Admittedly, there's not much snark in the following.
Kos has discussed how Republicans maintain a circular logic wherein they assert government doesn't work while making sure they don't govern, ensuring the verity of their claim. This gumming up the works is done partly so that they can "shrink" government to the size where they can "drown it in a bathtub", to paraphrase Grover Norquist. Historically this argument is made that government, the "swollen teat of liberalism", must be reduced and certain services and functions "privatized", which will render them inherently superior to their former state. Anything having to do with government, that is "liberalism" is improved if it is "privatized", "for profit", and transmuted to the "market".
This tactic of rendering government services "useless" (FEMA) or declaring it "broken" (Social Security) has been quite noticable lately, but the practice has been ongoing for several decades, at least since Reaganism reared its ugly head. A primary casualty has involved our besieged health care system.
I live in Texas, one of the reddest of states, home of Dominionism, Halliburton, Enron, Rove/Bush, et al. (I know, I know, . . . and if I were younger I might consider relocating, but I'd hate to give the bastards the satisfaction).
Having volunteered quite a bit of time in the 80s and 90s at the local hospice, I became familiar with "not-for-profit" care, 501C-3s, community fundraising, and, alas, boards of directors. During this period, our local hospice grew from a small, struggling operation to one with a million dollar per year budget, all the while ensuring that every patient received the necessary care, services, and drugs--regardless of ability to pay.
In fact, the whole community took pride in this service provided to the terminally ill and their families, knowing that all of us would perhaps, at some future time, need those services. We had a bank of volunteers offering a variety of services, from patient assistance to relieving the stressed out family members, to doing yard work--you name it, we had volunteers. Several annual fundraisers helped supply necessary operating capital, as did generous instances of "planned giving", whereby people remembered the hospice in their wills and estates. Of course, Medicare and private insurance was billed as well. We continued to grow and serve an annually increasing census, precisely because there was not a thought given to a patient's ability to pay when it came to decisions of care or otherwise. Physicians, knowing that their patients received superior care at our hospice, overwhelmingly referred their terminal patients and families to us.
Which is why the "for profit" hospices were unhappy.
Those of you familiar with "not for profit" know that these businesses have executives who must answer to a rotating Board of Directors, usually prominent citizens who have time to serve on such Boards. During this period of tremendous growth the Board gave the Executive Director full lattitude to run the business, as the success spoke for itself. But as some of these Board members in the 80s rotated off, different ideas came into play: resistance to the Director's plans and ideas eventually coalesced into action to fire her; after a year, the Board recommended the now struggling hospice sell its "assets" to a competitor, a national corporate "for profit" agency. The "market" was opened, standardized you might say, and soon our community had half a dozen competing hospices, including our original, none of them any better than the others in terms of service or care, because the philosophy had changed to a corporate "bottom line" mentality. Only services that could be billed and reimbursed would be provided; the "extras" offered by the "not for profit" became a fleeting memory.
A similar chain of events occurred a few years ago at a local "not for profit" retirement center. Same thing: community jewel, reasonable rates, benefitting from community gifts and giving. Then new Board members come in, and within a year the Director is replaced, the facility becomes insolvent and is sold to a "for profit" competitor. Again, these were stolid business leaders, but active Republicans. They seemed to not be able to allow a business that operated with the goal of the community weal over profit to continue even to exist. I'm fairly certain money was passed to facilitate both businesses struggling before their eventual sale and assimilation into for profit corporations.
These local examples serve as analogy to what has happened to our overall health care industry, which, like the hospice example, was not originally oriented toward "profit". I was born in the 50s and remember as a kid in the 60s when most large cities had hospitals affiliated with churches or universities. Dallas had Parkland, which was the city/county hospital housing Southwestern Medical School, Baylor (associated with Baptist church), and St. Paul's (associated with Catholic church); Ft. Worth had All Saints (Episcopal)and Harris (Methodist). Later Presbyterian built a hospital.
My point in mentioning the church affiliations is not to espouse religion but to assert that the goal of hospitals then was providing patient care, not making a profit. The institutions to which the hospitals were affiliated helped accomplish this goal by underwriting the medical mission. In the city hospitals, the taxpayers did the same thing. Hospitals were adequately staffed, patients weren't discharged too early, medical decisions weren't made by beancounters somewhere in Dystopia. It wasn't perfect--just more humane.
In the 70s and 80s we saw the trend shift as corporate medical facilities (formerly "hospitals") began attending to the dictates of insurance companies, wresting control from the doctors and shifting attention from the patient's chart to the insurance companies' bottom line(s). Of course, what could be more fitting? The amorality of the Market as context for ethical considerations of patient care.
We read with horror daily the Republican onslaught toward "government": FEMA, the Department of Justice, EPA, FDA, NASA. This destabilizing is and has been happening, though, at both the national and the local level and constitutes a willful ideological attempt, begun decades ago, to dismantle the social infrastructure of liberalism. Sometimes it happens in towns and cities by someone running out the "not for profits". Perhaps in your town these debates are still occurring. Here, not so much.