Part of the planning process before entering into a military engagement is called “shaping the battlefield.” It’s a strategic maneuver that aims to create a warfighting environment in which your strengths are optimized and your weaknesses are mitigated. With the election of Joe Biden as President, it appears that the war over healthcare in America is headed toward a four-year period of “shaping the battlefield” that will be conducted by all sides involved in the conflict.
Thankfully, due to the ineptness of the previous Trump administration, a critical period of Republican majority passed without any major damage to the Affordable Care Act (ACA). It certainly wasn’t for lack of trying, but the strategy of “repeal” without a “replacement” was too much for even the Republicans to bear, not to mention the Supreme Court. However, even with quasi Democratic control of the Presidency, the House of Representatives and the Senate, it is debatable whether meaningful change in the ACA or the drive toward a true “public option” will be possible, at least during the first two years of a Biden administration.
There is a very tangible rationale for this downbeat situation and it’s called Americans for Prosperity (AFP). AFP is a political action committee (PAC) controlled by Charles Koch. For many years the “Koch Brothers” have advocated against a “public option” for healthcare and have worked relentlessly to undermine any expansion of Medicare or the existing ACA. However, the Brothers went through sort of a “quiet period” during the Trump Administration. Much of this probably had to do with the death of David Koch in 2019, a common distaste for Trumpism, and the never-ending drama of politics during the Trump administration. For those of us who firmly believe in massive healthcare reform, we essentially came out of 2017 to 2020 with the status quo, which is a much better situation than it could have been.
The problem now, however, is that Charles Koch and the AFP are quietly shaping the battlefield for a healthcare showdown. AFP is actively lobbying at the state and federal level for a “personal option” and the effort is comprehensive, well thought out, and has nearly unlimited financial resources. AFP is suggesting that a “personal option” that consists of a series of legislative changes that promote tax credits, increases in health savings accounts, and eliminating regulations is better than a government-run healthcare system that is all-inclusive.
AFP’s mandate is a mirror image of Charles Koch’s Libertarian principles of “individual freedoms” but it assumes that individuals have a choice of options in which a decision for one or the other results in a non-material opportunity cost. Unfortunately, our current healthcare system does not offer these kinds of choices. Our only choice is to “have or to have not.” When millions of Americans face a simple decision as to whether or not they can afford to go to the doctor, the decision is extremely material and consequential. The choice between healthcare and bankruptcy is not a Libertarian theory that can be solved with a few hundred dollars more in a health savings account.
Both sides of the political aisle are being inundated with AFP propaganda, an effort that only began in earnest in late 2020. So, Mr. Koch is back in the game after a four year slumber and they are trying to “shape the battlefield”; a tactic that was absent during the previous administration when no alternative to the ACA was provided by the Republicans. But now, and for the foreseeable future, the “personal option” will gain traction and the debate will begin to boil down to an easily manageable battle of the catch phrases of “personal” vs. “public.” It’s a smart move by AFP and their messaging is clear and concise – have control of your own destiny or be controlled by the government. This will permeate the political arena for the near term and provides an alternative that 2017 to 2020 never offered.
Democrats and Republicans must be challenged with a clearer, more concise message on the “public option” and it needs to start happening now. It is easy to determine who will win the battle when only one side takes the initiative to “shape the battlefield” prior to beginning the conflict. Healthcare was the number one priority for voters in 2020 and the 2018 mid-terms. Action needs to be taken now because the battlefield for healthcare will be the 2022 elections. AFP has a head start and will show no mercy just because the Biden administration is dealing with COVID, voter rights, and infrastructure bills. AFP will rally their forces during these distractions, win a few state-level skirmishes related to state Medicare expansion and slowly but surely take the higher ground unless those of us on the “public” side of the equation show an equally determined counter-attack. President Biden is marketing “bold change” and courage of conviction. Now is the time to back it up with resources and action or else we will begin the battle at the extreme disadvantage of competing on the enemy’s battlefield that has been prepped and shaped for two years without a challenge.