"WELL, THERE YOU GO AGAIN": A TRAGICOMIC HISTORY OF AMERICA'S ETERNAL HEALTHCARE DEBATE
OR: HOW WE LEARNED TO STOP WORRYING AND LOVE OUR MEDICAL BILLS
Ladies and gentlemen, boys and girls, gather 'round for the greatest show on Earth—no, not the circus (though the resemblance is uncanny)—it's time for America's Annual Healthcare Debate! That's right, folks, it's that special time of year when we all pretend we're going to solve a problem we've been arguing about since your great-grandparents were doing the Charleston.
Ronald Reagan famously quipped, "Well, there you go again," during a 1980 presidential debate, and while he wasn't talking about healthcare at that particular moment, he might as well have been describing the next four-plus decades of American political discourse. Because if there's one thing Americans love more than apple pie, baseball, and complaining about the weather, it's having the exact same argument about healthcare over and over and over again, like some sort of policy-based Groundhog Day where Bill Murray never learns his lesson and we're all trapped in Punxsutawney forever.
A Brief History of Going Nowhere Fast
Let's take a magical mystery tour through America's healthcare debate, shall we? Buckle up, because this ride has been going in circles since before your grandma was born.
1912: Teddy Roosevelt, that magnificent mustachioed maverick, includes health insurance in his Progressive Party platform. Spoiler alert: it doesn't happen. But points for trying, Teddy. At least you got Mount Rushmore out of the deal.
1930s: FDR, facing down the Great Depression with the determination of a man who refused to let polio slow him down, considers including healthcare in the New Deal. But facing opposition fiercer than a rabid wolverine in a phone booth, he backs off. Even the guy who stared down the Nazis couldn't get past the American Medical Association.
1940s: Harry Truman takes a swing at national health insurance. The AMA responds with a propaganda campaign so effective it would make Don Draper weep with envy, branding the proposal as "socialized medicine"—which in 1940s America was only slightly less popular than actual socialism, communism, or putting ketchup on a hot dog in Chicago. Truman's plan dies faster than a mayfly with a heart condition.
1960s: LBJ, wielding the political capital of a landslide election and the subtle negotiating style of a freight train, manages to ram through Medicare and Medicaid. Finally! Progress! The elderly and poor get coverage! The AMA predicts the end of American medicine as we know it. Spoiler alert: American medicine survives, and doctors continue to drive nice cars.
1970s: Ted Kennedy proposes single-payer healthcare. It goes nowhere, but at least he tried. Points for consistency, Senator.
1990s: Bill and Hillary Clinton take their shot with the Health Security Act, a plan so complex it required a flowchart the size of a football field to explain. After a brutal political battle featuring "Harry and Louise" ads that scared Middle America more effectively than a Stephen King novel, the plan crashes and burns. The Clintons learn a valuable lesson: Americans hate two things—being uninsured and any plan to insure them.
2010: Barack Obama, displaying either remarkable courage or a concerning lack of pattern recognition, passes the Affordable Care Act. Republicans immediately vow to repeal it. Democrats defend it. The Supreme Court weighs in. The debate rages on. Somewhere, Harry Truman's ghost says, "Well, there you go again."
2025: Here we are, folks! The ACA subsidies are expiring, Congress is fighting about it, and we're having the exact same argument we've been having since Warren G. Harding was president. At this point, the healthcare debate is less a policy discussion and more a cherished American tradition, like Thanksgiving dinner arguments about politics, except year-round and with higher stakes.
The Haves and the Have-Nots: A Tale of Two Americas
Let's talk about the elephant in the room—or rather, the two Americas in the room. There's the America where people have good health insurance, probably through their employer, and they think the system works just fine, thank you very much. Then there's the America where people are rationing insulin, skipping medications, avoiding doctor visits, and playing a fun game called "Is This Chest Pain Worth $5,000 or Should I Just Hope It's Heartburn?"
This divide isn't just about healthcare—it's about fundamental fairness. It's about whether we believe that the wealthiest nation in human history can figure out how to ensure that a person doesn't have to choose between bankruptcy and chemotherapy. It's about whether we think a diabetic child's access to insulin should depend on whether their parents have a good job with good benefits.
Every other developed nation on Earth has figured this out. Canada did it. The UK did it. France, Germany, Japan, Australia—they all did it. They all have their problems, sure, but none of their citizens are starting GoFundMe campaigns to pay for their kid's leukemia treatment. Meanwhile, America—the country that put a man on the moon, invented the internet, and can deliver a pizza to your door in 30 minutes—apparently cannot figure out how to provide healthcare to its citizens without bankrupting them.
It's almost impressive, really. It takes a special kind of dysfunction to spend more per capita on healthcare than any other nation while simultaneously leaving millions uninsured and underinsured. It's like paying premium prices for economy service, except the plane is on fire and the pilot is arguing about whether fire extinguishers are socialism.
The Republican Roadblock: A Century of "No"
Now, let's address the elephant in the room—the actual elephant, the Republican Party mascot. Since FDR first floated the idea of government-involved healthcare, Republicans have fought it with the tenacity of a honey badger protecting its young. Their arguments have evolved over the decades, but the conclusion remains the same: "No."
1940s: "It's socialized medicine! It's communism!"
1960s: "Medicare will destroy American healthcare!" (Narrator: It didn't.)
1990s: "Government-run healthcare will be inefficient and bureaucratic!" (As opposed to the current system, where you need a PhD to understand your insurance policy and a law degree to dispute a denied claim.)
2010s: "Obamacare is tyranny! Repeal and replace!" (They've been working on that "replace" part for 15 years now. Any day now, surely.)
2020s: "We can't afford it!" (We can afford $800 billion annual military budgets and tax cuts for billionaires, but universal healthcare? That's just crazy talk.)
Look, I get it. Republicans have legitimate philosophical concerns about government overreach, market efficiency, and individual freedom. These are worthy topics for debate. But at some point, after a century of blocking every single proposal for universal coverage, one has to wonder: Is this principled opposition or just reflexive obstruction?
The irony is that many Republican voters actually support Medicare—they love it, in fact. "Keep your government hands off my Medicare!" became a rallying cry, apparently unaware that Medicare is, in fact, a government program. It's like saying, "Keep your government hands off my Social Security, my public roads, my fire department, and my military protection!"
Medicare for All: The Solution Hiding in Plain Sight
Here's the thing that drives me absolutely bonkers about this entire debate: We already have the solution. It's called Medicare. It exists. It works. Seniors love it. It's more efficient than private insurance (with overhead costs around 2% compared to private insurance's 12-18%). It's popular across party lines. It's been operating successfully for 60 years.
The solution to America's healthcare crisis is so obvious it's practically wearing a neon sign and doing jumping jacks: Expand Medicare to cover everyone.
"But wait!" I hear the critics cry. "That's too expensive! Too radical! Too socialist! It'll never work!"
Really? Let's examine these objections, shall we?
"It's too expensive!"
Americans already spend more on healthcare than any other nation—about $4.3 trillion annually, or roughly $13,000 per person. We're already paying for the most expensive healthcare system in the world. We're just getting terrible value for our money. Multiple studies have shown that Medicare for All would actually reduce overall healthcare spending while covering everyone. We'd eliminate the massive administrative waste of our current system, reduce pharmaceutical costs through bulk negotiating power, and cut out the profit-taking middlemen who add zero value to actual healthcare delivery.
It's like we're currently paying for a luxury yacht but getting a leaky rowboat, and when someone suggests we could get an actual yacht for less money, we scream, "Too expensive!"
"It's too radical!"
You know what's radical? Medical bankruptcy. You know what's radical? People dying from rationing insulin. You know what's radical? A system where your health insurance is tied to your employment, so losing your job means losing your coverage during the exact moment you're most financially vulnerable.
Medicare for All isn't radical—it's common sense. It's what every other developed nation already does. Calling it "radical" is like calling indoor plumbing "radical" because we've been using outhouses for so long.
"It's socialism!"
Oh, for the love of—Medicare already exists! We already have socialized medicine for seniors! Are we going to start calling fire departments and public libraries "socialism" too? (Actually, don't answer that. Some people probably would.)
Here's a newsflash: We already have socialism in America. We have socialized fire protection, socialized police protection, socialized roads, socialized military defense, socialized education, and socialized healthcare for seniors, veterans, and the poor. The question isn't whether we have socialized services—we do. The question is whether we're going to extend the same healthcare coverage we give to 65-year-olds to 64-year-olds. And 63-year-olds. And everyone else.
The BS Stops Here (Or At Least, It Should)
Every year, we have this debate. Every year, we hear the same arguments. Every year, thousands of Americans die from lack of healthcare access, hundreds of thousands go bankrupt from medical bills, and millions suffer in silence, rationing medications and skipping treatments they can't afford.
And every year, we do... nothing. Or worse, we fiddle around the edges with subsidies and tax credits and individual mandates and insurance exchanges—complicated Rube Goldberg contraptions designed to preserve the private insurance industry while pretending to solve the problem.
It's time to stop the BS.
It's time to stop pretending that the current system works.
It's time to stop pretending that "access" to healthcare is the same as actual healthcare. (You have "access" to buy a Ferrari too, but that doesn't mean you can afford one.)
It's time to stop pretending that employer-based insurance makes any sense in a modern economy where people change jobs frequently and gig work is increasingly common.
It's time to stop pretending that a system that leaves millions uninsured and underinsured is acceptable in the wealthiest nation in human history.
It's time to stop pretending that we can't afford Medicare for All when we somehow manage to afford everything else we actually want to afford.
Phase It In: A Practical Path Forward
"But how do we get there?" I hear you ask. "The transition would be too disruptive!"
Fine. Let's phase it in. Lower the Medicare eligibility age by five years every year. Start with 60, then 55, then 50, and so on. Give the system time to adjust. Give healthcare providers time to adapt. Give the private insurance industry time to find new business models (or, you know, go the way of the buggy whip manufacturers—creative destruction and all that).
Or do it by adding a public option to the ACA exchanges—let people buy into Medicare if they want. Let the public and private systems compete. If private insurance is really so much better, they'll have nothing to worry about, right? (Spoiler: They're terrified of this option because they know they can't compete with Medicare's efficiency and lower costs.)
Or lower the Medicare age to 50 and raise Medicaid eligibility to cover everyone under 200% of the poverty line, then gradually close the gap in the middle.
There are a dozen different paths to universal coverage. The details can be debated. What shouldn't be debatable anymore is the goal: Everyone covered, nobody bankrupted, healthcare as a right, not a privilege.
The Choice Before Us
As we suffer through yet another iteration of this eternal debate, as Congress fights over ACA subsidies and Republicans propose "repeal and replace" for the umpteenth time and Democrats argue over public options versus single-payer, let's be clear about what's really at stake.
This isn't about policy details or budget projections or economic models. This is about values. This is about what kind of country we want to be.
Do we want to be a country where a cancer diagnosis means financial ruin? Or do we want to be a country where people can get sick without going broke?
Do we want to be a country where your health depends on your wealth? Or do we want to be a country where everyone gets the care they need?
Do we want to be a country that spends more on healthcare than anyone else while leaving millions uncovered? Or do we want to be a country that joins the rest of the developed world in guaranteeing healthcare as a human right?
The answer should be obvious. The solution is staring us in the face. Medicare for All. Now. Not in five years, not after another decade of debate, not after we've perfected every detail of the plan. Now.
Because every day we delay, people suffer. Every day we delay, people die. Every day we delay, families go bankrupt. Every day we delay, we choose to maintain a system that prioritizes profits over people, that values insurance company bottom lines over human lives, that treats healthcare as a commodity rather than a right.
Well, There We Go Again... Or Do We?
Ronald Reagan's famous line has become a perfect encapsulation of American political discourse: "Well, there you go again." Round and round we go, having the same arguments, reaching the same impasses, accomplishing nothing while pretending to care.
But it doesn't have to be this way. We can break the cycle. We can stop going in circles. We can actually solve this problem that we've been debating since 1912.
All it takes is political will. All it takes is courage. All it takes is deciding that enough is enough, that the status quo is unacceptable, that we're better than this.
Medicare for All. Phase it in over five years, ten years, whatever it takes. But commit to it. Make it happen. Stop the endless debate and actually do something.
Because if we don't—if we continue this charade for another decade, another generation—then shame on us. Shame on us for having the resources to solve this problem and lacking the will. Shame on us for choosing politics over people. Shame on us for being the richest nation on Earth and refusing to care for our own citizens.
So here we are again, folks, at the annual healthcare debate. Same time, same place, same arguments. The question is: Will we finally do something about it, or will we just keep going in circles until the heat death of the universe?
The answer is up to us. Medicare for All. Now. Let's stop the BS and get it done.
Well, there you go again, America. The ball's in your court. Try not to fumble it this time.
P.S. - If you're reading this while rationing your insulin, skipping your medications, or avoiding the doctor because you can't afford the copay, I'm sorry. You deserve better. We all do. And maybe, just maybe, if enough of us demand it loudly enough, we'll finally get it.
