Opinion: Why I Don’t Really Care About Single-Payer Or The Graham-Cassidy Bill

Sep 22, 2017

Credit Abraham Schwab

With Republicans still reeling from their failure to repeal (and replace?) Obamacare, Democrats are pushing for single-payer health care.  

This has created quite a buzz. As a consistent advocate for it, Bernie Sanders has inspired a name for it (Berniecare), Trump has called it a curse (but has also said we must have it), and a number of publications have looked into how it would work. And, to me, all of this is just noise and distraction from a fundamental question: Should we work to provide health care for people regardless of ability to pay or not?

It’s for this reason that I can’t get worked up about the apparent efforts of the Trump administration to undermine Obamacare. Or the most recent Graham-Cassidy bill that attempts (again) to repeal and replace Obamacare. That is, I’m not upset about what happens to Obamacare or the possible failure to get a single payer system.  

If Obamacare fails, so be it. The important question is: “What are we aiming at?” All of the talk about death spirals, and impending doom of Obamacare, and how Trump’s administration has cut funding for advertising for Obamacare can be settled into two camps. 

In the first camp, we find individuals, organizations, and public servants who take seriously the effect of health on opportunity and think the universal provision of some minimal level of health care is needed to ensure a just and democratic society. For this camp, the problems of Obamacare demonstrate fixes that are needed or the need for a new system entirely in order to achieve that goal.

In the second camp, we find individuals, organizations, and public servants who are indifferent to the effects of health on opportunity and think health care should not be provided for the whole of the population. For this camp, the problems of Obamacare are more reasons to abandon it in order to stop trying to provide health care for everyone. As with the previous iterations, the Graham-Cassidy bill would eliminate health care coverage for millions in the same insidious fashion as previous repeal efforts.

And so I have trouble getting worked up about “single payer” health care because the first and most important question is not about strategy, but perspective. I honestly don’t understand how anyone can take the view that decision about getting needed health care should be a cold calculus of economic trade-offs or that when an acute health care need arises it makes sense for some people to risk bankruptcy. 

The question before us is not really “single payer” or “Obamacare v 2.0” or something else. The question is “should we provide some level of health care for everyone?” If yes, then it’s just a question of strategies to try and achieve that goal, and identifying which one will work best becomes a question of analysis and trial and error. If no, well, then it drives home a feeling of being a stranger in a strange land. It means that, as a country, we’ve decided that we should be indifferent to the suffering of others, that we don’t really care about equal opportunity, and that caring for the well-being of others is some kind of mistake. We might as well have the Graham-Cassidy Bill pass the Senate. 

All that said, I’ll be calling my senators and encouraging them to vote against the Graham-Cassidy bill. I hope you will too.

Abraham Schwab is a Fort Wayne associate professor of philosophy and medical ethicist.

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