Universal Healthcare
Malcolm Gladwell, one of my favorite writers, is now blogging. In this post he writes about criticisms of his positive understanding of the Canadian universal health care system.
In the comments on my about-face on health care, a number of people make the familiar criticisms of the Canadian system. Care is rationed. You wait a lot longer for certain elective procedures than in the United States. Technology is not as up to date, etc. etc. These arguments are, to some extent, entirely accurate. But I’m not sure they are relevant. They aren’t criticisms of the system, after all. They are reflections of the how well the system is funded—and that’s an important distinction. On a per capita basis, Canadians now spend on health care—and I’m not sure of the exact figure here—something like 60 percent of what Americans spend. If that were increased to, say, 65 percent, many of the rationing and wait-time problems would be alleviated. The problem with American health care, by contrast, is systemic. No simple increase in funding fixes the problem. In fact, we already spend far and more the most on health care than anyone else in the world.
I still long for a stronger movement advocating for universal health care in the US. Beyond regular working people (who increasingly are losing health coverage; I heard a recent report pegs the number of uninsured at 45 million), there are some powerful and important potential allies that have largely stayed out of the conversation. Increasingly, when the few organizations and large companies with largely organized work forces face union contract negotiations, health care (for current employees and retirees) has become the issue that has led to strikes. A large part of the “legacy” cost that is hurting large manufacturers is health care for retired former workers. Also, small businesses regularly lose their best employees to larger employers who can still afford to provide decent health care benefits. State and other governmental budgets are being squeezed by increasing demands on services like Medicare and Medicaid. So, other than health care industry itself and big pharma, it seems a very large and strong coalition could be built.
One under utilized argument is that dependence on health insurance may be preventing valuable risk taking on the behalf of potential entrepeneurs and under-educated workers. A single illness or injury can destroy the financial foundation of a household that does not have health insurance. It’d be much easier to risk starting a new business or returning to school full time, making the financial sacrifices necessary, if the health and welfare of your self and family weren’t threatened by the unknown. And this is the kind of risk taking we need, especially where economies are falling apart, like in the Midwest.
Organizations working toward universal health care in the US:
April 3rd, 2006 at 11:41 am
Rachel and I went to see The New Pornographers (from Vancouver) a little while back, and the show was peppered by comments about universal health care. One such instance went something like this: you guys need to get health care! Last time I was sick, I went to the doctor and was like “sorry dude, I can’t afford this” and he was like “that’s cool. Do you want a massage with that?”
April 7th, 2006 at 12:52 pm
I had never contemplated the entrepreneurship angle on universal health care until I started hanging out with Canadians who say things like “Oh, right. You can’t quit your job because you won’t have health care otherwise.” It is absurd. All of it. The sort of absurd, headache giving political issue that paralyzes me even though I am shelling out just over $400/mo to keep myself insured.
The Nation had some strange coverage (okay, so I couldn’t even get through it) of GM’s failure to step up and demand universal health care, even though they would benefit dramatically if they could stop buying insurance (as an example of what happens when you don’t read the whole article, I’m left to just assume that the difference they’d have to make up to cover increased taxes would be less than they are currently paying.)
Interesting, but they didn’t have any good answers (I stopped reading around the mention of looking like a socialist at cocktail parties–like GM would actually shoot themselves in the foot just so their CEO can look good at parties? I call bullshit on that.) to why Detroit backed off the fight.
What I don’t understand, is why the whole rest of the country isn’t up in arms over this. Not unlike almost everyone who immediately forgets the injustice of the drinking age the day after their 21st birthday, most folks who’ve worked out a health insurance solution stop thinking about it. Employers are the ones that ought to be throwing a fit about having to manage health care for their employees. The Welfare Law Center, probably a fairly typical small non profit, and not so a-typical for a small business in this regard, devotes enormous resources just to negotiating for decently priced employee coverage. And decently priced turns out to come to more than $400/mo per person. I have a hard time believing that the Federal government couldn’t do better. Hell, I bet Haliburton could do better.
Which brings me to what I suspect is the real reason that most folks can’t figure out how to get behind this. Just because the government is perfectly capable of managing universal health care, that doesn’t mean they would at all. The odds are pretty good that Bechtel would get a no-bid contract to do nothing and we’d all be even worse off than we are now.