We often hear boasts about American exceptionalism. But there is at least one area where being exceptional is a negative.
Most other wealthy democracies have made health care a de facto right of all. Yet we have been arguing about whether to do so for nearly a hundred years and haven’t done it yet. We spend twice as much as other wealthy countries on health care, but still leave 15 percent of our people completely without health care coverage and many more vulnerable to illness-related financial hardship.
I recently helped organize a panel discussion at a conference in Washington, D.C., celebrating the 50th anniversary of Medicare and Medicaid, to examine why achieving health care as a right in America is so hard. The participants included world-class experts from academia, medical journalism, public service and advocacy groups. Here’s a summary of what emerged from our discussion. It’s not a very flattering picture of current American politics, culture and values regarding health care, but I think it’s accurate.
The barriers to reform these experts identified fall into four categories:
Apathy. Think of labor unions or corporate executives with tax-subsidized Cadillac plans. “I’ve got mine. Why should I worry about anybody else?” We pay dearly for such thinking. Or, think of the young and healthy who don’t believe they need health care and are willing to go without coverage despite the cost to others should they need care.
Fear, distrust and anger. Fear of change, not trusting that people are going to be better off if things change, no matter what that change is, especially if government is involved. Fear by doctors and other health care professionals that reform would be too effective in controlling health care costs, resulting in loss of profits and income.
Ideology and ignorance (not stupidity). Health care is complicated, and most Americans don’t understand the health care system or that there are better ways organize it. This includes doctors. We are trained to be experts in clinical medicine, not health care systems. Many Americans are unaware (ignorant) of the fact that wealthy countries have health care systems that are more popular than ours, produce superior results, include everybody and cost about half what we spend. It doesn’t occur to us that people in other countries don’t even think about money when illness or injury strikes. Many of us seem to subscribe to a unique ideology — rejected by most cultures — that health care must be “earned,” no matter how much or how little control a person has over their health status. Many are put off by the idea of accepting any government assistance, often known as “being on the “dole.”
Greed. This may seem harsh, but the evidence is piling up. The widely accepted view of health care as just another business is uniquely American, at least in degree. Some people view the health care system as a way to prevent, diagnose, treat and cure disease and assist in healing. Others view it as a business opportunity. These two differing views frequently are in conflict. The medical-industrial complex in the US is an enormously profitable industry. Those putting profits above appropriate and effective health care would like to continue to be able to do so, and they use their wealth and the influence it buys in our corrupt political system to make sure they can.
Some believe the American health care system has become more of a wealth-extraction machine — from people who buy health care products and services to those who sell them — than a system concerned with health and well-being. This view is reinforced by recent news stories about the seemingly opportunistic and predatory pricing of critical medicines, nursing homes taking legal custody of elderly patients as a means of getting control of their bank accounts and aggressive collection tactics that include garnishing the wages of low-income workers, even by “nonprofit” hospitals.
A recent report by the charity Oxfam revealed that the health care and financial services industries are the largest contributors to increasing income and wealth inequality throughout the world.
These barriers to reform can and are being exploited by those with a financial or ideological interest in maintaining the status quo. If you wonder why health care reform in the US is so difficult, just remember AFIG: apathy; fear, distrust and anger; ignorance and ideology; and greed.
To succeed in reforming our dysfunctional health care system, we must continue to motivate the apathetic, reassure the fearful, educate the ignorant and call out the greedy. We have a lot of work to do.