Perception is reality. The age-old adage has been used and abused by everyone from our politicians to totalitarian dictators. In George Orwell’s novel 1984, the protagonist, Winston, lives in a dystopian future where government controls all aspects of life by carefully manipulating perception, and thereby the people’s reality. When Barack Obama passed the Affordable Care Act (ACA), he not only forever cemented his legacy, but also the American public’s perception, and future, of health care.
Health insurance was a concept originally adopted by large employers in order to keep their employees productive. Like any service, it was viewed as a commodity, a choice to which people or corporations could choose to allocate their funding if they deemed it worthy. During WWII, a wage freeze incentivized employers to begin offering healthcare and pensions to attract qualified workers. In this role, insurance was governed by market forces, and medical innovations flourished because physicians and hospitals were incentivized to keep their patients alive and happy. As medical innovations allowed people to live longer, healthcare for the elderly became a more pressing issue, and with a commanding majority, Democrat Lyndon B. Johnson created Medicare in 1965, which guaranteed “free” medical care for the retired. This was the first instance of government sponsored health insurance in the US, and would later serve as the precedent for Medicaid and the ACA.
Margaret Thatcher once keenly noted that “the trouble with socialism is that you eventually run out of other people’s money.” This quote has, in fact, proven to hold true to all modern democracies, where the general public falls prey to promises of more benefits and fewer taxes, leaving future generations with the ballooning tab. Nowhere is this more evident than in healthcare.
Passing the ACA, which expanded Medicaid to all those within 133% of the poverty line, mandated insurance companies to sell to the previously uninsured who suffer a plethora of costly pre-existing conditions, and heavily subsidized health insurance for millions of others. Obama made ‘healthcare for everyone’ a public expectation. The Democrats carefully crafted their public message, utilizing social media, pointing to the “socialist” Nordic utopias as a case-study, and most of all, establishing a moral high ground. Anyone who rejected the notion of government healthcare was “greedy” and “hated the poor.” They neglected to mention that Nordic countries have incredibly low corporate taxes and homogenous populations.
Constitutionally, one is no more entitled to free healthcare than to free groceries from your local supermarket, or that raising taxes on the rich would only stifle investment in the economy. But facts no longer mattered. They controlled the narrative, and perception is reality.
Republicans, who at first were eager to entirely dismantle Obamacare, have learned the hard way that taking away benefits is a lot harder than giving them out in the first place. All the recent Republican proposals have attempted to toe the line between appearing to make broad reforms and save money while actually maintaining almost all the benefits and subsidies Obama introduced. President Trump himself has repeatedly promised healthcare to everyone; he has even ignorantly pointed to Australia’s single-payer healthcare system as an example to strive towards. Obama’s legacy of universally guaranteed insurance, no matter how expensive, inefficient, or outright inferior, isn’t going anywhere anytime soon.
Ultimately, Democrats may have lost the battle in 2016, but they have won the war over the hearts and minds of the American public. Washington Post columnist and former physician Charles Krauthammer is likely correct in predicting the impending introduction of single-payer health insurance when the Republican proposal inevitably fails, wrought with same flaws as the ACA. It won’t matter anymore that America’s healthcare system has for centuries been the gold standard in medical innovations, research, accountability, patient-physician interaction, or end-of-life options. As long as progressives paint themselves as the saviors of the masses, statistics and budgets will pale in comparison.
In 1984, Winston struggles to stay true to reality in the face of incessant brainwashing and propaganda. The dystopian government goes so far as to teach him that if they will it, 2 plus 2 actually equals 5, which sounds ominously similar to the deceitful accounting used to justify both the ACA and the Republican replacement plan. 1984’s foreboding ending should serve as a warning: “But it was all right, everything was alright, the struggle was finished. He had won the victory over himself. He loved Big Brother.
And Americans, the protectors of personal liberty and the free market, now love universal healthcare.
Adam Barsouk
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