Editor's Letter: The health-care debate

last updated 8 January 2015

With the nation’s supply of Hitler mustaches running low, it’s possible the health-care discussion will take a substantive turn when legislators return to Washington this month. Or maybe not. The legislation remains terra incognita to most Americans; only one-third of poll respondents chose the correct definition of the “public option”—and many of them may have been guessing. Facts are obscure and frequently muddled. In comparing health care in the U.S. to care in other countries, for example, we hear a lot about life expectancy. Trouble is, “American” life expectancy is fragmented. Asian-American females live almost until 90. African-American males, on average, don’t make it to 70. Whose lives are we discussing?

Such stark divergences have political contours. Rep. Hal Rogers represents Kentucky’s 5th Congressional District, where life expectancy, at 72.6 years, is the lowest in the nation. The lives of Rogers’ constituents are a full decade shorter than those of Rep. Jim Moran’s constituents in Virginia’s 8th District, one of the nation’s wealthiest. Moran’s Virginians and Rogers’ Kentuckians do not use the same health-care system in any meaningful sense; no such “system” exists. Instead, we have a patchwork, the quality of which varies significantly by geography and socio-economic status. Moran, a Democrat whose suburban constituents seem to have access to fine health care, supports reform; Rogers, a Republican whose rural constituents appear to be struggling under the status quo, nevertheless prefers to maintain it. To understand that peculiar dynamic, you probably don’t need specialized knowledge of health-care sciences or systems. A passing familiarity with political science likely suffices.