It is not a conversation about numbers, it's one about values
Something has to change. Despite claiming to be the best country in the world, the United States does a shameful job of supporting its citizens. From education to health, our systems fail when compared to other similarly rich countries. The average life expectancy in the US is two years below the OECD average. Compared to the same countries, our obesity rate is more than twice than average. And despite its poor performance, the U.S is spending $9,892 per capita on health. That’s more than any other country, and twice the average among similar-sized economies.
To make matters more concerning, many health issues within the US are worsening while the global trend is improving. This indicates very clearly that there is something gravely wrong with the way we address health in this country. In recent years, cardiovascular deaths, mental distress, premature death and maternal mortality have increased. No other country has ever experienced this kind of backward movement.
Many Americans insist on their country’s exceptionalism; yet in measures that matter, we are far from exceptional. The US ranks 24th in achieving UN-established health goals. The countries that perform better than us include wealthier regions like Western Europe and Nordic socialist states; but we continuously also fall behind countries like Cuba, Singapore, Israel, Cyprus and Slovenia among others that have significantly fewer resources. We often even rank in the thirties for some health indicators.
Our health-care system itself contributes to this far-from-ideal picture. 28.5 million Americans are currently uninsured, even after the implementation of Obamacare. Of those uninsured people, 7.8 percent are children in poverty. These discouraging statistics only represent averages- it is even more troubling when one begins to approach the issue from a standpoint of equity.
The U.S. has the worst income, wealth and health inequity in the world. It’s visible in every aspect of American life and in every department of the federal government. For example, black women are two times more likely to die prematurely than white women, and black babies are four times more likely to die than their white counterparts. Differences in health outcomes are apparent across racial, residential, income and education groups. If we want to be what we claim we are, these inequities must be fixed.
So where do we go from here? Who’s at the top of those rankings and what are they doing right that we’re missing? Across the board, countries that mirror more socialist systems perform the highest on health indicators. Nordic countries like Denmark, Finland and Sweden also have the highest levels of happiness, which confirms hypotheses that population mental health is closely tied with traditional physical health indicators. These countries emphasize primary interventions and preventative measures with high taxation rates. While these countries are considered ethnically homogenous, which putatively makes it easier to develop social programs, the health of their populations are improving with increasing heterogeneity. So there is something that they are just doing better than us. They have developed systems that are more efficient with lower costs that encourage cooperation among providers. This type of system is strongest in the ways in which the U.S system is the weakest. Achieving universal health care does not even require the resources of a large country. As stated by the NEJM, “although Cuba has limited economic resources, its health-care system has solved some problems that ours has not yet managed to address”, particularly interventions focusing on population-level health. Their infant mortality is falling, unlike ours. They have the highest rates of vaccination in the world. While the Cuban system is not designed for consumer choices, lessons can be learned and applied from their across-the-board success.
Realistically, we can create a system within a democratic, capitalist society that supports universal health care. To accomplish this, we need to make changes to budget allocations. The U.S spend $623 billion on the military, equaling the amount of the next seven largest military budgets combined. Instead of spending excessive amounts of money on the military, we should invest in the quality of our citizens’ lives. And instead of investing in high-tech solutions that have been shown to reap few results, we must increase investment in preventative treatments. After all, we know that 80% of the increase in life expectancy over the past few centuries can be attributed to public health solutions like social programs, not medicine.
Economists, like Anamaria Lopez, Anders Fremstad and Dean Baker, agree that a more universal healthcare system is “the sustainable option”, stating that “humans require consistent, preventative health care and for-profit insurance isn’t designed to provide it”. Additionally, these economists add that adverse selection, the tendency of more high-risk individuals to purchase insurance than those that are healthy, is currently working against us when, in a new system, it would benefit us entirely. It is healthy for an insurance system to include as many young people as possible because they are less likely to require insurance in the near future. Including populations that are healthy in the mix of insurance pools, in ways that single-payer systems support, creates a larger pool with a smaller percentage of people needing to take from that pool in a given moment. It’s healthier for our economy and for our healthcare system.
There are plenty of Americans that support this kind of movement. In fact, a universal healthcare bill was introduced recently by 17 Senators. They collectively asserted that “the fear of losing the small benefits we currently enjoy is prohibiting us from enjoying far greater ones at half the cost” and that “those who deny the plausibility of a universal healthcare system are inevitably the same people who stand to benefit most from our current system”. Many conservatives believe that what we are talking about is socialism. However, research has shown that 92% of Americans believe that an ideal distribution of our national income has a slope significantly more equal than the distribution that exists in reality. The slope identified by the large majority would mean the lowest income quartile would live above the poverty line, that health would be achievable for all, and that there would still be plenty of the incomes disparities that encourage people to work hard and boost the economy. So why is it that Americans citizens (theoretically) support a more equitable, healthier society but lawmakers are unwilling to support policies that would lead us there?
I’m certain that the richest country in the world can manage the demands of a universal health system. As Atul Gawande says, “the debate surrounding universal healthcare is fundamentally about values, and we’re still having a serious, many-decades-long debate about whether people deserve a right to healthcare”. It is not a debate about whether we can afford a universal system; other countries have done it with far fewer resources. It is a conversation about values. The U.S remains one of the only countries that has not ratified literature identifying health as a human right. It is clear that “American values” are heavily tied up in separating those that are believed to be deserving and those that are not.
I argue that what’s keeping us from creating more successful policies are those sticky “American values”. From the time that we first start school, we are shown examples of the fruits of American labor and made to understand American exceptionalism. We are not often shown the ways in which we’ve failed or even committed unimaginable human rights violations. By a young age, most of us assert that the U.S is the best at everything. As we get older that same ideology morphs into a stubborn belief that we should not try to mirror the successes of any other country because that would be admitting that they’ve been doing it better, that we are not the best. Yet in any other field, any successful person would assert that we learn from those that are doing better than we are. Many American children are socialized to become people who scoff at socialist societies, or even just more equal societies, claiming that we’ve always got it better. The reality is that most high-income countries have been doing it better than us all along; that across the board, we fail to provide the opportunities and resources to our citizens that create and maintain a healthy, productive and happy society.
You’ve probably heard the phrase “pull yourself up by your bootstraps”. It’s a very common and very American phrase, used to encourage people to take control of their own lives and work hard. It implies that hard work will lead to success and happiness, but we know that this is far from the truth. We known that the sentiment only applies to the top of the social hierarchy who are granted the privilege of control over their futures. It is a privileged person who can honestly say that anything is possible with hard work and that the American Dream is entirely attainable. Claiming that everyone has total control over their life, implies that those who have not succeeded historically have not done so due to inherent inferiority, as opposed to the cumulative effect of discriminatory systems. If we begin to recognize the realities of our collective beliefs, created over time, we can create systems that are more equitable and more efficient.
Ideals of American exceptionalism, personal responsibility and individual prosperity, which only exist for those at the top of the social hierarchy, are what convolude the conversation and distract from actual problem-solving. We are so attached to the idea that America is perfect that we are unable to see the ways in which we can improve. Universal health care would benefit most the poor and the middle class, which is comprised of any and every racial group. This system would decrease health, income, racial and social disparities at all levels. We have the power to improve this country in a very real way and start moving towards a healthier and happier future as a society if we can begin to confront the realities of our uniquely American beliefs.