In recent years, seemingly every policy issue has been rebranded as a “health care” concern. Yet somehow health care in its own right – the actual medical system, its quality, costs and availability – has been virtually absent from this election cycle.
Once upon a time, “national security” was the standard trump card used to shut down opposition. Don’t like steel tariffs, Muslim bans or government invasions of your privacy? Jeez, you must really hate national security.
But there’s been a subtle shift in rhetoric these past few years. Now controversial policy objectives are often cloaked in the mantle of “health care” instead. After all, who can be against making Americans healthier?
Last month, for instance, the U.S. surgeon general released an advisory warning that parental stress is a serious public health concern – ergo, we need paid parental leave, universal preschool and affordable child-care programs. All of which happen to be programs Democrats already champion.
Public health has similarly been invoked as a justification for fighting climate change. After all, natural disasters and more extreme weather are linked with respiratory issues and infectious disease, among other maladies.
Reproductive rights have likewise been championed by advocates and providers as a health-care issue. Abortion care itself can sometimes save women’s lives, of course. Plus, even physicians who don’t specialize in pregnancy have been avoiding states with abortion bans. Which suggests degrading reproductive protections can degrade other kinds of medical care, too.
Perhaps it’s unsurprising that so many Democratic causes fit this rhetorical model. Polls show that voters trust Democrats more than Republicans on health care, so Dems might as well try to make more issues into health-care issues. But this reframing is not actually unique to Democrats. The political right has similarly co-opted health care to justify sometimes unrelated objectives, especially in the culture wars.
Recall that the Trump administration’s sweeping border expulsions were officially justified under a public health authority, known as Title 42, and were triggered by an order from the Centers for Disease Control and Prevention. More recently, Texas and Florida have weaponized their states’ medical systems against immigrants by requiring hospitals to record and then report patients’ immigration status (This has discouraged immigrants from seeking emergency and prenatal care.)
In recent years, LGBTQ+ issues have also migrated into doctors’ offices. Half of U.S. states have now banned or restricted access to puberty-blockers or other gender-affirming health care (most often for minors, but in some cases for adults).
Gun violence has been subsumed into the health universe by both parties, too, though in very different ways: Many on the left argue for treating gun violence as a public health epidemic – and, consequently, they cast gun controls as a necessary public health intervention. Meanwhile, politicians on the right allege that gun violence is driven not by too much access to guns, but rather too little access to mental health care. (Curiously, they forget this when it comes time to fund mental health programs.)
I’m sympathetic to many of these invocations of health – and, candidly, am guilty of the same rhetorical spin when defending causes I care about (such as reproductive rights or economic growth). That’s because health really does intersect with many other issues, whether as cause or effect.
“The scientific consensus is clear that health is related to all sorts of economic and social factors, including housing, jobs, and civil rights. So, these really are health policies,” says Harvard health economist David Cutler.
But there are downsides to this kind of mission creep. If health care is associated with everything, Cutler says, how do we prioritize different health interventions?
More significantly: If everything politicians do is depicted as being a teeny bit health-care-related, that alleviates pressure to do much about the health-care system itself.
There was strikingly little discussion of health care at either party convention this year, even though it’s among voters’ top issues and represents about one-sixth of the U.S. economy. Republicans can lecture about “pro-life” values or trans kids and pretend that substitutes for a serious discussion of health-care access and affordability. Democrats have done more to reduce certain health-care costs, such as seniors’ out-of-pocket costs on drugs. But, as KFF president Drew Altman has noted, they usually promote such policies in the context of promises to reduce the overall cost of living, rather than as part of an agenda to reform the health-care system per se.
To be fair: Health-care reform is really, really hard – both technically and politically. Both parties paid an electoral price when they tried, with varying degrees of success, to revamp the system back in 2010 (Democrats) and 2017 (Republicans). So, why bother trying again? Much easier to just say everything is health care, and health care is everything – and leave our broken health-care system to its own devices.
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Reach Catherine Rampell at crampell@washpost.com.
