The discussion about health care we're currently having is essentially campaign-style, in that it is utterly divorced from the practical effects of the various outcomes. We talk about what the Supreme Court will do, whether Republicans can force a repeal vote in the Senate, how the issue will play out in the 2012 election, and so on, but not so much about the fact that lives are literally at stake. The real question isn't whether one side of the political divide will benefit, but whether millions of people will manage to get coverage, whether people will continue to get sicker and die earlier than they otherwise would because they lack access to care, whether people will continue to be bankrupted by their medical bills.
But in a sad way, it's almost apt that the discussion is so far from those things. Ezra Klein points out the unfortunate reality:
In a world where the two parties' top priority on health care was providing answers for the uninsured and cost control, an argument over the best way to do health-care reform would be a very healthy thing. But that's not what we've got. We've got the Democratic Party, whose top priority is to try and solve our health-care problems and who've shown their commitment to that by moving steadily rightward over the last century in a bid to pick up Republican support for some sort of solution, and the Republican Party, whose top priority is that we shouldn't do whatever the Democrats are proposing and have proven their commitment to that by abandoning previously favored policy proposals as soon as the Democrats demonstrated any interest in adopting them.
Republicans may say they want to "repeal and replace" the Affordable Care Act, but nobody believes that. Their goal is repeal, full stop. It's something they want for both political and ideological reasons. There was a time when some Republicans were interested in solving the problems in our health care system, but today those Republicans are largely gone, and the only health-care question of concern within the GOP is how they can go about killing Obamacare. So what we're left with is a zero-sum political fight. Either Anthony Kennedy will decide to let the ACA stand, or he won't. Either Republicans will take control of the Senate and the White House in 2012 and repeal it, or they won't. Either Democrats will win, or Republicans will win.
But let's not forget the spectacular human cost that will result if Republicans do win. The ACA is far from ideal in many ways, but it does address most of the things that make our current system such a moral abomination. As I've watched this debate, a picture keeps coming into my head. The Supreme Court invalidates the ACA, leading Republicans to celebrate their victory. Mitch McConnell and John Boehner share laughs and smiles, maybe they even bust out the champagne. Meanwhile, all over the country, cancer survivors and people with chronic diseases watch the news in stunned silence, realizing that the return to the status quo ante means they'll reach the limits of their coverage, or they won't be able to get coverage at all. They'll sit with their families and worry and cry and fear, all while the laughter bursts from Mitch's office. And then maybe in 15 or 20 years, we get to try again.
-- Paul Waldman