Why don’t some Americans want a universal healthcare system?
Fear, ideology, and Stockholm syndrome
I recently published a post, “Universal healthcare means freedom, not slavery.” The subtitle was a greater part of my point: “In a free society, healthcare is a right, not a privilege.” The article was meant to counter an argument that has grown in the right-wing discourse: that healthcare cannot be a “right,” because that implies the public is “entitled” to the labor of health care workers. I also countered some other arguments, for example, that universal healthcare is “not affordable,” that it’s not politically possible, that what we really need in healthcare is to “free the market” and “increase competition,” and that countries with universal healthcare experience “longer wait times.”
First, the good news. My post was well-received by the majority of readers. Four weeks later, the post rests at 1,600 “claps” by ~200 unique accounts. The post has received 62 comments, with at least half of them positive and in strong agreement.
In the comments, readers shared their knowledge and experience with the US healthcare system, and other healthcare systems, often agreeing that universal healthcare is by far the preferable system, and the US system is barbaric in comparison. The evidence is clear, by looking at systems around the world, that universal healthcare systems are better economically — they treat more while costing less — and they are better ethically — they cover everyone, no matter anyone’s immediate financial situation.
It is also true that one-third of US citizens owe debt collectors for medical bills; millions of residents go bankrupt in the US, every year, over medical expenses (which are the number one cause of US bankruptcy); tens of millions are uninsured, and many more under-insured (which means these people can’t get healthcare, and yes, that is worse than if they had to “wait in a line”); and finally, 45,000 die per year in the US due to lack of health insurance. These are not problems in countries with universal healthcare systems.
Partly because of these facts, it makes sense that a majority of readers would have liked my last post. Polls have shown again and again that most Americans want a universal healthcare system, and this is despite all the propaganda pushed on Americans — day after day — by the corporate media, pharmaceutical and insurance industries, and the right-wing politicians who are paid by the former to lie in their defense. Yet, still, a majority of this country believes in adopting a universal healthcare system.
Now, for the bad news. While the United States is supposedly a democracy, it is not actually. To create and maintain a “Medicare for All” universal healthcare system in the United States, we are going to have to fight and defeat some comparatively small, but extremely powerful forces — in government, in the industry, and in the media. This will require us to build even more support than we currently have.
We do have a majority of support, but it is a slim majority. And our government, especially the one we have right now, hardly gives a damn what the majority wants or doesn’t want. They care much more about appeasing their campaign donors than the American people.
Still, much of the rest of the US population can be swayed to our cause. And political and corporate corruption can be overcome. This is what will be required to implement a universal healthcare system.
But aside from the industry, and the politicians, we are fighting to sway our fellow citizens over to what we believe is a better alternative — for all of us. And in that regard, here is what we’re fighting against.
Fear of change is often a normal thing. Transitioning to a new system from our current system — which is based around the health insurance industry, and has been for as long as we’ve known — brings along with it a major unknown. Especially to those who have decent or good health insurance, right now — and may be fine with their current medical care — a transition to a “new” system has potential to cause a lot of fear and anxiety.
Am I going to lose my insurance in the transition? (No, by the way.) Will I no longer be able to “choose” which doctor I go to? (False.) Am I going to have to wait in long lines for care, like the TV news and Republican politicians claim? (*And it’s not just the Republicans who claim this; Democratic politicians can also be found making this claim. But it is mainly Republicans who use this line, and medical officials and patients in other countries often tell us that this is untrue, and these politicians are deliberately bullshitting.)
Is my health care going to be “rationed,” like it supposedly is in other countries with universal healthcare systems? (Again, like they repeat on the news and in the halls of Congress?) (See again: Republicans who are paid to lie their asses off.)
The ultimate fear may actually stem from a fear of “government” in general. Trust in government is low —the lowest in modern US history — and Republicans stoke fear that a “government takeover” of health care implies that our healthcare system will simply become as bad as the US “government” has become. In other words, universal healthcare will be as atrocious as US Congress, where members of Congress tell their hollow lies to defend the existing industry.
I understand the fears, but they are misplaced. Learning the truth can ease these fears. Having genuine conversations with people who are simply scared of system change can increase the likelihood that they will no longer be scared. Maybe they will even embrace a system change. So, here’s some truth about what US single-payer activists (and a few courageous politicians) are fighting for.
- Medicare for All, which is the universal system being proposed in the United States, is not a “government takeover” of healthcare. It is not a “nationalization” of the healthcare system. (In the UK, one poll shows that their nationalized healthcare system is their “greatest source of pride”— but we’ll gloss over that for now.) Rather, MFA would be like the Canadian system. (The Canadians have a similar story: they voted for Tommy Douglas, the man who introduced universal healthcare, as “The Greatest Canadian.”) Under this kind of system, private clinics still exist. The healthcare system of doctors, nurses, hospitals, and medicine is not run by the government. It is simply funded through government, and guaranteed to residents through legislation — rather than our money being routed first through the “middle men” of private insurers (who are first and foremost concerned with profit, not health). Decisions on who gets treated, and how they get treated, will be made less by private insurance, and more by the scientific community, the medical community, and the patient.
- Under Medicare for All, the vast majority of the population will pay less than they are paying now for healthcare. As evidenced by every single country around the world that has the same or similar systems, a universal healthcare system will cost less than what current US citizens are paying through private insurance. By cutting out administrative waste — and eliminating the profit motive of individual insurance companies (who can raise premiums for a variety of their own reasons), and regulating the pharmaceutical industry (who have near-free reign to charge whatever they want for drugs, and thus, charge way above their actual cost), we save massive amounts of money by paying much closer to the actual cost of care.
- Everyone will be covered, no questions asked. If you lose your job, or want to change jobs — you will still have healthcare. And so will your family. Employers will no longer be required to shop and maintain health insurance plans for their employees. Everyone in the work world — that is most of us, including both employees and employers — wins on this arrangement.
- We will experience less stress and doubt about when to seek medical care. It is a well-known phenomenon in the United States for people to wait too long to go to the doctor, because they can’t afford co-pays, haven’t reached their deductible, or simply can’t pay the inflated cost of other procedures that are not covered by insurance. Then, these people who defer doctors’ visits, and pass on paying for medicine, get sicker — often reaching a terminal stage of disease that could have been prevented — or, then require more expensive and longer duration of treatment to get better again. (Which is another reason US healthcare costs are higher.) It simply costs more to treat sicker people for a longer duration, and we have a lot more people in this category due to the nature of our system that rests on the “good will” of private insurance.
- Low or no co-payments— this is, again, one part of how we pay less in a single-payer system. Bernie Sanders’ recently introduced bill includes a provision for no co-payments. This would make it free, on most occasions, for patients at point of service, encouraging us not to wait to go to the doctor until it’s too late. But it’s also a matter of plain convenience. Just go to the doctor; you don’t have to pay every time you’re going in or out. If it sounds too good to be true, they already do this in many other countries, and these countries are not as wealthy as ours.
It is true that not “everything” will be covered under a universal healthcare system. This is true in every country. There is still a limited amount of resources and healthcare personnel to go around. But let’s compare this universal system to the current US system, which again, suffers from all the previously-mentioned issues that are ways of denying care: uninsurance, underinsurance, bankruptcy, high drug prices, high co-pays and deductibles, and unnecessary illness and death due to inability and ineligibility for treatment.
And anyone who says we don’t have to “wait” for doctor’s appointments in the United States — or for certain medical procedures — is either incredibly ignorant, or lying their asses off. It’s true: US healthcare is “rationed.” It is neither instant, nor unlimited, just like in all the other countries.
Now, let’s move on to another reason why a large minority of honest citizens in the US would still not like this idea of universal healthcare.
For some people, you can show all the evidence you want that something is better than another thing. You can even assuage their fears completely. And they still won’t believe you.
Some people are simply stuck on a big idea; it’s their ideology, and their understanding and even their character may rest on it.
In healthcare, the most prevalent thread of ideology arises directly out of US hyper-capitalism. It is the idea that “competition” and “the free market” are always the answer to improving both quality and quantity; and on the flip side, that “government intervention” is always bad.
“If only the US government de-regulated the healthcare industry even more — (even though the US healthcare system is already less “regulated” than most or all universal healthcare systems around the world) — THEN, and ONLY THEN, will we see better prices and better quality of care!
More people will be covered, because they’ll have more “choice” in the market! (If they aren’t covered, it’s their fault and they should give up everything they have and move where they live, or get a better job or something, or invent a novel company or device that will make them rich — then, they can afford healthcare!)
Ahh, the religion of the free market. Of course, if the free market dogma were true, it would seem to be universally true — across industry — and it would therefore also apply to the healthcare system.
Healthcare is not only an economic problem, it is also a moral problem and public health issue. Even if a universal system were more expensive, it would still be “right” to do it, if it were remotely possible. And yet, even when it comes to economics, the evidence is strongly against a “market” healthcare system.
The “free market” ideology was developed mainly by a handful of sociopathic assholes, like Milton Friedman and Ayn Rand — pushed by academics, some of their acolytes, like within the Chicago School of Economics — and fleshed out into something “smart” and appealing. And then, this ideology was sold to the public at large, by puppet politicians such as Reagan and Thatcher.
This all took place under the great satisfaction of super-rich folks, like the Koch brothers, who — since they foresaw a massive return in their efforts over the long haul — would spend a small fortune on funding the propogation of this ideology. The Koch brothers (and others like them) knew that the public would never accept the naked truth of their ideology, which is that it undermines democracy, creates a permanent underclass, and harms the majority. So, they would have to re-package their self-serving theory into arguments for “choice” and “freedom”.
This is the ideology still regurgitated by “free-market” advocates, including in the healthcare domain. [Strong reading recommendation: Misinforming the Majority: A Deliberate Strategy of Right-Wing Libertarians.]
Reality is breaking through the ideology, however. The truth is that it makes better economic and moral sense to do a universal system, than to “leave it to the market.” This “market” is comprised of people whose main driving motive is profit — and in healthcare, profit is accomplished by denying care whenever, and however, possible. As long as something maintains or grows profit, then raising prices, even to the point of inaccessibility for many “consumers” — is not only possible, but desirable.
The “market” does not “self-correct” here, because medicine and medical care are so necessary that there is no “alternative” for the “consumer” to threaten “going elsewhere” or “voting with their dollars.” Obviously, insurance and pharmaceutical profits are very high, with small threat to their profits even though costs are high.
Finally, the doctrine of “competition” — and that it can correct this problem — is a farce. What is rarely discussed in the conversation about “competitive markets” is that in a “competitive” economic system, the goal is to win — and the reality is that, eventually, there are winners. This “competitive” “free market” economic system inevitably leads to domination by an increasingly smaller amount of stakeholders. And guess what happens then?
The cycle starts all over again. When one company “wins” over the other, the “winner” gets a stronger hold on the market. “Competitive” capitalism ultimately leads to many or most firms succumbing to the “stronger” or more “successful” firms, and then, the barriers to entry into the market (entrepreneurship) become extremely difficult or impossible.
The “stronger,” remaining few corporations and wealthy individuals, like it that way. And they want to keep it that way — because then, they keep winning. When they win, they make more money.
Saying that we need a more “competitive” healthcare market simply is saying that the government must step in to break up the biggest companies — that the resources should be re-distributed, and the marketplace should somehow be “reset” — and then we start all over again, until the market is dominated and monopolized once again. We “compete” again, until someone wins again, then the mergers happen and we get to where we are today.
“Increasing competition” is a bad solution, in other words, to the very problem competition created in the first place. And this is why “corporatism” is not different from capitalism, but, a stage of capitalism. (But I digress…)
Finally, if the counter-argument is not a matter of free-market ideology, there is the desperate turn to semantics. Healthcare cannot be a “right,” because that requires others’ labor. Even if well-meaning, and even though it is an argument often made in the name of “liberty,” it is ultimately a deflection from the real issues of our healthcare system — and whether an alternative would be better.
I addressed this point in my previous piece. The naysayers in the comment section did their best to miss my point. The point, and reality, of a universal healthcare system, is that we would simply pay less — through public funding mechanisms, rather than private insurance premiums — for everyone to have ensured coverage. Under Medicare for All, no healthcare workers are forced to become healthcare workers, and no healthcare workers will be forced to stay healthcare workers. When it comes to universal healthcare, whether it’s called a “right,” an “entitlement,” or “public funding of healthcare that strengthens the risk pool and allows for cheaper and better access to all residents” — is simply a semantic argument. If you don’t want to call it a right, fine — and maybe you’d even be technically correct. But at least know about the alternative that you are denying while getting hung up on the choice of one word for this better system.
The overarching point, regarding ideology, is this. Some highly “ideological” folks can be convinced; some may never be. But on this issue, they’re wrong, and we don’t need them to advance our cause. We convince who we can — by being truthful and honest, and then we carry on with our work.
There is one final, related point I want to make about the single-payer naysayers.
It is again worth nothing that most people who read an article, and like it, never comment. So, the comment section is not an accurate representation of everyone’s opinion. With that said, about half the comments in my previous article were negative — and the ones that were negative, were often very, very negative.
Some of these negative comments could be perceived, without much stretching, as threats to my person. From “If you don’t like it here, then get out,” to “If you like socialism so much, move to Venezuela or Russia,” all the way to “I have lots of guns, so don’t come near my residence.”
It’s strange, though, because I’m on the side of healthcare for all, and I know that we could have it, with everyone also having to pay less for it.
It’s strange… because of the current conditions in the United States. I’m willing to bet that many of these people who hate me for wanting universal healthcare are not even living in great conditions — with regard to healthcare, or otherwise — and some of these people may be scared, or ideological — but even these two factors cannot explain everything. All I can see that’s left is Stockholm syndrome.
Stockholm syndrome is “a condition that causes hostages to develop a psychological alliance with their captors as a survival strategy during captivity.”
Even despite how bad the US healthcare system is — even despite the mass inequality in the United States, and declining quality of life — even despite the rising unemployment — even despite the absurd working conditions, and lack of labor rights in the US — even despite the rising mortality rate, and declining life expectancy — even despite the outrageously priced prescription drug medications in the United States (far more expensive than in the rest of the world)—even despite all that is going badly in the United States (and there is a lot going badly right now) — there are still all these people who are willing to defend not only the US healthcare system, but the entire economic status quo.
It’s sad, and upsetting. My heart goes out to all captors of the private-insurance based US healthcare system; the oppressive US workplace; and ultimately, the uniquely US brand of hyper-capitalism, which still has so many in its cold grip.
Do you want healthcare for all, or not? Do you want it to cost less than what we’re currently paying? Do you want to take a small risk for a system change — a change that, according to the overwhelming majority of evidence, would be better for pretty much everyone?
When more of us are well, it creates a virtuous cycle. And when more of us are sick, more of us become prone to sickness — whether it’s physically, mentally, or otherwise. Antibiotic resistance has been on the rise, and has the potential to become a crisis of epidemic proportions. Degenerative disease and environmental pollution are causing more sickness and death than ever before. Mental health is also being neglected, and a greater social illness looms.
It would make a lot sense, and it would certainly seem wise, for everyone to have the healthcare they need. And we need to do this as soon as possible. No one is trying to trick you here. I am not trying to trick you. Bernie Sanders is not trying to trick you. The other countries who claim this is possible, and actually do it in reality, are not trying to trick you. We can all have healthcare. And we will pay less for it.
It’s not a zero-sum game. A better world is possible.
If you are not convinced, then please, at least try to entertain the possibility.
For those of us who are convinced — and able — we’ll have to work for it.
Don’t be discouraged when the opposition fights back. We are right. History will favor us. And when we do get universal healthcare in the United States — after first being so fought against, and demonized — we will be thanked for our efforts. It will become “obvious” that universal healthcare was the right idea all along. And the fear, the ideology, the Stockholm Syndrome will all fall away.
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