Why Doesn't America Have Universal Comprehensive Health Care?

Of all the major industrialized nations, the United States of America is the only one whose citizens do not enjoy the benefits and security of a universal comprehensive health care system. Why is this so? The shortest answer is contained in the words "class warfare." But the next-to-the-short answer is, "Because powerful, selfish, private economic and professional interests have so far blocked the enactment of such a program.' The longer answer is, "Because such powerful interests operate in a society and political system in which their money is the overwhelming force that determines who gets nominated and elected; in which those interests own the mass media and therefore control the issues and emphasis on the public agenda in which organized labor has been beaten down; and in which the electorate is constantly indoctrinated with anti-government and 'anti-socialist' propaganda."

That substantially answers the question although there are a few other historical and sectional factors, along with powerful ethnic and racial prejudices, that could be added to this noxious mix. We Americans must always remember that, as the poet Robert Frost wrote, "America is a Funny (Peculiar) Place." (Actually, it's "America Is Hard To See." Same thing. Worth looking up)

But, even so, is it perhaps true that the United States still has the best health care system in the world? Oops! Wrong question. Because the answer is, "NO!" Of the top twenty four industrialized (modern) nations, the U. S. ranks twenty-first in infant mortality and sixteenth in life expectancy. Yet we spend more than 40 percent more per capita on health care than any other nation. And over 40 million Americans today are without any health care insurance, which means, of course, that many of our fellow citizens go without routine health care and so must frequent emergency rooms to obtain any help, a treatment which is much more costly than it would otherwise be. Irrational system, unfair system; no good reason for such a system.

Moreover, a poll of the people in the top ten industrialized countries shows that Americans are the least satisfied with their system, that Canadians are the most satisfied, and that all of those other more satisfied peoples enjoy either socialized medicine or national health insurance.

Note: In "socialized medicine," as in Sweden and Great Britain, doctors are salaried civil servants and the government itself (that is, the citizenry) owns and operates most of the hospitals, with some others being run by non-profit organizations. With a "single-payer," or national health insurance plan, doctors are in private practice and most hospitals are not government owned and operated. Doctors and hospitals, as well as pharmaceutical and medical device companies, must negotiate their fees and charges with the government agency in charge of financing the plan and articulating its organization. In regard to the costs of drugs especially, this centralization is one of the reasons health care costs are lower in single-payer systems, and it also explains why drug companies fight so hard against any single-payer plans.

In both socialized medicine and national health insurance plans, cost-control mechanisms have been effective in restraining inflationary pressures while providing universal, comprehensive care. Another major difference between such systems and the American way is the absence of any health insurance companies, of which America has over fifteen hundred, all with different types of coverage, rules, regulations and bureaucracies, and all of which are primarily concerned with boosting their profits: shareholder and CEO interests are considered more important than patients' needs.

At least since the 1940's, massive majorities of the American people (70 to 75%) have voiced their support for a universal health care system, even at the cost of an increase in taxation. It is sadly true that in our form of "democracy," this cannot be translated into a legislative reform. Nothing exceptional here: the vast majority of Americans favor a reduction in the Pentagon budget. What we get are increases that even the Pentagon says are unnecessary. This "disconnect" between expressions of popular aspirations and the public policies adopted by both major parties is so commonplace that, as William Greider points out, it now seems "normal" to almost everyone. Some democracy.

The problem, then, is not one concerning the desirability, the efficiency, the economic rationality, or the affordability of a universal health program. The problem is political, ideological, and social. Looking at such important issues as the comparative costs, the coverage (universal versus partial), the efficiencies, the morality of the matter, and the preservation of the patient's choice of doctors, it is clear that a single-payer national health insurance plan (whether "socialized medicine" or not) is the most rational and equitable way to provide all Americans with this essential service, as a right and not a privilege.

Which brings us back to our original question: why doesn't America have such a rational and equitable system? It is not for lack of effort. But each time the reform was attempted, powerful forces managed to block or pervert the good intentions, to the extent that one historian labels the whole process "an exercise in failed reform." Early in this century, for example, some units of the American Medical Association looked favorably upon the idea of a national health insurance plan. After all, the conservative authoritarian, Bismarck, introduced such a plan in Germany so it could not be considered "socialistic." (Note: this benign view of Bismarck changed after 1917 and soon his plan was being labeled by the medical profession as an aspect of the German attempt at world domination.)

Such a national insurance plan posed no threat to professional medicine as it was then organized. But the AMA itself, along with other economic entities, including powerful corporations and some labor unions for their own reasons either blocked any reform or simply did not push for it in the first place. Of course, after the "Bolshevik Revolution," and throughout during the "Red Scare" of the 1920's, practically any attempt at the meaningful reform of any American institution could be tarred with the "communist" brush and effectively squelched.

Even after the onset of the Great Depression and the inauguration of the "New Deal," health care took a back seat as reformers struggled against the problems of massive unemployment and extreme poverty, especially as it affected the elderly. Although a majority of Americans still supported the idea of a collective instead of an individual approach to health care, unemployment insurance and Social Security were the main concerns of the reformers. Before his death in 1945, Franklin Roosevelt came out in favor of universal health care and in November, 1945, Harry Truman asked the Congress to enact a national insurance program "to assure the right to adequate medical care and protection from the economic fears of sickness."

Sadly, Truman's plan was resisted by the AMA. Predictably, it was fought tooth and nail by the pharmaceutical industry. Pathologically, the corporate media and conservative politicians, mainly Republican but joined by Southern Democrats, denounced the plan as "socialistic." When Republicans took over Congress in 1946 it meant that national health insurance was once again declared dead. Since then, America has only been able to obtain the enactment of the Medicare/Medicaid programs, which only passed because they were richly sweetened with plums to the medical profession and the promise of huge guaranteed bounties to the pharmaceutical industry.

The Clinton health plan debacle of 1994, a Titanic that never even made it off the drawing board, is the most recent essay in futility. It was destined to fail because Clinton did not even consider confronting the forces opposed to any reasonable, equatable reform: the insurance industry the hospital industry, organized medicine, the medical devices industry, and the pharmaceutical industry.

There is an economic message here obviously, economic self-interest impels these groups. But here is a "class" factor that is even stronger: American corporations would immediately benefit by having the costs of their health care taken off the corporate books and "socialized" in a universal plan. However, the bosses would lose a powerful weapon of control over their workers if such a plan were enacted. As it is, workers have much to fear when they lose their jobs: they lose their health care coverage as well. And as it is, the bosses can hold down wages by threatening to reduce health care benefits. Actually, over the past two decades, the bosses have been doing both - cutting wages and reducing benefits - but working people in general and even "organized labor" are much too weak to do much about it all.

Unless and until Americans perceive the reasons for their comparative economic disadvantages: namely, two decades of class warfare legislation that benefited the rich and the corporations, two decades of class biased policies, in which the rich were taxed less and the workers taxed more, two decades of laws that penalized labor and rewarded capital, but during which time eight trillion dollars in stock equity alone has accreted to the top 10% of our income groups; and, unless and until Americans inform themselves of their true conditions and possibilities, we shall continue to be the only advanced industrialized nation whose citizens do not enjoy the benefits and security of a national health care system.

Then again, our present system is so unfair, so irrational, so replete with injustice, pain, and unnecessary morbidity and mortality, it may by itself bring enough Americans to their senses - at which point they will respond to the question, "Is this as good as it gets?" with a resounding "NO!" ... and then get busy and change it into something worthy of a free people.

Two-immediate steps interested readers can take: join with the Physicians for a National Health Program, 332 S. Michigan Ave., Suite 500, Chicago, IL 60604; (312) 554-0382; and get involved locally with Oregon's "SPARC' - the "Single-Payer Action Reform Committee." (in Ashland, call 541-482-6543). SPARC is working now to place an initiative on the Oregon ballot in the year 2000 calling for an Oregon single-payer health care plan. Similar groups are working toward the same end in California, Washington, and Alaska.

Disclosure: I am a member of both PNHP and SPARC.

Gerry Cavanaugh, a resident of Ashland, Oregon, is a retired professor of history and social theory. His life experiences and observations along with his professional studies have led him to conclude that only by subordinating corporate economic power to the civil libertarian democratic society can citizens insure equality and social justice.

This article appeared in the "Ashland Sentient Times", Ashland Oregon, in February 1999 and is used with the permission of the author. It comes to us by way of James Ramsell's single-payer mailing list.