About halfway through CNN’s Tuesday evening debate between Senators Bernie Sanders and Ted Cruz, Sanders tried to pin Cruz down on a fundamental question: Is healthcare a right?
Cruz circled around the question, talking about rights as protections from government overreach. The right to guns came up, naturally, and he got nearly misty eyed talking about the right to pursue life, liberty, and happiness. What he believed in, Cruz said, was the right to access to healthcare. Sanders pounced. If you can’t afford healthcare, he said, “Access doesn’t mean a damn thing.” It was the most clarifying exchange of the differences between two men at the far poles of U.S. politics.
CNN billed the topic of the debate at the future of the Affordable Care Act, but it wasn’t really that. Sanders was cast in the role of defending the ACA, which he did dutifully but half-heartedly, when he wasn’t pulling the discussion to what he really wanted to talk about: the need for a a “simple,” Medicare-for-all system, which was a major part of his platform as a candidate, and which he asked the audience to “please join me and fight for.”
“What we are looking at is a dysfunctional system,” he said at one point, while acknowledging that Obamacare had increased access to healthcare for about 20 million people. But there was no escaping the fundamental question of those — 28 million or so — who remain uninsured. “Every single year,” he said, “tens of thousands of our fellow Americans die because they [lack insurance and] don’t go to the doctor when they should.”
For the GOP, the debate represented a last hurrah of sorts: the chance to offer a critique of all the ways that Obamacare has come up short, without any responsibility for creating viable alternatives. It summed up, in other words, eight years of magical thinking about how Obamacare had ruined “the best healthcare system” in the world.
The magical thinking is about to crash about against some cold, hard realities.
One is that there is actually very little appetite for an immediate repeal of the law without a replacement. A Kaiser Family Foundation survey in January found that only 20 percent favored that option, while 75 percent wanted no repeal, or wanted the GOP to have a plan in place first. Another is that there is no plan. Recently leaked audio of a Republican retreat found that, for all their bluster, Republican leaders are divided and confused on how to proceed with Obamacare repeal. In Tuesday’s debate, Cruz rehashed some GOP favorites, like allowing insurance companies to sell across state lines and promoting health savings accounts. And he seemed to think that simply repeating the word “empower” would make it mean something. Even Republicans, apparently, aren’t persuaded that any of it amounts to much of a plan.
If they lack a path forward, though, Republicans did get some wordsmithing from the GOP strategist Frank Luntz, who suggested that they call whatever they come up with “repair.” That smoke and mirrors will likely be little comfort to their voters, who stand to lose the most from Obamacare repeal. Kaiser found that, of the 11.5 million people who bought insurance through the Affordable Care Act, well over half — 6.3 million — live in GOP-controlled House districts. Repeal and “repair” is also most likely to hurt rural, elderly people — in other words, Donald Trump’s base.
In his early remarks, Cruz noted that “there’s an urgency to honor the promises we’ve made.” That’s not exactly true, since the only promise the GOP has made is to repeal Obamacare, and only 20 percent of the population seems to feel there’s any urgency about it.
Nonetheless, this debate promises to be — as it has so often been in U.S. politics — a defining theme of the coming months, consuming much of the first year, or more, of the Trump administration, as it did for Bill Clinton and Barack Obama. Republicans have all the power, but no plan. The Sanders wing of the Democratic Party has a plan but no power. And yet: There is hope in the fact that this debate tends to force fundamental questions, like whether healthcare is a basic right.
If Republicans found their path back to power in part by standing fiercely in opposition to Obamacare, Democrats might find a path back by, as Sanders did on Tuesday, defending what it has accomplished and simultaneously making the case for moving beyond it. Trump has insisted that the GOP’s replacement plan will “have insurance for everybody.” As with everything Trump says, there’s no way to know what that means to him, if it means anything at all. Even so, it’s on the record, and it’s at least an implicit acknowledgement that healthcare is a human right. Democrats must insist on that standard and must hold him to it.