Every advanced economy in the world provides its citizens with a baseline guarantee of health care—while Americans have been bamboozled into believing that this perfectly normal arrangement is somehow "communism." But after decades of paying astronomical sums for a system that delivers insecurity, bureaucracy and often mediocre results, they may finally be wising up. The question is whether their political leaders, especially Democrats, are prepared to catch up.
With the November 3 midterms approaching, health care has become a major electoral issue. An October Pew Research Center poll found that 68 percent of registered voters consider it very important to their vote. A separate KFF poll found that 82 percent want candidates to address health care costs, with Democrats enjoying a nearly two-to-one advantage over Republicans in voter trust. No wonder: premiums, deductibles and medical bills can devastate family finances.
Critically, a new Axios-Ipsos poll suggests a more fundamental reconsideration of the system. Some 43 percent support Medicare for All, compared with 24 percent opposed and 32 percent unsure. And 66 percent favor greater federal spending to lower health care costs. Striking numbers in a country where universal coverage has long been portrayed as socialist tyranny.
That caricature sustains a system benefiting insurers, pharmaceutical manufacturers and their lobbyists. Americans are discovering that supposed freedom often means dependence on employers, insurers and bureaucrats. Among the more comical absurdities is tying health insurance to employment. It is like attaching car maintenance to your tennis court—there is simply no logical connection.
The financial consequences are staggering. The United States spends nearly $15,000 per person annually on health care, almost twice the average of comparable wealthy countries, without receiving twice as much care. Higher prices and costly administration sustain a lucrative ecosystem of insurers, hospitals, pharmaceutical companies and intermediaries. Illness generates revenue and complexity creates opportunities for profit.
I have spent most of my adult life outside the United States, including long stretches in Britain and Israel, and I can assure you it does not have to be this way. Both countries have their problems (especially Britain in recent years), including for some procedures waiting lists, budget pressures and overstretched medical professionals. Both—in particular Israel—also offer excellent, cutting-edge treatments and care.
In Israel, everyone is covered through a national health insurance framework, with competing nonprofit health funds delivering services. If you want the private option, that is always available, and sometimes quicker and better. Britain has its National Health Service. France, Germany, the Netherlands and Switzerland employ different combinations of public financing, mandatory insurance and regulated private providers.
The details vary. The principle does not. Health care is treated as a basic social guarantee, much like public education, sanitation and emergency services. People contribute because they understand that illness is not an unusual personal failure. It is an unavoidable feature of being alive.
Americans have instead been sold a bizarre notion of freedom: the freedom to negotiate with an insurance company while undergoing chemotherapy. The freedom to remain in a job you hate because changing employers might disrupt your family's medical coverage. The freedom to discover that a procedure recommended by your physician requires authorization from someone whose incentive is to refuse.
This dysfunction is damaging the very people entrusted with keeping Americans alive. In a Scientific American essay, Dr. Clay Marsh, a physician and health sciences leader at West Virginia University, described a system that rewards hospitals and medical professionals for treating sickness rather than maintaining health. The resulting business model, he argued, exhausts caregivers while perpetuating the very conditions that make patients ill.
Marsh pointed to widespread physician burnout and the corrosive effects of treating medical professionals like assembly-line workers. Doctors enter medicine to heal people, only to find themselves navigating insurance requirements, reimbursement incentives, administrative demands and institutional competition.
It is difficult to imagine a more perverse arrangement: a health care system that makes its patients financially anxious and its healers physically and emotionally exhausted.
There are powerful commercial interests that benefit from the perversity. Insurance companies collect premiums, negotiate payments and manage claims, with financial incentives that conflict with timely, comprehensive treatment. Pharmaceutical companies benefit from patent protections and pricing arrangements that can make essential medicines vastly more expensive in America than elsewhere. Both industries maintain formidable lobbying operations to influence the rules under which they operate.
Not every dollar of profit is illegitimate, and developing new medicines is expensive and risky. But the combined effect is maddening.
So it’s refreshing to see that Americans are losing patience. The Axios-Ipsos poll found that roughly half of Republicans, Democrats and independents would be less likely to support a candidate receiving money from pharmaceutical political action committees. Similar proportions expressed reservations about contributions from health-insurance PACs.
Critics of universal coverage warn that government involvement would place medical decisions in the hands of bureaucrats. Yet private insurers already employ armies of administrators to determine which treatments will be covered, which providers are acceptable and which claims can be rejected.
The standard American objection is that universal coverage would require higher taxes. Perhaps. But this is a misleading way to frame the question.
Americans already pay through insurance premiums, deductibles, copayments, employer contributions, taxes and prices inflated by inefficiency. Employer-sponsored insurance is not free money from a benevolent corporation; it is part of the cost of employing workers. Which brings us to the Democrats.
For years, the party has approached Medicare for All with fear. Its leaders defend the convoluted Affordable Care Act, a halfway measure at best that essentially retains the current system, propose subsidies and incremental improvements, and carefully avoid promising fundamental restructuring.
Sure, voters fear losing existing insurance arrangements, and the Republicans have long successfully associated government-run health care with rationing, taxation and diminished choice. They have used skilled persuasion to prolong terrible policy. Time for the Democrats to find persuasion skills. Have faith; the case is strong.
Imagine a thought experiment, in which the current healthcare arrangement was extended to elementary education. Kids go to first grade if parents’ employers offer that in a plan, through insurance with co-pay. Others must pay tuition at the level of an Ivy League university. And tens of millions who cannot would go without.
Freedom, choice and the American way? We can do better.
Dan Perry is the former London-based Europe-Africa Editor and Cairo-based Middle East Editor of The Associated Press, chairman of the Foreign Press Association in Jerusalem and the author of two books.
The views expressed in this article are the writer’s own.