WASHINGTON ― If you haven’t watched the floor of the U.S. House of Representatives during a big vote, you should. It’s instructive, and depressing.
What you see ― what I saw from the press gallery on Thursday during the vote to replace Obamacare ― was the distilled essence of two vastly different Americas glowering and shouting at each other.
There is no more vivid juxtaposition in American life today.
On the Republican side: a phalanx of mostly white, mostly Christian, mostly men talking earnestly about liberty, freedom and unshackling business.
On the Democratic side: a bouillabaisse of races, ethnicities and genders, significantly black, Latino and female, talking about collective responsibility, quoting Dr. Martin Luther King Jr. and insisting that health care is a universal right.
The United States has always lived under an uneasy truce between public and private, profit and communal principle. Once a generation, war breaks out, and this one ― over extending the government’s role in health care ― currently looks like it will never end.
After Republicans passed their “repeal and replace Obamacare” bill by the narrowest of straight party-line margins ― and without the slightest idea of how much it would cost or how it would really work ― Democrats sang “Hey, hey, hey, goodbye” as a taunt. Not a single Democrat had voted for the bill.
Over seven years earlier, Republicans had taunted the Democrats when they, on a straight party-line vote, passed the Affordable Care Act to begin with.
Congress has devolved into these take-no-prisoners parliamentary-style factions on a host of issues, but none more so than on health care. (Don’t forget 1993, when then-first lady Hillary Clinton engineered a sweeping national health plan and delivered it to Capitol Hill, where it died without a vote.) The question is: Why?
To start with, we spend far more on health care as a percentage of GDP (17.1 percent) than nearly any other country in the world. Revamping that behemoth system is the equivalent of rebuilding all the airports while not canceling any flights.
The health care sector also produces trillions of dollars annually in revenue for private business entities, which either like matters just the way they are or want to control whatever changes Congress proposes to make.
Aside from perhaps religion and guns, health care is the most personal of public issues, with lives literally at stake.
And simple arithmetic shows increasing pressures as baby boomers reach retirement and younger, less affluent generations fret ― not unjustifiably ― about the burden of paying for their elders’ care, either through higher taxes or higher insurance premiums.
The most logical answer would be to totally “socialize” the risk and the burden through a comprehensive national insurance program. It’s what every other major industrial nation does. It’s what President Harry Truman first seriously proposed in 1945.
But if Americans ever do that, we won’t go all the way to government-run services. We’ll make government (like the Department of Veterans Affairs) purchase medical care from private health providers, who would essentially become regulated utilities. And even that is a full-on nightmare to the industry.
For decades, the health care industry fended off serious consideration of a national system by appealing to the deep-rooted individualism and self-reliance in the American character. That’s the line House Majority Leader Kevin McCarthy (R-Calif.) took as he sold the American Health Care Act to the House in the last minutes before the vote.
There would no longer be mandates and onerous rules, McCarthy said. There would be “care without control” by government. This was a vote, he assured his colleagues, “for liberty.”
Speaking to her own cheering faithful, House Minority Leader Nancy Pelosi (D-Calif.) cited Martin Luther King for the proposition that health care is a universal human right ― in America and everywhere. The Republicans who voted for Trumpcare, she warned, “have walked the plank” from moderate to radical.
Pelosi vowed retribution in the next congressional election, just as the GOP had exacted revenge for the original Obamacare in the 2010 midterms.
This bill, she told Republicans as she stared across the House floor, will be “tattooed on your forehead. You will glow in the dark on this one.”
That sounds like a condition that won’t be covered, even if the bill somehow becomes law.