Universal Coverage: A Disgrace It’s Taken So Long

Tens of millions of Americans lack health insurance. Extending coverage to them has been a core goal of health reform proposals since the 1960s. President Richard Nixon offered a universal health plan in his first administration, but since then Republicans have hesitated to commit the nation to so costly an undertaking. Is it time to rethink? Should Republicans accept universal coverage as a goal?  We posed this question to NewMajority’s contributors.

The answer:  Mexico, Turkey, and the United States.  Ok, what is the question?

What are the only three OECD-countries — the 30 largest free market democracies, broadly defined — in which sizable numbers of citizens lack health insurance?

Not company our nation usually keeps.  Nor should it.  The idea that we can’t afford universal health insurance, as many FF contributors say, is just, well…let’s just say, it’s a bit more plausible coming from Mexico and Turkey, countries which are famous for sending legions of their people to wealthier countries like the U.S. and Germany. That enormous sum of money that Republicans keep warning us about–oh my goodness, over $1 trillion spread over ten years, the money it would take to insure about 97% of our population (to do it well, it would probably take about $1.4 trillion) — is less than 1% of our country’s estimated GDP over that same ten year period. Let me repeat that:  Less than 1% of estimated GDP over that same ten year period.  Nor would this add to the deficit, as this will be paid for by higher taxes and a reduction of payments to hospitals.  Yes, sometimes you actually have to pay for things you purchase, something conservatives used to support.  But, no matter:  We are a very, very wealthy country.  We can afford a defense budget larger than that of the next 20 countries combined.  We can afford an unfunded war in Iraq now in its sixth year.  We could afford to pay for the prescription drug bill and gratuitously launder about $200 billion of the taxpayers’ money to the insurance industry.  Yes, the United States can afford this.

Moreover, in every other advanced capitalist country, the question which David Frum has posed to Frum Forum is a settled issue, as banal and uninteresting as pondering whether the earth circles the sun.  And note this, FF conservatives:  This is an axiomatic policy for conservatives in all of these countries, too.  While conservatives in France, Canada, the UK, and Germany may vigorously criticize their healthcare systems (as do those on the left), none of them would ever propose as a remedy the following:  “Why don’t we eliminate lifetime insurance coverage for 15% of the population, including children and the near poor?  If they can make it to an ER, great.  If not, tough luck.”  The notion that ad hoc ER services is in any way equivalent to broad health insurance can be addressed as follows.  You’ve all heard, of course, recently, of how Investor’s Business Daily ignorantly argued that the British NHS would have, essentially, put Stephen Hawking to death if Hawking had had the bad luck to be British.  Of course, Hawking is British — and immediately issued a statement saying that the NHS provided him with excellent treatment his entire life, had indeed saved his life (he suffers from a very rare variant of ALS that can result in chronic survival with many of the symptoms that ALS compresses over just a few years).

An easy hit for advocates of universal insurance, that one. But did it make any of you wonder:  What would happen to an American who suffered from what Hawking suffers from — or cancer, or severe heart disease — who lacks health insurance? Say, even the least sympathetic case, one of those arrogant 25-year olds, who think they are going to live forever, and wake up with a deadness in their legs, and are diagnosed with MS — I know someone like that, perhaps you do, too.  What happens to those people in America when they don’t have insurance?  What happens after they “show up at the emergency room”, in Bradley Smith’s inelegant phrase?  This is what a number of you seem to think is fully the equal of having quality health insurance (of the kind you yourselves have, about which more later).  So you’re diagnosed with MS or ALS, or you found some blood in your stool time and again, and you go to the ER, and you’re diagnosed with colon cancer.  So:  you followed Mr. Smith’s advice, and you showed up!!  Now what?  Is the ER going to refer you to a specialist whom you can’t afford to pay for?  If you have cancer, is the ER going to provide you with chemotherapy or a radiation protocol?  If you have ALS like Stephen Hawking, what should you do?  Go back to your house and cry?  Try to get on Oprah, and hope that people will pity you, and provide you with charity?  Just crawl up in a spastic ball on the street and die?  American conservatives:  tell uninsured Americans—your fellow countrymen and women, you who evoke love of country so frequently–about what they should do after they’ve “showed up at the ER.”  What’s the next step in their treatment plan?  These are questions that your peers, i.e. other conservatives in every other advanced country on earth, never think about.  Because they have accepted the premise that healthcare is not a commodity like a personal computer or a car.  If someone lacks the money for a car, or a more expensive car than they can afford, we say:  too bad, that’s the market system.  You get what you can pay for.  But we don’t do that with healthcare, do we?  If we really did that — if you all were really as rigorously libertarian as you claim to be — you wouldn’t even bother with the fig leaf of the ER coverage.  People who couldn’t afford care would just be left to die on the street — after all, if they can’t afford healthcare, tough luck.  Just as if they can’t afford to buy that car, or a house, or sofa, or a lamp.  We don’t say, “Just show up at Crate and Barrel — you’ll get an emergency sofa, if you’re just ‘dying’ to have one.”  Nor should we.  But, um, healthcare is different isn’t it?

Yes, you can’t quite bring yourselves to an entirely ruthless conclusion, can you?  You don’t have the guts, American conservatives!  Alas, you can’t bring yourselves to do what every other conservative in the Western world has done either — admit that your position is intellectually and morally incoherent and unsustainable.  No, healthcare is not like any other commodity in a capitalist economy. In fact, it’s not a commodity at all.  It’s why we call ourselves “patients” when we go to a doctor, not “customers.”  It’s why we keep those ER’s open — to salve our conscience, right, Mr. Smith?  Even if we all know that a visit to an ER is not remotely equivalent to the sustained medical attention that a cancer sufferer would need over the course of his or her illness.  Nor is it, ironically enough, like the sustained care that Stephen Hawking received from the socialists at the NHS.  And isn’t it odd, too, that we act as if people in these other countries we know well — entirely civilized, advanced countries like Canada, Denmark, the Netherlands, Germany, France, even the UK — are dropping dead on the streets of the cities and town as if from the Black Plague every day.  Oddly enough, many of us have been to these places, and this isn’t true — people receive excellent medical care at less cost than our system provides.  And most of those citizens are quite happy with their care.  But it’s like the old joke about the adulterous husband:  “Who are you going to believe, me or your lyin’ eyes?”

So, finally, conservatives, ask yourselves this:  If you can so blithely assume that “show up at an emergency room” is the equal of universal care, would you willingly give up the health insurance that currently covers yourself and perhaps your family?  After all, you, too, could “show up at the emergency room.”  What’s the difference, no?  Six of one, half a dozen of the other?  No reason that wouldn’t be good enough for your spouses and your kids either, I would think.  I would feel stronger about the efficacy of the ER model of U.S. universal healthcare (which, as David Frum has pointed out, is actually the most expensive way of covering the uninsured — but since when should conservatives care about cost?) if the courageous writers on this site advocating it on behalf of their fellow citizens would be willing for themselves and loved ones to undertake it, too.  What, no takers?  I didn’t think so.

American conservatives write often about patriotism and love of nation.  I wonder:  Do they ever feel even a tiny bit of shame, maybe at least the blush of embarrassment, when reading that our country lacks the minimum level of social decency promulgated by every one of its peer nations — and that we stand at the bottom in this category with the likes of Mexico (a nation Americans frequently mock) and Turkey?  That even a dictatorship like Singapore provides universal care?  That our great free market ally, Taiwan, does so, too?  That this is just something that nations across the world, and conservatives, liberals and social democrats simply agree is a benchmark of modernity and civilization, no more controversial, but every bit as essential as the traffic light. Can data like this ever be something to feel proud about, about which to love a nation that much more:  “Unlike all but two of the other 30 richest nations on earth, we, the richest and most powerful of all, the one with the most advanced universities and science, only insure 85% of our people.  If a poor person–or a feckless, seemingly healthy young person–suddenly contracts cancer or ALS, they will receive emergency care–but no follow up treatment.  This is what makes America great.”

If American conservatives were to start with the same predicate that their conservative colleagues abroad do, i.e. universal health insurance coverage is both an uncontroversial and indispensably humane prerequisite of an advanced, wealthy nation — then every other part of the healthcare system would be open to debate between right and the left:  delivery systems, overall cost, public versus private mechanisms of insurance dispensation.  Indeed, Germany, the Netherlands and Switzerland are all examples of nations which provide high quality universal coverage through private insurance markets (non-profit, mostly, in the case of the Swiss).  All of these issues and more are ones that people of good faith and good will can disagree about.

But if American conservatives continue to oppose universal health insurance coverage, they will remain the outliers of the civilized world.  What your position can only be reduced to—once the nonsense about the ER being consonant with real insurance is laughed out of the discussion—is:  I’ve got mine, Jack.  You can dress it up anyway you like, but that’s what it comes down to.  And when the leader of the oldest conservative party in Europe declares his party to be “the party of the NHS” (and, yes, leave aside that nobody is proposing anything like the NHS in the U.S., nor will anybody), you can be reasonably assured that not only do no conservatives anywhere outside this country agree with you, but that everybody sees through you, too.

But, hey, any of you who want to switch to that “ER universal coverage” plan are free to write to your insurer and terminate your coverage.

Bueller?  Anyone?

To read other contributions to this symposium, click here.