Making Healthcare Care

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The United States healthcare system doesn’t seem to care. Despite the passage of the Affordable Care Act, which granted subsidies to low income families in hopes of making access to healthcare universal, lack of healthcare coverage remains an overwhelming problem in the country. 29 million Americans are currently uninsured and in vulnerable positions, according to a Gallup Survey.

The poor condition of American healthcare is largely due to prohibitive insurance premiums, or the amount of money that individuals must pay to receive coverage from a certain insurance policy. These insurance companies are only motivated by profit and act as a barrier preventing millions from receiving treatment. Additionally, the efforts the Affordable Care Act made in benefiting Americans are currently being undercut by the Trump Administration, which has attempted to roll back the program and is expected to continue to do so in 2019, according to Vox.

These shortcomings are also intricately linked to racial and class-based divides. Although upper-class households are afforded the luxury of receiving quality healthcare, less affluent citizens, especially lower class people of color, are more likely to be pushed into tricky situations. Families that can’t afford medical insurance but choose to purchase it can be pushed toward bankruptcy due to high costs, thus exacerbating inequality. However, the households that choose to opt out of insurance altogether face a lack of vaccinations, therapy or other forms of treatment, such as disease or chronic illness symptoms. A study published in March of 2009 by the American Journal of Public Health found that lack of insurance results in 45,000 deaths on a yearly basis.

Professor of health policy and public health at the City University of New York School of Public Health at Hunter College David Himmelstein said that the rise of neoliberal economics has shaped the healthcare system in a negative way.

“The vast majority of new coverage under the Affordable Care Act was government funded but delivered through private insurers,” Himmelstein said. “That’s a classic neoliberal approach—government funds some sort of need but relies on the private sector to deliver it. That just doesn’t work with healthcare. Because the neoliberal market solutions demand that we try and run healthcare like a business, we incur not just inequalities in care that result from markets but also tremendous transaction costs.”

Lack of healthcare also endangers transgender people, as many are unable to undergo hormone replacement therapy or surgery, due to financial struggles, Julie Hollar, a Ph.D candidate at the City University of New York Graduate School, wrote to Fairness and Accuracy in Reporting. Without these resources, transgender people have to obtain money through illegal methods such as sex work or crime in order to receive these treatments, which are often medical requirements, according to a study conducted in 2010 by the Seattle Journal for Social Justice.

The current web of private and public control of healthcare has also resulted in the creation of “death gaps,” where families who earn just enough money to avoid needing subsidies under the Affordable Care Act are left without healthcare, despite needing financial assistance.

Himmelstein said that these problems are inevitable given the current structure of the American healthcare system.

“The healthcare isn’t just failing around the edges, but it’s failing in a way that is central to its operation,” Himmelstein said. “The only way to solve the financial problems of people who can’t afford care and of people who can’t hold down the costs of our system is a very fundamental change overall.”

One proposed solution to these problems is single-payer healthcare. As opposed to the current model of healthcare, where patients give premiums, or a payment to serve as income for insurance companies, in exchange for treatment, the federal government replaces insurance companies, and it uses taxes instead of premiums to sponsor medical providers under a single-payer system. Politicians such as Senator Bernie Sanders (I-VT) have publicly supported a healthcare expansion of this sort, and some politicians such as Governor Gavin Newsom have sought to create a statewide single-payer healthcare program in California.

Himmelstein said that such a national healthcare program would be effective.

“We ought to have what most other developed nations have: some sort of national health insurance where everyone is covered, people are guaranteed a reasonable living and hospitals are guaranteed reasonable operating costs,” Himmelstein said. “Canada is a reasonable example of a system that works well. Hospitals would get paid the way a police department or fire station is paid in the U.S.”

The efficacy of such a system has been recognized on a large scale. A 2012 study by the New England Journal of Medicine found that state-sponsored medical insurance played a substantial role in decreasing death from disease or infection in the states that had reformed their medical programs. Additionally, research scholar under Princeton University’s Program on Science and Global Security Laura Kahn wrote in The Bulletin that she has found that healthcare expansions will also prevent the outbreak of deadly viruses.

“America’s piecemeal healthcare and public health systems are inherently less able to handle [medical] crises,” Kahn wrote. “The Affordable Care Act helped fill in the gaps, but really, the only way to prepare for the eventuality of pandemics or bioterrorist attacks is with a single-payer government-run system that covers everyone.”

The main objections to single-payer healthcare are that the program would devastate the American economy, stifle medical innovation and increase the rate of unemployment. Another large criticism is that single-payer healthcare is politically infeasible, given that it was one of the most controversial issues in the 2018 midterm elections, according to Business Insider. These arguments, while they do have some credence, do not account for the full scope of the current state of America’s medical system.

Although single-payer healthcare may seemingly damage the economy since it requires an ambitious restructuring of American taxation policy, in reality, it would benefit the U.S. in numerous ways. According to Doctor of Medicine from University of Illinois at Chicago and Chair at the Physicians for a National Health Program Ed Weisbart in an article published under the American Medical Association Journal of Ethics, a national healthcare program would streamline the medical health system by creating one unified administration to monitor public programs, as opposed to the complex network of public and private systems that currently exists. A single-payer medical system would also allow for mass acquisition of drugs as opposed to smaller purchases from various companies, which reduces the cost of services.

Additionally, Himmelstein said that a single-payer system would slim the budget for healthcare, empowering other sectors of the economy.

“For most of the American industry, this would be a tremendous shot in the arm,” Himmelstein said. “At this point, there’s more money going into healthcare than steel for American automobiles. When we’re competing with other countries, we’re draining our industrial base to pay for healthcare. When we pay twice as much per person than what the Germans, Canadians or French are, that saps our economy.”

Even if there is an economic downturn as a result of a single-payer healthcare program, that should not matter over the lives and well-being of millions of Americans. To say that impoverished communities should again be put on the back burner because the economy matters more than them is flawed logic that allows for issues like poverty to go unnoticed and remain pervasive within society.

Arguing that single-payer healthcare would stifle innovation of medical products is also a misguided critique. Associate Professor of Medicine at Harvard Medical School Aaron Kesselheim wrote in the Journal of the American Medical Association that publicly-funded research through non-profit centers is responsible for the development of innovative medical technology and not the work of private corporations and researchers.

Privatization also stifles medical research, as scientists are incentivized by profit rather than genuine desire to create better technologies. In fact, two-thirds of applications for new drugs sent to the U.S. Food and Drug Administration are for slight modifications in existing medicines, according to John Geyman, professor emeritus of family medicine at the University of Washington, in his book How Obamacare Is Unsustainable: Why We Need a Single Payer Solution for All Americans.

Additionally, although single-payer healthcare would result in the loss of some jobs, a 2012 study published under the New England Journal of Medicine said that a more efficient public health program would enable resources to be invested in such fields as education or retirement savings. This would create more jobs in other sectors, which would account for any jobs lost and benefit other parts of the American economy. Reshaping American healthcare would simply result in the reallocation of workers instead of mass job termination, Himmelstein said.

“We need to find some useful work for the vast numbers of people employed in healthcare but doing nothing but paper-pushing,” Himmelstein said. “We could readily use those people to do useful work in the healthcare system taking care of people. There are clear transition plans for helping move the million and a half people who are currently doing useless things like billing.”

Despite the fact that Americans see divisions in how healthcare should be approached, a substantial push for single-payer healthcare could turn the concept from paper into policy.

Given that Democrats were able to claim the House of Representatives after the midterm elections, the party now has a more substantial footing to reach their goals.

According to the New York Times, Democrats should now have the ability to resist President Trump’s efforts to repeal the Affordable Care Act.

Also, a 2018 August Reuters poll showed that 70 percent of the American public would support a national healthcare program providing insurance on a universal basis to citizens.

Even if single-payer healthcare is seemingly impractical, Himmelstein said that the nature of social reform is unexpected and fast-paced.

“Major social changes happen suddenly and unexpectedly with things that often seemed impossible just a few years earlier,” Himmelstein said. “Few would have thought that gay marriage would be legal throughout the U.S. fifteen years ago. We have every reason that this can happen in our healthcare system because such a broad cross-section of the American people and of American industries are in trouble with this system.”

Every politician seems to be in agreement that American healthcare is in need of change. Although Republicans are currently pushing for less government intervention, with an end goal of expanding privatization, it is important for the left to counter those demands with an embrace of single-payer healthcare.

Fighting for the well-being of the Americans whose interests are not currently being defended by the federal government is important, and continuing to push for a national healthcare program will help the left do so effectively.

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Panorama Magazine