Senate Majority Leader Mitch McConnell (R-Ky.) had planned to vote on the bill this week. But Senate Republicans, chastened by the uproar from critics and dissent within their own ranks, said Tuesday they would put off voting until after they return from the July 4 holiday recess.
In the meantime, it’s worth considering the issue in a more global context. Health care is an essential need in any society. In many places, in both the developed and developing world, governments play active roles in providing care, lowering costs, or both.
No country has the exact system as the other, nor is any country’s system free of critics and detractors. But you’d be hard-pressed to find any other wealthy nation in the world where the very idea of universal coverage provokes such partisan division.
The Affordable Care Act, often known as Obamacare, was an effort to expand health insurance coverage to millions who would otherwise be too poor to pay for it — or too sick to afford what insurers may charge. (Its precursor, of sorts, was implemented by a Republican governor in his state.) But most Europeans would look at the power still given to private insurance companies, as well as the high costs many Americans still shoulder, and consider Obamacare to be a centrist, if not center-right, political compromise. Indeed, the ideas at the core of Obamacare were ones long championed by conservative health-policy wonks.
Yet many Republicans viewed Obamacare as a tyrannical “socialist” plan to force people to pay for insurance they didn’t necessarily want. For years, Republican politicians have espoused the principle of “personal responsibility” — the supposition being that if you want health care, you’ll get employment and do what’s needed to afford it. The free market, they argued, would naturally provide sufficient options — never mind the various ways insurance companies placed ceilings on coverage or punished those with preexisting conditions.
The “free-market competition” espoused by Vice President Pence in the tweet above has led to spiraling costs in a medical system run mostly by for-profit companies and hospitals. According to OECD data — indicators for a bloc of developed countries — the United States spends close to 20 percent of its gross domestic product on health care, nearly $10,000 per person, roughly twice as much as countries like Britain, which has a nationalized health service. Americans, as a whole, pay more to get less.
“It is not just that U.S. healthcare is expensive, with price tags often far higher than those in other developed countries,” wrote Elisabeth Rosenthal, editor in chief of Kaiser Health News. “At this point, Americans face astronomical prices that quite simply defy the laws of economics and . . . of decency and common sense.”
She goes on: “Our prices for tests, drugs, hospitalizations and procedures — old or new — have gone up dramatically year by year, and are vastly higher than in other developed countries. Indeed, prices for similar interventions in other countries have often declined.”
What explains the difference? Some observers point to a cultural gap between Americans and those across the Atlantic. A 2011 Pew survey found that Americans tended to value individual liberty more than Europeans, who saw a positive role for the state. “Nearly six-in-ten in the U.S. (58 percent) believe allowing everyone to pursue their life’s goals without interference from the state is more important,” noted the report. “Majorities in all European nations polled in 2011 said guaranteeing that nobody is in need is more important.”
But this kind of American exceptionalism would be a lazy answer. Just north of the border, you have an English-speaking society that embraces its own pioneer myths of hard work and self-reliance on the frontier, but which also has a health-care system that seeks to provide universal coverage.
“Single-payer systems, like the Canadian version, or a single provider system, as seen in the United Kingdom and other countries, provides the means of bringing care under the umbrella of a single, accountable authority,” explained two Canada-based doctors in an article for STAT News, a health-care news site. “This is neither socialism nor an attack on individual liberty. It is simply making a promise: to protect each other from disease and preventable harm, recognizing that our capacity to do so is perhaps the most meaningful measure we have of our society’s worth.”
The profound unpopularity so far of the GOP-proposed replacements to Obamacare show that many Americans also want a system that better ensures the collective well-being of their society.
But the fact that it doesn’t yet exist is also a reflection of unhealed divisions in American society. In an article in the Atlantic, Vann Newkirk II points to a forgotten plank of the civil rights movements of the 1960s: access to health care.
Various countries in Europe had already instituted universal health-care schemes. But, as Newkirk noted, “America’s developing peculiar, private, decentralized, job-pension-based health-care infrastructure was the only fit for a modernizing society that could not abide black citizens sharing in societal benefits, and one where black workers had often been carved out of the gains of labor entirely.”
State-subsidized programs like Medicare and Medicaid, which came into existence a year after the 1964 Civil Rights Act, essentially forced hospitals to see black patients and helped “end formal segregation.” Decades later, Obamacare disproportionately helped expand coverage to people of color. But the new efforts pushed by the Republicans, wrote Newkirk, “will move America away from eliminating racial inequalities in health and health care.” It’s just another unfortunate way the U.S. system may distinguish itself from the rest of the world.
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