Stop Playing Politics – Provide Americans Universal Health Care – Part 1

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Although Republicans in Congress push to cut President Biden’s proposed budget significantly, they will not touch the military, but they threatened to cut the health budget. The nation’s health system is too expensive and impacts our federal budget, but it also doesn’t serve the public’s health needs.

The military and Medicare budgets combined evenly account for about 40% of the federal budget. The health budget includes Medicare for all seniors and CHIP and Medicaid programs that pay health care costs for those who meet low-income guidelines.

President Biden, in his recent State of the Union address, warned Americans that the Republicans were coming for their Medicare.  Overnight, Republican Minority Senate Leader Mitch McConnell publicly rejected Sen. Rick Scott’s (R) campaign manifesto to sunset all federal programs, including Medicare. 

McConnell must have read the recent survey by AP Votecast showing that the only group voting Republican by a majority in November’s national elections were those 65 and older.

Despite the recent Republican retreat from a conversation about cutting Medicare, maintaining Biden’s proposed healthcare budget will neither balance the budget nor fix our healthcare apparatus.  

Providing everyone with decent, affordable health care will be unattainable unless we adopt Universal Health Care (UHC). The alternative will be to leave almost 30 million Americans uninsured, according to the Peter G. Peterson Foundation.

Universal Health Care does not necessarily cover all ailments for all people. But it does mean that all people have access to healthcare when and where needed, without financial hardship.

President Lyndon Baines Johnson took the first step toward achieving that goal in 1965 when he persuaded Congress to enact government health insurance for senior citizens. Unfortunately, it took 20 years to accomplish this after President Harry Truman proposed UHC.

President Barak Obama took the next significant historic step 45 years later when he got Congress to pass the comprehensive healthcare reform law Affordable Care Act (ACA) in 2010. Up to then, the total number of uninsured averaged 15 percent. 

Since 2014, when the ACA was amended, 39 states have chosen to expand Medicaid eligibility and establish health insurance marketplaces through ACA. As a result, the uninsured rate has fallen to around 10 percent. Still, in 2021 64% of uninsured adults said they were uninsured because the cost of coverage was too high.

And uninsured rates are not spread evenly across demographic groups. For example, the uninsured rate is 5.7% for White, while the largest minority group, Hispanic or Latino, has an uninsured rate of 17.7%. In addition, youth, those under 35 years old, which make up 59% of our population, have the highest rate of being uninsured. 

Because of not having insurance, or inadequate insurance, a 2019 Gallup poll found that 25% of U.S. adults said they or a family member had delayed treatment for a severe medical condition because of cost. Sixty percent of personal bankruptcies are caused by medical bills, with most of those people being underinsured.  

Most significantly, the lack of health insurance is associated with about 45,000 excess preventable deaths per year, according to a study conducted by the American Journal of Public Health in 2009.

Conservatives argue that making our economy even more free market can provide the best health coverage due to competition and keep our budget balanced.

However, the conservative Fraser Institute’s Freedom Economic ranked countries New Zealand, Australia, and Denmark as having a friendlier capitalist economy than the US, and they provide better health care according to the 2021 CEOWorld Magazine‘s Health Care Index. They also spend half of the $12,318 we spend per capita on health care. Our per capita cost is by far the highest in the world. And that cost is a burden to both individuals and the government. 

The non-partisan CEOWorld Magazine’s 2021 Health Care Index provides one of the most respected rankings of nations by how well they provide health care to their citizens.

They use “a statistical analysis of the overall quality of the health care system, including health care infrastructure; health care professionals competencies; cost (USD per capita); quality medicine availability, and government readiness.” The US placed 30, right behind Mexico but one notch above Lithuania. We should at least be in the top ten. 

Despite Medicare and ACA, the US is still the only developed nation without a functioning universal healthcare network. As a result, millions of Americans go without health coverage in the wealthiest nation in the world as measured by our GDP.

Our economy is larger than the combined total of the next eight largest national economies, exempting China. It is not for the lack of money that we have a poor health system. The reason is that politicians from both the left and the right have resisted a universal health system that shares health care costs between government and private entities. 

Democrats and liberals have pushed for universal health care, with government funding going back to FDR. Except for Teddy Roosevelt, all subsequent Republican presidents have adhered to a free-market health system as a better alternative.

However, the Republican position since Ronald Reagan has turned beyond debating the merits of how to provide a national health plan to actively overturning any programs deemed “socialist” that provide broader health care facilitated through governments. Instead, a free-market ideology and a private-profit-driven health delivery system shape that position.

President Donald Trump was the latest example of this trend when he tweeted that Republicans would seek to replace the ACA after the 2020 election. When that attempt failed, they passed the Tax Cuts and Jobs Act of 2017 which eliminated the ACA requirement that people maintain health insurance or pay the penalty. 

Requiring everyone to have health insurance is often used by countries to sustain an efficient risk distribution among participating public and private insurance providers. Without everyone being insured, healthier people will be picked up by private companies leaving the sick to be covered by the public health care plans. 

Republicans and other critics of ACA expected the change to cause the ACA insurance network to collapse financially. American University Professor Aparna Soni analyzed the impact of this change with that possibility in mind.

Soni Used data from the 2015–19 Census Annual Population Survey to compare pre-and post-repeal insurance levels in states that did and did not impose a state mandate in 2019. She found a 24% increase in the likelihood of becoming newly uninsured in states with no federal or state mandate. In other words, the free market did not meet the health needs of those unable to afford insurance through private providers. 

Conservatives argued that ACA would hurt the economy and, by extension, contribute to budget deficits. However, ACA reduced payments to hospitals under Medicare and Medicare Advantage plans, which lowered the expected growth of Medicare expenditures by 20 percent.

Overall, Medicare spending fell from 2010 to 2018. Meanwhile, the annual increase in national per capita healthcare cost was modest by historical standards creating no attributable spike in the nation’s budget deficit.  

America has the least effective and most costly health system of any economically developed nation because our politics are driven by a culture where citizens fear losing the freedom to select a health care provider of their choice. That belief reflects our country’s legacy of being founded on the principle of protecting personal freedoms. It is sustained by a profit-oriented market that promotes the acquisition of certain commodities and services as safeguarding personal freedoms. 

Consequently, the health industry relies on keeping government regulation of health care to a minimum so that their products and services do not have to compete with cheaper and possibly better options. Republicans fanned the fear of big government controlling our health choices by describing ACA as an attack on our freedom.

Since ACA was signed into law in 2010, Newsweek found at least 70 Republican-led attempts to repeal, modify, or curb the Affordable Care Act. Immediately preceding the 2014 midterm elections, the Kaiser Family Foundation’s found that 84% of Republican-affiliated healthcare ads attacked the ACA. The Democrats, meanwhile, barely mentioned it, with only 11 percent of Democrat-affiliated ads promoting it. 

The barrage of Republican attacks resulted in unfavorable polling toward ACA, reaching its historic high of 53% for one month in 2014. Overall, polling has shown that the country has been evenly divided over accepting ACA, with the unfavorable opinion slightly in the majority until Donald Trump’s first year in office. Once he took office with his MAGA agenda, polls never showed opposition greater than support. Support for ACA reached a historic high of 58% in 2022.

Republicans noted that significant change in public attitude, and they started walking back their previous criticisms. In the new House Republican one-page “Commitment to America” blueprint for their policy objectives, there is no mention of ACA. It is no longer portrayed as the cause of our budget deficit. 

Republicans failed to eliminate ACA and never revealed the health plan they promised to have as an alternative. However, progressive Democrats failed to secure a single-payer system for health care to replace ACA. Sen. Bernie Sanders, one of the progressives’ primary advocates, refused to support expanding ACA. Instead, he pushed for the government being the “single payer” for virtually all health care services.

Public opinion did not embrace either path toward establishing a national plan for health care. Americans may adopt a system that citizens in other developed democratic republics have chosen, one that mixes public and private financial and delivery systems to achieve universal health care. 

What has been missing from the debate between liberals and conservatives is an understanding that universal health coverage is not what either side describes. Citizens living in countries with UHC are neither in prison nor in a utopia. There are wide varieties of it, but all result in a healthier population than ours.

Viewing the differences among the countries with universal health coverage reveals that private insurance may not disappear. Often government works with private companies.

Whether the delivery is through the government or private companies, the bottom line is that no one is left without the affordable health coverage needed to live a healthy life.

Without understanding how comparable countries implement Universal Health Coverage, we will continue to blame the other political party for a health system ranked below a score of far less wealthy nations. 

Citizen Politics will explore how implementing the UHC practices from other countries can provide more equitable, affordable health coverage for Americans.

Nick Licata is the author ofBecoming A Citizen ActivistandStudent Power, Democracy and Revolution in the Sixties. He is the founding board chair of Local Progress, a national network of over 1,300 progressive municipal officials.

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