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Making Health Care “Accessible and Affordable” Isn’t the Same as Making It Universal and Free

Centrist Democrats use phrases like “accessible and quality health care” to sound like they support reforming the broken US health care system while avoiding the only genuine reform: removing health care from the market altogether.

Joe Biden speaking with attendees at the 2020 Iowa State Education Association Legislative Conference in West Des Moines, Iowa, on January 18, 2020. (Gage Skidmore / Flickr)

In promoting the latest phase of his legislative agenda, President Joe Biden recently tweeted the following:

Access to quality, affordable health care should be a right in America — not a privilege. My Build Back Better Act will help fulfill that promise by extending tax credits to lower premiums for folks on the Affordable Care Act and lowering prescription drug costs.

Notwithstanding its underwhelming second portion (Biden’s statement achieving the climbdown from sweeping moral proclamation to tax credits in a mere two sentences), plenty of well-meaning Democratic partisans probably missed the subtle rhetorical sleight of hand at work in its first.

For over a decade at least, centrist Democrats have engaged in an effective if cynical balancing act vis-à-vis their messaging on health care reform — trying, and often succeeding, to placate an electoral base strongly in favor of a universal, single-payer option and a donor class overwhelmingly opposed to all but the most tepid and toothless policy changes. Biden’s sentiment thus enjoys quite a hallowed lineage among Democratic politicians, who’ve increasingly made misleading descriptors like “accessible” and “affordable” their stock and trade while eliding the sweeping reforms a majority of Americans want and need.

You don’t have to look very far to find senior Democratic figures committing themselves to some variation of the proposition that “health is a right, not a privilege.” Revisit the health care sections of the 2016 and 2020 Democratic platforms, in fact, and you’ll find it in both. The language used in 2016 was arguably more unequivocal, the 2020 version edging toward the same rhetorical sleight of hand recently used by Biden: “Democrats will keep up the fight until all Americans can access secure, affordable, high-quality health insurance — because as Democrats, we fundamentally believe health care is a right for all, not a privilege for the few.”

At face value, and when paired with the language of rights, adjectives like “accessible” and “affordable” read more as intensifiers than qualifiers, which is a major reason they appear so often in speeches, statements, and campaign pledges by centrist liberal politicians. Who among us, after all, is against care that’s both cheaper and easier to use?

The structural problem with the United States’ health care system, however, is precisely its reliance on a market-driven model — i.e., one premised on the irreconcilable contradiction between public need and private profit. There is, quite simply, no actual way to make health care a right without removing the logic of commodities from the equation altogether: a route that by definition precludes talk of better “affordability” or “access.”

There’s a reason this kind of language tends to be absent in societies with actually existing universal health care systems. People in places like Canada and the UK, by and large, would find the kinds of things America’s liberal politicians say on a regular basis both strange and alien, and for good reason. When a country has experienced the decommodified version of health care, there’s generally no going back — and the very idea of having to flash your credit card at a hospital or doctor’s office no longer computes.

It’s a fact that health insurance companies and their powerful lobby understand all too well, which is one reason they’ve spent untold sums on advertising to undermine the push for Medicare for All. It’s also the reason that the only real path toward making health care a right runs through direct confrontation with the corporate health care industry and its profit-driven model — a confrontation that’s certain not to happen as long as words like “accessible” and “affordable” remain watchwords.