Health care is not like other aspects of the economy. Among other reasons, that’s because when people become very sick they may not be in a position to suddenly get appointments with expert doctors, or find their way to clean and good-quality hospitals; they may not be well enough to research treatment options and compare prices for those, to choose what’s affordable.
The language of consumerism is irrelevant to anyone facing serious illness. When I hear academics and analysts talk about a “free market” that would or should drive down the costs of health insurance, treatments and medications, I consider it a cruel philosophical joke. Cruel, because it reduces patients to objects by which insurers and hospitals might profit. Philosophical, because people who think that market forces apply to actual medical care have got their heads in the clouds. And a sick joke, because the architects of these strategies seem to be laughing at, diminishing, and possibly abusing, the pain of others.
President Trump says he’s a healthy man with “great genes.” He may indeed be fortunate, if he and those he loves don’t require much in the way of medical care. He is also a wealthy man, a billionaire, and so even before becoming President of the United States he might have chosen any of the best doctors and surgeons to take care of him, if he or anyone in his family needed care.
But Trump is an exception, an outlier; most Americans are not billionaires, or millionaires. Millions live with illness, after illness, and will develop illness. We depend on affordable access to doctors and good hospitals, for our lives.
There are many problems with the so-called American Health Care Act, “Trumpcare,” as there are, admittedly, with Obamacare. Neither is perfect. But Trumpcare is a lot worse. Trumpcare solves nothing, but will cause harm and many deaths, due to failure of states to provide care to people who are disabled and chronically ill, if Medicaid is capped, and of private insurers to provide care, if essential benefits are nixed. An estimated 24 million Americans will lose their insurance. I could spell out some of the more onerous details in Trumpcare, but numbers are not my point.
One of the few things that’s clear about the health care legislation is that Trump doesn’t care about the details. He doesn’t need Trumpcare, or Obamacare. He’s indifferent. Rather, his personal history and finances suggest that he doesn’t know what it’s like to be wanting of health care, with possible exception of remembering the fate of his older brother, whose death in his early forties Donald attributes to alcoholism.
That he’s given an ultimatum to Congress: Trumpcare, or keep Obamacare, reveals his indifference. An ultimatum is no way to treat people who need medical care, or persuade lawmakers, in a civilized society. It is a desperate strategy, to get what he wants, so that he can soon advance other legislation, such as tax relief for the wealthy, private takeover of infrastructure, and who knows what else is up his businessman’s sleeve.
For Trump, this deal has little or nothing to do with health or care. For him, it’s just a deal, a negotiation, part of a bigger package in which patients are disposable, have no voice and everything to lose. I hope our legislators will recognize that Trumpcare is not like other business transactions, and say no.