Big issues demand a courageous response

On healthcare, firearms and immigration, our system is avoiding hard answers

In America, we see the highs and lows of healthcare delivery. (Photo by National Cancer Institute on Unsplash)

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Imagine my surprise to find a crowd on hand as I was wheeled into an operating room this week. It hadn’t struck me until that moment that a major procedure was at hand, though I guess you might count anything involving heart repair and general anesthesia as major. I just hadn’t expected the dozen or so physicians and nurses who were suddenly swarming my gurney. “Thank you all for being here,” I said weakly – kind of a silly thing to say, like what you might offer at a going-away party, which I earnestly hoped this would not be.

Let me note quickly here that everything has turned out fine: The flawed aortic valve that was delivered with the rest of me seven decades back was successfully replaced, thanks to a team performing at a high level of medical science — well, and thanks, also, to a generous bovine’s inadvertent sharing of tissue. Now I’m supposed to take it easy for a few days, with the expectation that my new valve will probably keep going until something else stills it years ahead.

That morning in the operating room, though, and later in my hospital bed, I was struck by the great disparity in American healthcare. I saw both sides of the coin.

First, I had the good fortune of having been monitored for 20 years by a cardiologist, who a few weeks back announced that I should wait no longer for a transplant. Then, astonishing technology enabled surgeons to use a slight incision in my groin to deliver a new valve into the left chamber of my heart, there to be deployed so that I might avoid the early deaths of my mother and her father. It’s nearly miraculous.

Later, during a night in the hospital room, I got a different view of healthcare, one delivered via a lesson on the employment shortages plaguing our system. I waited in vain for help while my anesthesia-anguished body rejected the hospital dinner I had been served. A beeper at my bedside signifying the end of a vial of intravenous medication kept going. I couldn’t sleep, and couldn’t wait to get home.  

Anybody who has had much interaction with American healthcare could tell you similar stories, or much worse. Wait times for care are too long. Hospitals are under-staffed, and there’s too much turnover due to low pay scales and exhaustion from Covid treatment, which led many in healthcare to leave their careers. Health insurance is costly and complex, often sticking people in the middle class with unaffordable bills.

There’s usually a lot of talk about healthcare in campaign season, but real solutions are elusive. You get the impression that politicians would rather talk about the system’s failures than do anything to enable its success. That’s not a unique dynamic in American politics, unfortunately.

The U.S. spends more on healthcare as a share of its economy than any of the 10 other high-income countries of the world, but we have the lowest life expectancy and highest suicide rate. The obesity rate is double that of other advanced economies. We have the highest number of hospitalizations from preventable causes and nearly the top rate of avoidable deaths — these statistics mainly a result of our failure to tackle gun violence.¹

You might think facts of that sort would prompt politicians to try to make matters better. But healthcare is one of those issues that is more important than it is interesting, leading most politicians to avoid it, especially in primary season. There’s more campaign mileage to be gained by wooing voters on social issues and convincing them that the economy is stacked against them. Talking about the hard work of fashioning smart legislation around healthcare is a downer. Yes, healthcare amounts to one-fifth of the nation’s economic output, but Donald Trump would rather talk about the nonexistent fraud of the 2020 election, and Ron DeSantis fairly jumps at the chance to beat up on people — emotionally, mind you — who aren’t straight and white.²

So no significant healthcare legislation has been enacted since Barack Obama’s Affordable Care Act became law in 2010. Republicans in Congress set out in 2017 to deliver on Trump’s vow to abolish Obamacare, but they couldn’t get the bill through a Republican-led Senate. They might count their lucky stars: Taking away health insurance from 35 million Americans, the number currently enrolled in Obamacare, and substituting nothing in its place, which was a fair reading of the last Republican platform, would have been quite unpopular.

So just now, Republican presidential candidates aren’t talking much about healthcare – except, of course, to the extent that the issue applies to abortion and LGBTQ rights. Those topics move primary voters in this election cycle, along with crime and border security. But we’re no more thoughtful in addressing those issues than we are in healthcare.

Consider immigration. The most recent change in U.S. immigration law was in 1986. A more far-reaching effort came a decade ago, arising from negotiations among four Republican and four Democratic senators (all but two of whom remain in the Senate today). But while the 2013 legislation passed the Senate with a wide bipartisan majority, it never got to a vote in the House — because that chamber is more responsive to shifts in the electorate, and by then, the Republican conference had been captured by the right-wing Tea Party movement.

The Republican party is now identified in no small part by its antipathy to immigrants — both undocumented people crossing the southern border and people from other countries whom many Americans believe are here to take away the jobs of native-born citizens. But every expert agrees that the nation desperately needs immigrants. They help counteract the slowing growth rate of the U.S. population — growth that could help drive the expansion of the labor force and contribute to overall economic prosperity. In fact, if Americans weren’t so hostile to immigrants, we might find labor shortages falling in such fields as healthcare.³

But that sort of thoughtful analysis doesn’t get people elected. It’s much more fun to cheer or whine when the governors of Florida and Texas put undocumented foreigners on flights or buses to Martha’s Vineyard or New York City — which is partisan playacting that takes us not a step closer to the immigration reform that should have been enacted a decade ago. There’s a smart policy ground between the extremes of open borders (which nobody in public life actually supports) and the lockdown of a nation that needs the cultural energy and job performance of newcomers to this land. Nobody right now is trying to find that policy ground.

The stalemate over the easy availability of guns in America is another case in point — that is, of politicians preferring to talk about an issue rather than do anything about it. Perhaps 434 million guns are in private hands in the U.S., and it is inescapably true that the easy availability of firearms is a key factor in another distinction for the U.S.: the highest homicide rate among developed countries of the world. Nobody is confronting that issue just now, because the gun lobby has captured so many politicians, who in turn have sold Americans on the idea that they need lots of guns.⁴

It's not that the issues that seem so thorny just now — gun safety, immigration, healthcare and more — are impossible to solve. The challenge lies in the reluctance of politicians to give up their rhetorical attacks and actually do their jobs.⁵ Certainly there are a lot of examples of public figures who have stepped forward with solutions to big issues of the day and thereby put their own careers at risk. John F. Kennedy wrote about people in our history who did just that, in his classic volume, Profiles in Courage. “To be courageous,” Kennedy wrote, “requires no exceptional qualifications, no magic formula, no special combination of time, place and circumstance.”

It requires, rather, a moral foundation and a determination to make a difference in American society. That’s what we should expect of everybody who puts themselves on a ballot. It sounds hopelessly naive just now, though, doesn’t it?

The science of economics teaches us that a commodity is made more valuable by scarcity. Maybe that’s why we’re so saddened by the absence of political courage in most circles nowadays — because it was a priceless jewel among America’s many treasures. Long at the heart of American democracy, courage seems to have mostly gone missing in recent years. It demands a high price, but those who display courage deserve our devotion. At the very least, we’ll want to thank them for being here, because we know that what they do can help us heal.

1. https://www.health.harvard.edu/blog/is-our-healthcare-system-broken-202107132542

2. https://www.pgpf.org/blog/2023/04/healthcare-spending-in-the-united-states-remains-high#:~:text=Healthcare%20spending%20in%20the%20United%20States%20totaled%2018.3%20percent%20of,their%20most%20recent%20data%20update.

3. https://www.jec.senate.gov/public/index.cfm/democrats/issue-briefs?id=38F98E34-153E-453F-99F0-9D964ED66CBC#:~:text=For%20example%2C%20immigrants%20also%20help,the%20contributions%20of%20immigrant%20workers.

4. https://www.niussp.org/health-and-mortality/americas-high-homicide-rate/#:~:text=Introduction,this%20level%20(Figure%201).

5. https://www.washingtonpost.com/politics/2022/09/23/republicans-are-keeping-health-care-arms-length-this-election/

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