On February 7, 2017 CNN hosted a debate between Senator Bernie Sanders and Senator Ted Cruz on the future of healthcare in America. Essentially, Senator Sanders made important arguments for universal healthcare for all Americans and healthcare plans that would be affordable to all, not just the wealthy. Rather than “repeal and replacing” the Affordable Healthcare Act, Bernie Sanders advocates for the expansion of Medicare so that all Americans and to make healthcare affordable. Senator Cruz criticized the Affordable Healthcare Act (ObamaCare) as an example of what happens when big government takes control over your healthcare and consequently, your life. He criticized President Obama for promising Americans that they could keep their healthcare coverage and could keep their doctors, both of which didn’t happen, once ACA was rolled out. He went on to explain how the new healthcare plan that his Republican constituents were proposing would include things like Health Savings Accounts, limits on the cost of healthcare premiums and deductibles that would help make healthcare affordable to all Americans.

However, what was central to Senator Cruz’s arguments was that government would be taken out of the health insurance business and instead, there are proposals that emphasize private, free-market competition between healthcare provides (]CIGNA, AETNA, QualCare, AmeriHealth, and so on.) that would drive down the costs of healthcare insurance. For those who believe in competition with the free market system and the potential to drive down costs if prospective buyers were to purchase plans offered in other States rather than just the State where they reside is music to their ears. Senator Cruz made an interesting point when quoting statistics that profits from the ten largest insurance corporations went from a total of $8 billion in 2008 to over $15 billion in 2015, blaming Obamacare for the dramatic increase in insurance company profits. Cruz added that under Obamacare the average American saw an average of $5642 in their insurance premiums and an average of $5000 in annual deductibles. Again, Senator Cruz blamed Obamacare and concluded that for these reasons Republicans want to take big government out of healthcare insurance.

Everyone is familiar with the abysmal roll out the Affordable Healthcare Act (ACA) had when it came online back in 2014. Everyone also remembers how the ACA website that crashed, people being closed out of certain plans and the often confusing descriptions of many plans that became difficult to understand let alone to make informed decisions.
Another point of contention was that President Obama promised that Americans could keep their health insurance and continue to see the doctors that had been treating them. Well, neither of those things happened. But then Americans began to realize some of the benefits of the ACA. For example, insurance companies could no longer deny people coverage on the basis of pre-existing conditions, that parents could insure their sons and daughters until age 26 under their healthcare plans and that many plans made some provisions for both mental health coverage as well as medical coverage in keeping with the Mental Health Parity Laws.

Prior to the passage of the ACA, there were approximately 50 million Americans who lacked healthcare coverage, which was one of the reasons why the World Health Organization (WHO) ranked the U.S. 37th among countries in across the board healthcare. The U.S. is 37th? How can that be when the rich and famous travel from far and wide to come to top medical centers in the United States when they need medical treatment? Our low ranking resulted from our poor grades in palliative care and the fact that we had 50 million people without coverage. Those 50 million without health insurance became the victims of what is referred to as Social Darwinism. Basically, Social Darwinism is when social or political policy determines who will live and who will die. Based on Darwin’s concept of “survival of the fittest” those who have greater wealth (and therefore deemed “fitter”) have a better chance of surviving given their access to healthcare options. For the poor, unemployed, underemployed, and those without health insurance, the options are few therefore, mortality rates are often higher among the poor. Our infant mortality rates in the United States are abysmal, especially compared to other industrialized countries. So unlike Sarah Palin’s rants about Obamacare resulting in “death panels," the real death panels were already in existence among those 50 million Americans who had no health coverage and couldn’t afford it. For those poor souls if the choice came down to going to the doctor, filling a costly prescription or feeding one’s family, the choice was simple and pragmatic. For those without health coverage, one visit to the emergency room could result in total financial ruin and certain bankruptcy.

Also, when President Obama proposed the Affordable Healthcare Act, it was with the intention of saving American companies, both large and small the overwhelming expense of providing their employees with healthcare coverage which has risen exponentially over the past 15 years or so. Healthcare coverage is now one the largest expenditures for both companies and for employees who now are expected to contribute to the monthly premiums. For example, the reason why a car made in Detroit costs more than a car made in Mexico is that autoworkers are provided with healthcare coverage by their employer. The goal of Obamacare was to reduce this burden from American corporations but this too didn’t happen or at least not the way it was supposed to.

For anyone who is interested in why the Affordable Healthcare Act did not reach the lofty goals it originally set out to attain, watch two PBS Frontline programs which you can stream from pbs.org. The first program was aired on April 13, 2010 and was entitled “Obama’s Deal." This program chronicles that backroom deals that were struck to get the ACA passed. The second program aired more recently on January 16, 2017 and is entitled “How Obamacare Became a Symbol of America’s Divide." Both programs provide enlightening information on why the Affordable Healthcare Act fell short of what the Obama administration had envisioned.