The Need to Fundamentally Recast the Healthcare Debate?

The Need to Fundamentally Recast the Healthcare Debate?

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The debate over the Republican Party's campaign to repeal Obamacare has focused mostly on the vote counting and less on the specifics of the proposed legislation. One reason for this is that the politics side of it is more exciting and the policy side a bit convoluted and dull. The policy side is complicated because commentators have been trying to describe the details of a conservative policy logic that are entirely theoretical and deliberately obtuse regarding health and tax policies and based on a broader and somewhat veiled agenda of redistributing and concentrating wealth upwards. It is evident now that Trump's campaign promises to come up with a better and cheaper health insurance plan to replace Obamacare were completely hollow.

For Latinos, the stakes in this debate are very high. While 18 percent of Whites report having no usual source of health care, the figure for Latinos is 29 percent. Despite Obamacare, 23 percent of Latinos under 65 years of age are without health insurance, and 21 percent depend on Medicaid. Of those Latinos 65 and over, 28 percent are on Medicare and Medicare Advantage. Then there are the millions who are undocumented whose access to the health system is more problematic. These are gross numbers that do not convey adequately the daily cumulative health problems facing the Latino community, many of whom may not even be aware of their actual health status and are largely marginalized politically to boot.

In light of these Latino realities, the debate, I would argue, needs to be recast in terms of health care as a basic human right and not merely a commodity. Within this context, no healthcare policies are being developed by the Republicans that can seriously address the health needs of the majority of the American people. The issue ultimately should no longer be how many people are or are not insured, or the costs when nothing is being done to contain them. Rather, despite the red-baiting from the Right, it should be how to promote the movement for universal healthcare. The proposal by Senator Bernie Sanders of "Medicare for all," for example, makes a lot of sense, especially for a Latino community with so many working and low-income people.

Besides the obstacle of the Republican free market ideology, there is an enormous medical-industrial complex that also needs to be taken on. This includes the insurance companies, private and nonprofit hospitals, the pharmaceutical corproations, surgical equipment companies, individual and group practice doctors, nurses and health workers unions, their lobbyists and on and on. A Medicare for all system would require, in addition, a significant transformation of this vast and complex sector, something which very few seem to be even discussing and apparently no one is taking on.

We see news reports every day of heartbreaking abuses by these health providers that includes malpractice and price gouging, among other outrages. But as we see increased dread over the Republican proposals to replace Obamacare, it is these same providers who come forth as the experts and champions of those opposing these draconian Republican plans. This medical-industrial complex then ironically emerges in the media as the good guys defending the poor. But are they really?

As there are calculations about how many people will be losing health insurance coverage, the medical-industrial complex is basically calculating its bottom line in terms of profits. The problems experienced by Obamacare are the result of being a program overlaid on a largely dysfunctional health insurance system that the Democrats have failed to fix. As the Democrats now belatedly come out in a tepid support of Obamacare, they need to also assume much of the blame for providing a rationale to the Right for its repeal.

But the big question is how do we decommodify healthcare? One way not to do so is to ignore this issue and engage in the weeds of the pros and cons of an essentially anti-health Republican program logic. By doing so, some think that you can actually improve the GOP proposal. In fact, there has been so much media coverage of the politics that many think the Republican plan has already been adopted! The idea that there is a need for more fundamental changes in the country's health system is simply not on very many people's radar.

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Here there is a role for Latino leadership to play. While most national Latino groups are involved to a lesser or greater extent on campaigns to resist the Trump agenda on health care and support Obamacare, their voices are not emerging as significant in the current debate. Part of the problem is the media's stereotyping of Latino concerns as being solely on immigration issues. This has also been the result of the low profile that Latino advocacy organizations have assumed in framing their advocacy and lobbying in traditional terms that may no longer apply under Trump. The current crisis can potentially be an opportunity for Latinos to play a leadership role in this health debate in ways that can move it in directions more relevant to Latino community realities.

Latinos should be advocating the idea that health, unlike a wedding ring, lawn furniture or other commodities, is a life-and-death service. They should be advocating that it should be recognized in this society as a basic human right, as we have defined education, work, civil rights, public safety and national defense needs. And it needs to be promoted more intensely and widely as such. As long as we keep seeing health care as merely a certain percentage of the GNP, no different than a toaster oven and narrowly as simply something that is done by a profit-driven medical profession, we will continue to perpetuate a health system that undermines the health of most Americans. This, by the way, is the case, whether or not the Republicans get their way emasculating Obamacare.

Does this sound socialistic? Maybe. But keep in mind that we already have a very successful federal government-run Medicare program that has, as far as I know, failed to make all of our seniors into Marxist-Leninists. Its expansion would, however, make most Americans healthier and economically more secure.

Angelo Falcón is President of the National Institute for Latino Policy (NiLP). He can be reached at afalcon@latinopolicy.org.