To the Editor:

No one wants to talk about this question, least of all the folks who make our laws. But isn’t this the question that underlines the ongoing “debate” about “repeal and replace” — or just “repeal” — the Affordable Care Act? Is health care just another product that has to be purchased — if you can afford it — or is it a duty that arises from the nature of this country and its people?

We are not people who let poor people die for want of food, hence the food stamps program; or for a place to live, hence the public housing and other subsidies in the housing market. These are not perfect solutions, but their very existence shows that we are not heartless people.

Perhaps people are afraid to tackle this question because of the furor that would likely arise from those who call themselves conservatives. They wail about government taking on these problems. They believe that everything should result from the activities of a private market.

President Franklin D. Roosevelt was not afraid of “big government” solutions to social problems, nor was President Lyndon Johnson. Their courage, and their ability to appeal to “the angels of our better nature” in addressing the problems gave us Social Security, Medicare, Medicaid and a host of other programs. How many of you would want these programs repealed? The screams would be deafening.

Legislators are not answering these “why” questions by laying out the principles that would undergird whatever program is finally adopted. Instead, what we hear is point-scoring: how much or how little public health can we get away with paying for. The Affordable Care Act is viewed by many legislators as just another “big government” program that has to be reduced — with the apparent consequence that many millions of Americans who now have health insurance will lose it.

Let’s have public debate about the principles that should lead us to some form of universal health insurance for all Americans, a condition that exists in all other industrialized countries from Japan to Canada to most of Europe. Let’s figure out a way to prevent people from dying or going bankrupt because they could not pay for treatment they need. We can do this, but only if the Congress reverts to the normal process of governing — hearings where different ideas are explored and solid legislation is developed.

John Vanderstar

Waynesville