Deconstructing the Mythology That Made Its Failure Inevitable, So We Can Finally Demand Better
The Affordable Care Act succeeded at what it was designed to do. It expanded insurance coverage to millions of previously uninsured Americans. It eliminated pre-existing condition exclusions that had denied coverage to people who needed it most. It created regulated insurance marketplaces with subsidies for middle-income families. It allowed young adults to stay on parents’ plans until age 26. By the metrics of insurance expansion, Obamacare achieved remarkable success.
But by the metrics that actually matter for human health and wellbeing, America continues failing at healthcare, and Obamacare perpetuated that failure. Medical bankruptcies still destroy family wealth even with insurance. Healthcare costs keep rising faster than wages. Millions remain uninsured or underinsured. Workers stay trapped in jobs they hate because they need employer coverage. Healthcare providers spend increasing hours on administrative tasks rather than patient care. People still delay or avoid necessary care because of cost.
This was not a policy failure. It was inevitable.
American healthcare philosophy is constrained by two interlocking mythologies that determine what is imaginable. The first is economic: a captured discipline presenting theoretical beliefs as natural laws, making fiscal constraints appear real when they are political choices. The second is political: a Cold War-era binary that frames any universal program as “socialist” and therefore ideologically suspect. Together, these mythologies made Obamacare’s failure at actual healthcare inevitable from the start. They also make genuine reform invisible, not just to policymakers, but to voters who cannot demand what they cannot imagine.
This creates intellectual gridlock. Voters internalize the mythology and self-limit their demands. Politicians reinforce mythological “conventional wisdom” because it is safe and popular. Voters hear the mythology repeated by leaders, further constraining their imagination. No one demands more because no one can envision more. No one offers more because there is no political reward for challenging beliefs voters already accept as truth.
This essay deconstructs these mythologies. By taking apart each piece of the belief system that constrained Obamacare and continues to constrain American healthcare, you can see the machinery that has limited your imagination. Once you see how the mythology works, you can break free from it. And once you break free, you can finally demand better.
Obamacare’s success at insurance expansion is not a partial victory to build on. It is the mechanism by which the broken framework perpetuates itself. Each success within the mythology reinforces the assumption that this is what healthcare reform can look like. Each person who gains insurance coverage while still facing medical bankruptcy, each regulated marketplace that still enriches shareholders, validates the framework’s assumptions. The mythology survives precisely because it delivers enough visible wins to appear functional while systematically failing at what actually matters.
Obamacare proved that market-based, means-tested, fiscally “responsible” insurance expansion is achievable. That proof now constrains future reform. The next proposal must work within the same framework or face accusations of being unrealistic, unaffordable, or socialist. Success within the prison strengthens the walls.
This is a distinctly American failure. Germany, Japan, Singapore, Costa Rica, and dozens of other nations provide universal healthcare at half our cost with better outcomes. They are not smarter or more virtuous. They simply operate outside the mythologies that constrain American imagination. What other countries see as obvious, that healthcare is a universal basic asset rather than a consumer good, remains invisible to Americans trapped within both a captured economic discipline and an obsolete political binary.
The question is not whether universal healthcare is possible. It is why America, alone among wealthy nations, cannot see that it is.
Let’s deconstruct the mythology and find out.
Deconstructing the Economic Mythology
America’s approach to healthcare rests on assumptions presented as economic law. Government has limited money available, so healthcare expansion must be “budget neutral” over ten years. Every dollar spent requires finding a dollar elsewhere through taxes or spending cuts. Deficit spending is fiscally irresponsible and economically dangerous. Private insurance companies provide valuable services that competition makes efficient. Means-tested programs are more “efficient” than universal programs.
These beliefs function like a lens. They determine what healthcare possibilities come into focus and which remain blurred, hidden, invisible. Through this lens, universal Medicare appears fiscally impossible. Single-payer appears economically naive. Healthcare as a right appears utopian rather than practical.
When politicians say “we can’t afford universal healthcare,” they are not reporting economic facts, they are speaking a coded language. As I detail in Your Mainstream Economics Decoder Ring, this language is designed to limit what you can imagine. “We can’t afford it” actually means “We choose not to prioritize it.” “Fiscal responsibility” means responsibility to wealthy donors, not working people. “Budget neutral” means maintaining artificial limits while corporate welfare faces no such constraints.
This coded language does not just constrain policy options. It constrains your ability to see alternatives. You hear it repeated so often by politicians, pundits, and economists that it becomes the water you swim in. The mythology becomes your own internal voice telling you what is “realistic” before you even articulate a demand. You self-censor. You accept less. You vote for candidates who promise only what the mythology permits.
To me the evidence points towards the Technofeudalism strategy that has gripped the U.S. for 50 years. However, once you see this pattern and the capture, you can start to break free from it.
The deeper problem is that economics is not a science. Real science requires three characteristics:
- willingness to test and abandon basic assumptions when evidence contradicts them
- ability to make reliable predictions
- and openness to alternative explanations resolved through evidence rather than institutional power.
Mainstream economics exhibits none of these characteristics. Instead of expanding what we can see, it contracts our vision to what existing power structures find acceptable.
The claim that mainstream economics is demonstrably false is not rhetorical. It is an empirical statement. The 2008 financial crisis that mainstream models said was virtually impossible. The European austerity policies that models predicted would restore growth but produced 27% GDP contraction in Greece. The quantitative easing that models predicted would cause runaway inflation but did not. The repeated failure of Phillips Curve predictions about the relationship between unemployment and inflation.
Each failed prediction is a demonstration. A scientific discipline would revise theories that fail this consistently. Economics does not. The demonstration is complete: the framework is false, and Obamacare was built on it. Its failure was baked in from the start.
Each failure of economics as science produced a concrete healthcare policy failure. Economics does not abandon failed assumptions, so Obamacare was built on the assumption that competition among private insurers produces efficiency, despite Medicare’s 2% administrative costs proving otherwise. Economics does not make reliable predictions, so Obamacare projected cost curves based on models that missed the 2008 crisis. Economics excludes heterodox alternatives through institutional power, so single-payer was “off the table” before negotiations began. Not because evidence showed it would fail, but because it challenged the mythology.
The discipline’s dysfunction is not abstract. It is inscribed in the Affordable Care Act’s 2,000 pages.
Deconstructing the Political Mythology
Economic mythology alone does not explain American healthcare’s unique failures. Other nations have economists trained in the same mainstream tradition, yet they achieve universal coverage regardless. What makes America’s economic mythology so sticky is that a second political mythology is layered on top: the capitalism versus socialism binary inherited from Cold War politics.
As I explore in Beyond Capitalism vs. Socialism, this binary is a zombie ideology. Intellectually dead but still shambling through American political discourse. It frames every policy question as a choice between “free markets” and “government control,” between individual liberty and collective welfare. Within this framework, universal healthcare automatically registers as “socialist” regardless of how it is structured, funded, or delivered.
This political mythology operates independently of evidence. Medicare is a government-run single-payer program that remains wildly popular among Americans who simultaneously oppose “socialized medicine.” The Veterans Administration provides government-run healthcare that recipients largely support. Yet the same people who benefit from these programs often reject extending similar coverage to everyone because of the labels attached.
The contradiction reveals that labels matter more than substance. Once something is categorized as socialist, it becomes ideologically impossible regardless of whether it works.
The mythology is so deeply internalized that voters police themselves before politicians even need to. Propose universal healthcare and watch Americans object on behalf of insurance companies they despise. They have absorbed the mythology so completely that they argue against their own interests, using language they learned from those who profit from the current system.
Recognizing this self-policing is the first step toward stopping it.
The two mythologies reinforce each other in a way that creates an almost impenetrable barrier. Economic mythology says universal healthcare is unaffordable. Political mythology says attempting it is ideologically dangerous. Together they create a double barrier: even if someone breaks through the fiscal illusion and understands that the federal government creates money through spending, they still face the socialist accusation. Even if someone recognizes that other capitalist democracies provide universal healthcare without becoming socialist states, they still face claims that “we can’t afford it.”
Each mythology provides backup when the other fails. Deconstructing one is not enough. You must see through both.
Countries not trapped in this American ideological framework simply build what works. Singapore combines aggressive government intervention with private enterprise. The government owns 90% of land and provides universal healthcare and public housing, yet hosts thriving private markets. Germany achieves universal coverage through non-profit “sickness funds” with private providers. Japan uses heavily regulated employer and community pools with government-set prices. Nordic countries blend competitive markets with comprehensive welfare states.
None of these countries debate whether their systems are “capitalist” or “socialist.” They evaluate whether citizens get healthcare. They adjust based on evidence about results. America alone remains trapped in a binary that makes pragmatic solutions invisible.
How the Mythology Made Obamacare’s Failure Inevitable
Look at Obamacare through this deconstructed lens and its design becomes inevitable rather than accidental. The mythology made certain choices visible and others invisible to its designers. But the designers were also constrained by what voters could accept. They could not offer what voters could not imagine demanding.
Premium tax credits phase out at different income levels. Why? Because the mythology says means-testing “efficiently targets” subsidies. Universal coverage was invisible as an option, both to policymakers and to voters who would have called it “unrealistic.”
Cost-sharing reductions exist as separate programs. Why? Because providing full coverage appeared “too expensive” through the mythological lens. The possibility that full coverage costs less in total was invisible.
The individual mandate forces healthy people into risk pools. Why? Because adverse selection must be corrected through market mechanisms. The possibility of simply covering everyone, eliminating adverse selection entirely, was invisible.
Insurance exchanges create competitive markets. Why? Because competition between private insurers appeared to drive “efficiency” through the mythological lens. The evidence that Medicare operates at one-sixth the administrative cost was invisible.
The employer mandate preserves workplace insurance. Why? Because the mythology could not see beyond the existing structure. The possibility that decoupling healthcare from employment might unleash entrepreneurship was invisible.
To readers outside the United States, this last point requires explanation. Unlike virtually every other developed nation, most Americans receive health insurance through their employers rather than through government programs or individual markets. If you work for a company that offers health benefits, your employer selects the insurance plan, pays a portion of the premium, and deducts the remainder from your paycheck. If you lose your job, you typically lose your health insurance. If you want to start a business, you must first solve the problem of how to insure yourself and your family, often at costs exceeding $20,000 per year for a family plan on the individual market.
This arrangement strikes citizens of other developed nations as bizarre, and it should. It is not the product of deliberate policy design or market evolution. It is a historical accident.
During World War II, the U.S. government imposed wage controls to combat inflation. Employers could not compete for scarce workers by offering higher pay, so they began offering health benefits instead. The IRS ruled these benefits tax-exempt, creating a massive subsidy for employer-provided insurance that persists today. After the war ended, the temporary workaround calcified into permanent structure. Unions negotiated for better benefits rather than pushing for universal coverage. The insurance industry built its business model around employer groups. Decades of path dependency followed.
What began as a wartime workaround is now defended as the natural order. A perfect example of mythology making historical accident appear inevitable. The employer mandate in Obamacare did not just preserve workplace insurance. It enshrined a system that gives employers leverage over workers, suppresses entrepreneurship, and ties Americans’ access to healthcare to their employment status. The designers could not see decoupling as an option because the mythology had made this accidental structure invisible as a choice. And voters, having internalized the same mythology, never demanded decoupling.
Each piece of Obamacare reflects what the mythology made visible:
- preserve private insurance
- expand coverage at the margins, work within fiscal constraints.
The result is a system that expands insurance coverage while maintaining insurance company profits, employer-based coverage, and massive administrative complexity. Given the mythology, this outcome was inevitable.
This is not a Democratic Party failure. Every Republican healthcare proposal operates within identical mythological constraints. Health savings accounts, association health plans, block-granted Medicaid, high-risk pools: Republicans accept the same economic mythology. Healthcare must be “budget neutral,” markets are efficient, fiscal constraints are real. They accept the same political mythology in reverse: government programs are socialist and therefore dangerous, private markets are capitalist and therefore virtuous.
The debate between Obamacare and its Republican alternatives is a debate about how to preserve private insurance, which means-testing approaches to use, how much to subsidize versus deregulate. Neither party’s vision can see beyond the shared mythology because both parties’ economists emerged from the same captured discipline and both parties’ strategists operate within the same obsolete political binary. And neither party’s voters demand more, because they have absorbed the same limitations.
The partisan healthcare wars are fights over details within a shared prison of imagination.
What Becomes Visible When the Mythology Lifts
Once you deconstruct the mythology, you can begin to see what it hides. The possibilities that appeared impossible become visible. The constraints that appeared natural reveal themselves as choices. And once you can see, you can finally demand better.
As I explain in Why Monetary Systems Matter, since August 15, 1971, when President Nixon ended dollar convertibility to gold, the United States has operated on a pure fiat currency system. This is not controversial theory. It is the documented operational structure of our monetary system.
In a fiat currency system, the federal government creates money when it spends and destroys money when it taxes. The government must spend money into existence before it can tax it back. The operational sequence is: government spends first (creating money), then taxes (destroying money).
This distinction, invisible through the mythological lens, changes everything. Your household budget works differently than the federal government’s budget. You and your community are currency users who must earn or borrow before spending. The federal government is the currency issuer who creates dollars through spending. When politicians compare the federal budget to a household budget, they are either confused about basic monetary operations or deliberately keeping you from seeing the truth.
Former Federal Reserve Chairman Beardsley Ruml stated explicitly in 1946 that “taxes for revenue are obsolete” for sovereign currency issuers. The Federal Reserve Bank of St. Louis confirms: “As the sole manufacturer of dollars, whose debt is denominated in dollars, the U.S. government can never become insolvent.” This is mechanically how the system works.
This understanding allows us to separate real constraints from mythological ones.
Real constraints are physical resources. Do we have enough doctors and nurses? Enough hospitals and clinics? Enough medical equipment and pharmaceutical production capacity? Can we train more healthcare workers if demand exceeds current supply?
These are real. You cannot treat patients without doctors. You cannot perform surgery without hospitals. You cannot prescribe medication that does not exist.
Mythological constraints are political choices presented as natural laws. “Budget neutrality” requirements for legislation. Statutory debt ceiling limits. “Pay-for” rules requiring revenue offsets. Assumptions about “fiscally responsible” deficit levels.
These constraints are laws we wrote and can rewrite. Once you see them as choices rather than facts, the possibility of choosing differently becomes visible.
The United States has abundant real resources for healthcare. We have hospitals operating below capacity, medical schools that could train more doctors if funded, nurses who could work more hours if compensated fairly, pharmaceutical factories capable of producing more medication.
The constraint is not real resources. It is political will to deploy those resources for universal healthcare. The “fiscal constraint” that dominated Obamacare’s design was entirely self-imposed through legislation we chose to pass based on mythological economics.
The real constraint is inflation, which happens when demand for real goods and services exceeds the economy’s capacity to produce them. Will universal coverage push demand beyond our capacity to deliver healthcare services? The answer is no. We have substantial unused capacity and can expand it through training programs and infrastructure investment.
The question changes from “how do we pay for it?” to “do we have the resources to do this?” And we do.
Why Markets Fail for Healthcare
The mythology presents markets as the natural, efficient way to organize economic activity. Through this lens, market-based healthcare appears sensible. Once the mythology lifts, you can see why markets systematically fail for survival goods.
Markets excel at discretionary goods where consumers can walk away, competition is genuine, information is available, and failure does not mean death. Nobody wants government-designed smartphones. Markets drive innovation and efficiency for optional consumption.
But markets systematically fail for survival goods where people cannot walk away. You cannot decline to have a heart attack because prices are too high. You cannot shop around when you are unconscious in an ambulance. You cannot negotiate with a monopoly hospital in a medical emergency. These are not optional consumer choices. They are survival necessities.
Patients cannot evaluate medical procedures like they compare televisions. Medical knowledge requires years of specialized training that patients do not have. Information asymmetries are inherent and unavoidable. True market competition requires informed choice, which is impossible in healthcare.
Many healthcare services tend toward monopoly. Hospitals need scale for specialized equipment and expertise. In many communities, there is one hospital system with effective monopoly power. Competition may be inefficient or impossible.
Markets optimize for quarterly profits, but healthcare requires generational thinking. Preventive care pays off over decades. Chronic disease management requires lifetime commitment. Market timeframes do not match social needs.
As I detail in my essay on why the U.S. needs Universal Basic Assets, when you provide healthcare subsidies or vouchers, insurance companies and healthcare providers capture that value through higher premiums and prices. The mythology made this invisible. It could only see subsidies as helping people, not as feeding rent-seekers.
This is precisely what happened with Obamacare. Medicare and Medicaid expansion led to healthcare costs rising faster than general inflation. Obamacare subsidies resulted in insurance premiums increasing to capture subsidy value. The pattern mirrors student loans inflating tuition and housing vouchers inflating rents.
Healthcare is an inelastic market where people must purchase the service, supply is constrained by powerful interests, switching costs are high, and information asymmetries favor sellers. In these markets, any purchasing power increase gets captured by price increases. You cannot decline treatment for life-threatening illness.
Your healthcare subsidy does not increase your real access. It becomes a subsidy for insurance companies and healthcare systems. The mythology said market mechanisms with subsidies would solve the problem. Once the mythology lifts, you can see that subsidies just feed the wealth extraction machine.
The efficiency mythology collapses entirely on evidence. Medicare administrative costs run approximately 2% of total spending. Medicaid administrative costs run approximately 5-7%. Private insurance administrative costs run approximately 12-18% of total spending.
These are measured costs from actual programs. Private insurance spends six to nine times as much on administration as Medicare does per dollar of healthcare delivered.
Why the massive difference? Private insurance administrative costs include marketing and advertising, underwriting and risk assessment, profit margins for shareholders, executive compensation (insurance CEOs often make $10-20 million annually), claims denial operations, network management and contract negotiation with thousands of providers, broker commissions, and multiple billing systems.
But the true cost appears in provider offices. Doctors and nurses spend hours daily on insurance-related paperwork instead of treating patients: prior authorization requests for routine procedures, appeals of denied claims, different billing codes for different insurers, documentation requirements that serve insurance companies rather than patient care.
The mythology could only see “private sector efficiency.” The evidence shows government-run Medicare delivers healthcare at dramatically lower administrative cost than private insurance markets. The efficiency argument for private insurance fails completely on actual evidence. The mythology persists not because evidence supports it but because institutions protect the limited vision.
What Other Countries See
While America debates healthcare using mythology, successful countries worldwide quietly abandoned ideology for pragmatic approaches based on what actually works. They can see possibilities that America’s mythology hides.
Successful healthcare systems mix public and private elements pragmatically rather than adhering to ideological purity. The UK combines tax-funded universal NHS with thriving private markets for those who want them. Germany achieves universal coverage through non-profit “sickness funds” with private providers. Japan uses heavily regulated employer and community pools, government-set prices, and private providers to achieve the world’s best outcomes at 60% of American costs. Singapore mixes aggressive government intervention with private competition, achieving higher life expectancy while spending 76% less per capita than America. Costa Rica abolished its military in 1948 and invested those resources into education and healthcare, achieving higher life expectancy than the United States at a fraction of the cost.
The pattern is clear once you can see it: successful countries provide healthcare as a universal basic asset, organize around real constraints like capacity and workforce rather than mythological fiscal limits, and create economic security that enables opportunity.
These nations do not debate whether their systems are “capitalist” or “socialist.” They evaluate whether citizens get healthcare. They adjust based on results. They build what works.
Denmark has higher business formation rates than the United States precisely because their comprehensive safety net allows people to take entrepreneurial risks without catastrophic downside. When survival is not at stake, people can think long-term, take creative risks, and build for the future. Economic security is not the enemy of opportunity. It is the foundation that makes real opportunity possible.
The Opportunity Economics Alternative
Now that we have deconstructed what limits American healthcare vision, we can see the alternative clearly. It is not just “better healthcare policy.” It is a fundamentally different way of seeing economic possibility. As I outline in Opportunity Economics, this framework recognizes that economic security is not the enemy of opportunity. It is the foundation that makes real opportunity visible and achievable.
The Opportunity Economics policy framework rests on three core principles that become visible once the mythology lifts.
- First, Universal Basic Assets over means-tested subsidies. Provide everyone with foundational assets like healthcare, education, and housing rather than cash subsidies that get captured by rent-seekers. This becomes visible once you can see how markets work for survival goods. Giving people healthcare dollars through subsidies, vouchers, or tax credits just inflates insurance premiums. Giving people healthcare itself through universal Medicare actually delivers healthcare.The core insight: in markets where people cannot walk away, provide the asset directly rather than money to purchase the asset. For discretionary goods, give people money and let markets work. For survival necessities, provide the asset universally and let people supplement through markets if they choose.
- Second, real constraints over mythological constraints. Organize policy around actual resource availability rather than artificial fiscal limits based on mythology. The question is whether we have doctors, hospitals, and equipment, not whether we have satisfied arbitrary budget rules designed to limit democratic choice.
- Third, economic security enables opportunity. When survival is not at stake, people can take entrepreneurial risks, invest in education, participate in democracy, and build for the future. This becomes visible once you can see economic security as foundation rather than hammock.
Universal Medicare for All is the healthcare application of these principles. Everyone covered from birth, no exceptions. Comprehensive benefits including medical, dental, vision, mental health, and long-term care. No premiums, deductibles, or co-pays for covered services. Single-payer administrative simplicity with one system and one set of rules. Negotiated drug pricing using monopsony power like other countries. Healthcare completely decoupled from employment.
This is not socialism. It is recognition that markets fail for survival goods, which is why every successful society uses non-market mechanisms for healthcare while letting markets handle discretionary consumption.
Universal Medicare is a baseline, not a mandate. Think of it as “Medicare for All Who Want It.” If you prefer to pay cash or maintain private insurance, the system accommodates that choice. If you want public coverage plus supplemental private insurance for additional services, that option exists. Everyone has support, but people have choice.
As for innovation: our current system dramatically hampers it. The private insurance model constantly denies care and only rewards innovations that make existing treatments cheaper, not exploration of new and experimental approaches. Resources flow to optimizing billing codes and claims denial rather than medical breakthroughs. A robust public system providing baseline care could actually free up resources for genuine medical innovation by removing the profit-driven gatekeeping that currently constrains what treatments get developed and approved.
Medicare’s 2% administrative cost versus private insurance’s 12-18% cost means roughly $400-500 billion in annual savings from eliminating insurance company overhead. Total current healthcare spending is roughly $4.3 trillion. Medicare for All would not require creating $4.3 trillion in new government spending capacity. It would reorganize how we deliver the healthcare we are already providing, eliminating waste in the current system.
Once you can see this, the question changes. It is no longer “can we afford universal healthcare?” It becomes “why are we paying twice as much for worse outcomes?”
The Opportunity Economy Toolkit provides practical tools for understanding these mechanisms and building coalitions for change.
What We Must Demand
Understanding how mythology limits vision is necessary but not sufficient. Knowledge without action changes nothing. The mythology persists because it serves powerful interests, and those interests will not voluntarily expand what we can see. Universal healthcare, universal basic assets, and economic security will not be given to us. They must be demanded.
But here is the crucial point: having deconstructed the mythology, you now have the understanding to break the intellectual gridlock. You can see beyond what you were taught was possible. You know that “we can’t afford it” is a political choice, not an economic fact. You know that “socialist” is a label designed to prevent you from evaluating evidence. You know that every other wealthy nation has solved this problem.
You can finally demand better.
Demand universal healthcare as a universal basic asset. Healthcare is a survival necessity where market mechanisms produce extraction, not efficiency. Universal Medicare for All provides foundational security that enables people to take productive risks. Everyone covered from birth. Comprehensive benefits. No premiums or deductibles. Healthcare completely decoupled from employment.
This is not socialism. It is recognition that markets fail for survival goods, which is why every successful society uses non-market mechanisms for healthcare. The evidence is clear: Medicare delivers healthcare at 2% administrative cost while private insurance runs 12-18%. Other countries achieve better outcomes at half the cost through universal systems.
This is not radical. It is what becomes visible once you see beyond the mythology. The only thing radical is continuing to accept a system that costs twice as much and delivers worse outcomes because the mythology says markets must be preserved.
Demand we transcend obsolete political categories. We must refuse the capitalism versus socialism framing that makes pragmatic solutions ideologically impossible. Universal healthcare is neither socialist nor capitalist. It is what works. The question is not whether a policy fits predetermined ideological categories but whether it mobilizes resources effectively to meet human needs.
Dozens of capitalist democracies provide universal healthcare. The binary that says we cannot is a political mythology, not an economic constraint. We must demand that economics function like other sciences: testing theories against evidence, abandoning theories that fail, and remaining open to alternatives that better explain how economies actually work.
Demand change through political organization. As I argue in Why Progressives Are Accidentally Helping Authoritarians Win, retreating from national politics into local solutions plays directly into the hands of those who benefit from our limited vision. Real power comes from controlling federal resources, monetary policy, and regulatory frameworks. We must engage at that level or accept permanent subordination to those whose vision serves only themselves.
This means building coalitions across traditional political lines. A Republican small business owner struggling against corporate monopolies and a Democratic worker wanting genuine opportunity share the same interest in an economy that works for everyone. As I explore in The Politics of Stakeholder Society, the deeper political divide is between universal stakeholding, where everyone affected by collective decisions deserves a voice, and conditional stakeholding, where only those meeting certain criteria deserve full membership. Economic insecurity enforces conditional stakeholding by making people too precarious to participate fully in democracy.
The forces benefiting from limited vision are organized, funded, and politically active. They control think tanks, fund academic departments, staff regulatory agencies, and lobby legislators. They will not expand our vision voluntarily. Change happens because organized people demand it and hold power accountable when it resists.
The Choice Before Us
America could have adopted this approach in 2010. We could have succeeded at healthcare, not just insurance. The doctors existed. The hospitals existed. The monetary sovereignty to fund it existed. What did not exist was the vision to see beyond economic and political mythology.
We can still expand that vision now. Universal Medicare as a universal basic asset. Economic security enabling opportunity for workers, entrepreneurs, and families. Healthcare philosophy grounded in evidence rather than mythology. A commitment to transcending the capitalism versus socialism binary for pragmatic evaluation of what works.
The alternative to America’s limited healthcare vision exists. It is called Opportunity Economics. It rests on core principles: Universal Basic Assets over means-tested subsidies that get captured by rent-seekers. Real resource constraints over mythological fiscal limits. Economic security as the foundation for opportunity rather than its enemy. Pragmatic evaluation of what works rather than ideological categorization.
But frameworks do not implement themselves. Policies do not pass because they are correct. Change happens because organized people demand it and hold power accountable when it resists.
The question is not whether universal healthcare is possible. Once you see beyond the mythology, you can see that it is. The question is not whether we can afford it. Once you understand how fiat currency works, you can see that we can.
The question is whether enough of us will see clearly enough to demand what the mythology has hidden. Whether we will break the intellectual gridlock that keeps voters accepting less and politicians offering less. Whether we will organize, mobilize, and insist on what becomes visible once the mythology lifts.
That is a political question. And only political action can answer it.
You have deconstructed the mythology. You can see what was hidden. You can finally demand better.
What will you demand?