Parker Potter is a former archaeologist and historian, and a retired lawyer. He is currently a semi-professional dogwalker who lives and works in Contoocook.

A while back, I saw an interview in which Sen. Rick Scott responded to President Biden’s State of the Union address by claiming that Biden had cut $280 billion from Medicare. The interviewer challenged the accuracy of that claim and the interview quickly devolved into an attempt to pin the label “Medicare threat” on the donkey (or the elephant). It was as if establishing a plausible basis for an ugly campaign attack ad was useful political discourse. It is not.

Lying just below the surface of the pointless gotcha game was the possibility of an important conversation. According to Sen. Scott, the Democrats cut $280 billion from Medicare because the Inflation Reduction Act gives the federal government the right to negotiate the prices it pays for prescription medications obtained through Medicare Part D, and $280 billion represents the projected savings that Medicare will realize as a result of paying lower drug prices. Sen. Scott said that allowing Medicare to save $280 billion is a mistake because it will deprive the pharmaceutical industry of $280 billion that it would have spent to research and develop new lifesaving drugs.

Leaving aside the question of whether the Inflation Reduction Act actually “cuts” Medicare, when Medicare recipients will continue to get their Part D benefits, Sen. Scott’s argument invites us to ponder this question: What is the better way to fund pharmaceutical research and development? One, directly allocating public money to the National Institutes of Health to conduct research itself or to fund university-based research, or two, filtering public money first through an insurance program and then through the balance sheets of drug companies before it is spent on privately conducted research and development?

This question reminds me of a conversation I once had with my mother, who spent fifteen years working in the front office of a medical practice. My mother was intelligent, opinionated, and dedicated to winning every conversation she ever engaged in. At work, she enjoyed seeing how far she could push the drug reps who descended on her office bearing gifts. She was particularly proud of the time she got one of them to bring the whole office a catered seafood lunch.

I registered some dismay, suggesting that the cost of her crab legs necessarily ended up in the prices that consumers pay for drugs. She defended the drug rep gift culture by noting all the free samples they left behind, some of which her bosses gave my father, allowing him the benefit of drugs he couldn’t otherwise afford. After my mother set the table, I swooped in with this: “So what you’re telling me is that you are in favor of socialized medicine.” My mother, a staunch Republican, swallowed her tongue.

While my comment to my mother was intended as a conversation ender, I tell that story here not as a final word in an argument for a single-payer government healthcare system, but rather as the opening to a conversation about how pharmaceutical research and healthcare should be paid for.

Healthcare, it seems to me, is a universal necessity that falls somewhere in the middle of a spectrum of necessities. At one end are things such as national defense, things that, most would agree, are best paid for by all of us together, with public funds. At the other end are things such as clothing, also a necessity, but one that is best left to individuals operating in the marketplace.

Between these two poles lie necessities such as health care and education. All would agree that medical care and education are necessities of life on an individual level, and most would agree that while society at large has no legitimate interest in the particular shoes that our fellow citizens wear, society as a whole does have a legitimate interest in the health and education of its citizens. Thus, as a society, we face difficult questions about which necessities are better acquired through private participation in the marketplace and which ones are better provided through collective public action.

My point is not to advocate for one model as the better way to deliver healthcare. On the contrary, my point is that this is an issue we need to talk about thoughtfully. We need to listen to those with views different from our own, and we need to drill down and explore the consequences of the positions we take. What are the benefits? What are the costs? What are the potential unintended consequences? What are the overarching purposes and goals of any particular system?

In short, we need real conversations rather than verbal jousting designed to do nothing more than paint someone else into a corner where they can be branded with the label “bleeding-heart liberal socialist” or “money-hungry conservative capitalist,” as if reducing an opposing viewpoint to a bumper sticker can accomplish anything other than further division.

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