Two perspectives on Universal Healthcare in the US
Writing: Justin White & Max Hunter
Illustration: Jess Cowie
So Long Rugged Individualism, Medicare-for-All is Coming
We’re all familiar with the Medicare-for-All stories, whether through tweets, Kickstarter campaigns, Facebook posts, news articles, or Bernie Sanders. The United States still remains the only developed country without a nationalised health system - a fact which is not surprising when you look at all of the other ideals that its politicians don’t subscribe to, such as the Paris Climate Accords, reduced university tuition fees, and the UN Convention on the Rights of the Child (UNCRC). All three of these are connected through a notion of rugged individualism, a theme preached in US politics since President Hoover campaigned for it in the late 1920s. For those unfamiliar with the concept (like I was before writing this article), rugged individualism is a belief system upholding the idea that every individual has the ability to succeed on their own, with little to no government intervention.
Put more directly, free market capitalism. In terms of healthcare, this rugged individualism might be an acceptable belief if you are lucky enough to have a stable, reasonably-paying job, and the health insurance that most likely comes with it. Yet for those without - who often have jobs quite the opposite of stable, or may be undocumented - a necessary combined tetanus and polio vaccination to send their children to school costing between $25-50 per dose could determine whether their children receive an education or not. Article 24 in the UNCRC states that “Children have the right to good quality health care – the best health care possible,” but then again, the US government forgot to ratify it. According to the corrupt politicians who receive funds from pharmaceutical companies, these issues aren’t a problem since the cost of healthcare is justified. Healthcare isn’t a human right, after all. Luckily, there is hope; universal healthcare is on the table for Democrats running against the current Republican president. But how could this work given more than a century of privatised healthcare, and how would Medicare-for-All shift American society and its culture of rugged individualism?
Dozens of Democratic candidates campaigned and won on a promise to pass nationalised health insurance. There is now a Medicare-for-All caucus in the House of Representatives with 77 members. All the Democratic candidates running for president support the idea. But there lies another problem; how can such a system be covered economically, and what type of system should be implemented? There are already six proposed plans in Congress. Despite a lack of consensus on who to tax, what to tax, or even whether to tax at all, almost all the plans wish to introduce government regulation on healthcare prices. Yet, this isn’t as easy at it seems. All but three senators in the Senate and nine out of ten representatives in the House of Representatives receive campaign funds from pharmaceutical companies. Therefore, in order to achieve Medicare-for-All, stricter policy needs to be introduced to negate corporations’ modern-day corruption of US politics. On a moral basis, government officials need to bring an end to their taking of funds from corporations, something Alexandria Ocasio-Cortez (D-NY) has campaigned on.
Nonetheless, the share prices of health-insurance giants are tumbling; a long awaited shift in healthcare since Theodore Roosevelt stated in 1890 that “no country could be strong whose people were sick and poor” finally seems inevitable. Despite the strength of the dollar and its controversial military, it is hard to see the US as strong. Civil unrest due to a problematically elected president and rising inequality levels not seen since the 1920’s have pushed the ‘United’ States to breaking point. Medicare-for-All could be a turning point for inequality, especially if Alexandria Ocasio-Cortez’s proposed 70% top marginal tax rate is used to cover a universal healthcare system - something that it has the potential to do by itself. Medicare-for-All could also serve to stamp out shockingly high levels of underemployment by reducing the amount of people who stay in dead-end jobs simply to receive health insurance. These are just two problems caused by rugged individualism, and yet Medicare-for-All has the ability to eliminate these issues and many others with the stroke of a pen.
Universal Healthcare: is America set to join the league of civilised nations?
God bless Bernie Sanders. The grizzled liberal veteran has announced that he will be seeking the Democratic candidacy in 2020, and even if he falls short of this, he has already made a lasting contribution to American politics. It has become common currency to discuss a leftwards shift in the Democratic field, due in no small part to Sanders’ trailblazing in 2016, and other firebrands like Alexandria Ocasio-Cortez. These figures have caught our imagination for a few reasons. The first is the dismal state of politics in general. The Democratic left has benefited from the backlash against and international humiliation of enduring a toddler in the White House. With the right displaying its dysfunctional face so blatantly and boldly, there is something refreshing about hearing stridently progressive voices from the left. Another is exhaustion. Exhaustion with the Democratic establishment that cannot feasibly accuse their Republican opponents of being funded by corporations and the mega rich because they are themselves in the pockets of Big Money. This ‘respectable corruption’ sits malevolently like a cancer at the heart of politics, on both sides of the Atlantic. Nowhere has this leftwards shift been more welcome or timely (and the corporate-backed opposition been so staunch) than in the issue of universal healthcare.
The United States pays more for its healthcare per capita than most of the developed world. It also gets far less for its money. For the $3.24 trillion paid every year, you would expect Americans to be among the healthiest people in the world. You would expect satisfied patients - you would expect nearly all of its citizens to be, well, looked after. This is sadly not the case. Roughly 9% of Americans have no health insurance. Another 26% are ‘under-insured.’ Compared with single-payer systems in the United Kingdom, much of Europe, and the Anglo-sphere, America’s system looks expensive, inefficient, and inadequate in the provision of care. So who does the US healthcare system work for? The answer: those who can pay for the best treatment, and the insurance companies that donate so generously to the campaigns of America’s members of Congress. Let’s look at Blue Cross Blue Shield, for example - a health insurance company that gave $3,031,675 in political donations between 2017 and 2018. During this period they were by far the biggest contributors. They were followed in second place by New York Life insurance, which gave $2,561,971, $116,675 of which went towards the campaigns of Max Baucus. Now retired, Baucus was one of the most insurance-friendly Democrats in Congress. He gained notoriety for ordering the arrest of doctors who showed up at his ‘roundtable’ discussions in 2009 to look into healthcare reform. When the voices of healthcare professionals are sidelined and insurance companies can buy themselves a dominant platform, is it any wonder that progress on universal healthcare in the US has been so torturously slow?
Ignoring, for a moment, that these arguments owe their strangle-grip on American politics to the strength of vested interests, let’s engage with the arguments themselves. A universal single-payer healthcare system is cheaper for a number of reasons. In this system there is less bureaucracy, overlap, and asymmetry. Resources are put where they are needed, not where the profit motive takes them. When buying drugs, a central authority can purchase them for less because they are in larger quantities. Prices can be negotiated from a stronger position. There might be job-losses from the reduction of overlapping provision, but we should encourage Conservatives to think of this in terms of market purity, as they so love to do. Why are we paying more than necessary for medicines in order to pay more doctors than we need? Furthermore, it is a fact that almost 9% of Americans are uninsured (and this number has risen dramatically since Trump’s attacks on Obamacare’s advertising budget). This statistic tells us that there are vast numbers of people in the US in need of care that they cannot currently afford. Providing these people with the care they need is not only a humanitarian (and national) duty, it is work that we can pay doctors for.
The right’s usual fallback is the cultural argument that single-payer healthcare involves the government making spending decisions for the country as a whole, and that such an idea is anathema to the American spirit of rugged individualism. Let’s not forget that there was a time when keeping a dominant military presence in every region of the world was anathema to the American spirit, but money has somehow been found for that. America should not be defined by cultural entrenchment - it is too dynamic a place for that. Leadership of the free world is defined not only in military and economic terms, but also in something deeper. In the task of looking after its own, the leader of the free world has been trailing behind for too long. It is time to get your house in order.