I have often mentioned Octavio Paz’ observations about the contrast in Mexican and American approaches to building and maintaining important institutional constructs. He states that Mexicans in power tend to throw out previous ideas and creations and replace them with new ones sometimes because the old ones are old and the new ones are new.
As a traveler in Mexico, I have witnessed a lot of changes in the way people-traffic is handled and yet, I mostly do not see that things have improved. It appears that doing things differently is more a result of a new regime in power.
Paz does not see that being the overriding tendency in the United States as practices and organizational creations tend to be regarded more as subjects for improvements, adjustments and reinterpretation. We can say that relatively speaking, our Constitution has hardly been changed since it was first adopted with its Bill of Rights amendments while the Mexican Constitution is changed every time a new government is seated.
Universal health care has become an issue of utmost importance in the country and is defining a large part of the 2020 election. Poll after poll shows this issue to be among the top 3 that also include the economy and the safety of Americans abroad and at home.
The Affordable Care Act (ACA) of 2010 represents the first successful attempt to create a comprehensive health insurance system that, with the right adjustments, can truly become a universal health care support mechanism able to include all Americans. Because of the political reality of our time, the ACA was designed as a public/private partnership that involved the federal government and insurance companies.
The fact that the ACA is currently a political football and a victim of an administration and politicians that want to do away with it does not take away its conceptual and practical value to a country still looking for solutions in the area. Those on the Right that want us to return to a private insurance system and those on the Left wanting “Medicare for All” personify both a leap backwards to how things were and a leap forward to unbroken ground that is the public option only.
I do not know that either of these approaches are the “American Way.” This is because health care benefits have historically come as a result of incremental changes.
From the Civil War to Presidents Teddy Roosevelt, Franklin D. Roosevelt, Harry S. Truman, Lyndon B. Johnson, Richard M. Nixon, Bill Clinton and Barack Obama there have been efforts to bring about elements of a universal health care system with few results and a lot of failures. Among the notable successes were the Great Society’s Medicare and Medicaid in 1965, Clinton’s Children’s Health Insurance Program (CHIP) in 1997 and the Affordable Care Act, a culmination of the work on the part of a number of Presidents and both Republican and Democratic Parties.
In the effort to get the Affordable Care Act passed, the public option in the plan was jettison. It was deemed a step too far at the time and not politically viable.
Going backwards to an exclusive private insurance option is not a winning choice. Going forward to an exclusively federal insurance system like “Medicare for All” looks attractive, but is it timely?
If we are to use the time-honored approach of incremental change, what should be the next step? This question is probably the most important given the fact that because of our political climate, health care insurance is broken and needs to be fixed.