free markets and the superiority of private enterprise over their public counterparts. When people say that Obamacare was a neoliberal project, they are referring to the fact that—while it expanded the access of healthcare coverage to millions who did not have it before—it maintained a system that granted access to coverage as opposed to providing coverage itself. Insurance companies still sold insurance. While Republicans decried the ACA as socialism for years—discontented liberal partisans have adopted this line to argue against universal programs too—the ACA was a fundamentally capitalist project.
Universal healthcare cannot exist with the profit-motive being the main driver of healthcare coverage. It would be more accurate to say that the ACA sought to regulate the markets, but not dismantle them. Even the public option—a government-provided insurance plan to compete with private insurers—maintained the existence of both the profit-motive and private markets. Nor does moving the healthcare debate to the state level provide a roadmap to universal coverage, as Pelosi suggested. A patchwork of universal programs in a handful of blue states and nowhere else still leaves private insurers a national monopoly and they will use their power of monopoly against state-led initiatives. Only a federally mandated Medicare-For-All program, if not an outright nationalization of the entire healthcare industry moves beyond private insurers dominating healthcare.
Arguing for an actual program of universal healthcare is not only a distinct position from protecting the ACA alone, it is the only position that asserts human healthcare is a right. Leaving healthcare up to the whims of the private sector—whether through the draconian Republican plan or the “capitalism with a human face” Democratic plan can only ever leave healthcare a privilege for those with the right amount of luck and money. As the Republican party has decided that we must now be richer and luckier to get by the argument for a program of universal healthcare only grows stronger. Arguing for anything less is just disagreeing on where the line of who-is and who-is-not worthy of life is drawn and little else.