Universal Healthcare

This post is a bit of a departure from the prevailing flavor of esoteric material found on this site – and more of a social commentary that touches the hands-on, day-to-day status of our lives, as opposed to taking the longer and higher level view of what we are trying to make of our lives on this world as a species of uncertain parentage.

In terms of what we are trying to make of our lives, one would think that “better health outcomes for all” would be a desirable goal for any country interested in the well-being of its citizens. But this appears not to be the case in the USA, given the Trump administration continuing attempts to repeal the Patient Protection and Affordable Care Act that was signed into law in 2010 by President Barack Obama to provide coverage to an additional 20 million people who were previously uninsured. However, even with what has since been called “Obama Care” there are still approximately 40 million Americans who still don’t have health insurance.

During his campaign for President of the US Trump described Obama Care as an “incredible economic burden” which resulted in “runaway costs, websites that don’t work, greater rationing of care, higher premiums, less competition and fewer choices” and promised to replace it a new healthcare bill that would give Americans greater choice and stop the current Obamacare “death spiral” of higher costs.

Trump’s objections to Affordable Care Act appear to have resonated with Americans who were against it because it made health insurance mandatory. This needs to be seen in the context that you end up paying for it even if you choose not to participate in it, as you will have to pay a tax “penalty” unless they qualify for an exemption, and this would include such things as affordability.

With millions more Americans now being covered under the Affordable Care Act it should not come as a surprise to anyone that the total cost of healthcare in the United States has risen significantly. But this is caused by more than just the fact that more Americans are being covered, as at $9,000 per capita the U.S. spends more on health care than anywhere else in the world. To give just one example, that is $6,000 per capita more than what is spent in Finland on health care, and with an infant mortality rate less than half than in the US.

Given these astronomical costs, it is difficult to believe that the US ranks about fifty-seventh in the world in infant mortality and thirty-sixth in life expectancy as reported by the World Health Organization in 2016. It gets even more embarrassing at the state level, where per capita more children perish in infancy in Mississippi than in Botswana, to give just one example. The conclusion has to be that Americans are not getting value for money when they are paying for health care, and there are some apparent reasons for this, the main one being a cultural one.

The best way to make that point is to look a Europe and the evolution of social health institutions and the fact that they are seen as being as much sociological as economic in character – e.g., as a way of life that will benefit the majority of people.  You will find this approach reflected in the universal healthcare programs of countries such as Australia, Austria, Canada, Ireland, The Netherlands, France, Germany, Denmark, Switzerland, Taiwan, Singapore, and Japan. There are many others—including Moldova and Portugal. This in contradistinction to the evolution of U.S health institutions into primarily an economic means, i.e., a way to make money regardless of whether this will benefit the greater whole of society.

Their health systems are simply framed by a different set of values. The primary purpose of their healthcare system approach is to provide decent medical care for all of their inhabitants. In contrast, our current American healthcare system is organized to transfer money from the many to the few.  (Dr. George Lundberg)

US attitudes with respect to any kind of universal health care are further complicated by the belief that the Government shouldn’t be in the Health Care insurance business.  This harks back to the assumption that any business will be run more efficiently and hence more cost-effectively from the private sector, where costs are a function of competition in the marketplace, hence guaranteeing the best value that money can buy, regardless of the service or product you are talking about.

This assumption is worth looking into a little further as it appears to ignore the primary raison d’être  of for-profit organizations, namely that they are in business to maximize profits. At bottom it is driven by the principle that you should always charge the highest amount the market will bear, regardless of your actual costs to produce or deliver your product or services, and regardless of the economic impact it has on the individual or community that you are operating in. Hence affordability is not something that comes to mind in the context of running a business that is looking to cash in on its market share as well as increasing it by buying out the competition.

If any of this seems contrary to or incompatible with what you would want to be the basis of an affordable universal health care service you will know why a wealthy nation such as the US of A has a problem in keeping up with the rest of the world in providing such an essential service for the majority of it citizens.

Finally, this whole matter of raising public support for funding something like a universal healthcare program falls afoul of the average US citizen’s inability to distinguish socialism from communism, and can be laid at the doorstep of their public education system.  For many Americans the implementation of universal healthcare would be the first step in becoming a communist country, never mind that successful capitalist free-market economies such as found in most – if not all – Western European Countries have adopted some version of this kind of health benefit for their citizens without having descended into communism. Seems to me the communist bogeyman as envisaged by Joe McCarthy is still very much around in the Land of the Free and Home of the Brave.