First of all, those appealing Bricker’s position with arguments of how much more harm would be visited upon people who would be excluded due to pre-existing conditions or could otherwise not afford insurance or treatment need to understand that Bricker doesn’t give a fuck about anyone. His only position is the ideological one that government shouldn’t provide any services or protections unless he feels like it should, which is at least a consistent argument. It’s selfish and also stupid, but internally consistent in the same way that Ayn Rand’s characters are all free minded and independent, even though they are trapped in facile plots with cardboard opponents living out rapey, overwrought dramas about fake innovation and narcissistic greed presented as misunderstood genius.
Why should government be involved in the health care business? Setting aside any arguments for human compassion or dignity, it makes sense from an economic point of view to not suffer costs of excessive lost time at or inability to work, facilitating the spread of preventable disease, ensuring that children get proper care and nutritional guidance so that they do not suffer avoidable chronic health conditions, et cetera. In terms of “wise policy moves” it makes good pragmatic sense to provide at least a basic level of medical care to everyone even if, as Bricker is, you are ideologically opposed to the idea. For fuck’s sake, the hermit kingdom of Cuba has had substantially lower incidence of severe neonatal problems and infant mortality than the United States since the 1990s. Can the biggest economic and industrial nation in the world not do better than Cuba?
There is also the matter that while fifty or sixty years ago health care was relatively simple–you went to the doctor to get antibiotics for your cough that won’t go away, to the emergency room for a broken bone or stiches, and made an appointment with your mortuary if you had cancer–and what insurance was available was supplementary and largely provided by employee or service organizations for their customers to offset costs, while today the mass of health care options, tests, pharmaceuticals, treatments, and services is so vast and the costs so poorly explicated that there is no way for a consumer to make a credible assessment of cost versus benefit. Hell, most doctors have no idea whatsoever about the costs of pharmaceuticals they prescribe or tests they send patients to, and if asked will refer a patient to billing which, often as not, will not provide a comprehensive listing of costs until the final bill is tallied. The notion that a consumer can control their own health costs in a system that has virtually no transparency is ridiculous to an extreme. And the idea that only bad people need insurance, while good people leave healthy, virtuous lives and therefore rarely require medical treatment is the apex of fucking hypocrisy coming from Congresspeople who are guaranteed acccess to medical insurance through the Federal Employees Health Benefits Program.
And this gets to the essential problem of the ironically titled Affordable Care Act: it did absolutely nothing to control or illuminate medical costs, and often ended up costing more with fewer benefits, especially for the people who had the least need for it. The subsidized marketplaces at least provided some degree of universal benefit, albeit often at substantially higher costs for those who without pre-existing conditions, and essentially no controls on the escalation of those costs. Genuine health care reform would hold both medical service providers and insurers to a fair standard of service versus actual costs with a cap on how much administrative costs and profit they could carry as overhead.
For the GOP–at least, everybody outside the Freedom Caucus–this is not an ideological issue even though they pretend that it is. It is an issue that insurers and pharmaceutical companies contributing to PACs and other campaign funding vehicles are pushing. It is a threat to their gravy train of obscured profitability, inefficiency, and waste; and for Trump it is purely a way to show that he’s good at the art of making deals, even though this is pretty much the worst deal he could possibly make short of hand Kim Jong-un a few nuclear weapons to add to his stockpile. It’s probably worth it at this point to give him a few bucks to build his stupid border wall if it would keep him busy playing with Lincoln logs until the end of his term, but of course, for Trump, Bannon, et al, it would just wet their limp dicks for another go around at the American public, just because they can.
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