Presidential Debate: The Glaring Omission

Did you watch the U.S. Presidential Debate a couple of nights ago? NBC News moderator Lester Holt promised viewers that the candidates would “explore three topic areas tonight: achieving prosperity, America’s direction, and securing America.”

That’s an incredibly broad set of topics, isn’t it? As promised, Mr. Holt’s subjects focused on everything from the global economy to the natural environment to the sources of social strife.

There was one subject, though, that wasn’t even mentioned during the ninety minute debate. Did you notice what former hot-button topic was completely omitted from the conversation?

It was the Affordable Care Act, commonly known as Obama Care. In fact, there was no reference to any element of health care policy whatsoever. The omission was surprising, given the controversial dominance of the subject in prior elections, and considering the central importance of the industry sector to the American economy and society.

So what are we to make of it? How should we interpret this startling lack of interest in America’s system of health care? Especially given the continuing controversies over the level of access to medical products and services, and the cost of that access, throughout the United States?

One possible explanation is that the very nature of the Affordable Care Act that made it so difficult to implement in the first place is now making it easy to accept in the minds of the American public. As you may recall, although the Act was initially described as a comprehensive reconstruction of the entire health system, its primary beneficiaries were to be the relatively few individuals who desired insurance coverage but who couldn’t obtain it.

Disrupt an entire nation’s system of care to benefit a mere 24 million individuals? In a nation of 300 million citizens? Opponents of the Act portrayed such an venture as a high risk, low benefit leap into the unknown. In retrospect, it was no surprise that so many citizens shrank from it.

But now that the Act has been in effect for six years, it has become the status quo. And guess what? The health care system hasn’t crashed. It’s still plagued with problems, to be sure, but now any future modification to the industry sector can itself be portrayed as a high risk, low benefit leap into the unknown. And that may be why the possibility of repeal or significant revision has vanished from America’s political debate agenda.

Indeed, individuals who wish to engender comprehensive reconstructions of other industry sectors may take heart from the current status of the Affordable Care Act. What lesson does it teach them?

Don’t settle for small, incremental, evolutionary changes. Instead, take a deep breath, swing for the fences, ride out the inevitable backlash, and focus on integrating the changes into the industry sector so deeply that they become inseparable from the status quo.

At that point, the elements of reconstruction may simply become part of the economic and social landscape of the nation. And the public may then simply accept the changes and divert its attention to other concerns.