America and Healthcare: The World is Watching... and Wondering

The debate over healthcare reform in the U.S. is fascinating.  Just trying to stay on top of the coverage is a full-time endeavour, not to mention the time it takes to understand and properly contextualise the pros and cons of each side of the argument. It is a topic that runs to the very core of political identification and ideological alliances in the U.S. and one that sheds light on America’s struggle to define itself. Does the American citizenry have a right to the standard of living enjoyed by most of the industrialised world, i.e., one that takes guaranteed universal healthcare as a given (see the U.N. Declaration of Human Rights on medical care)? Or does a particularly American suspicion of governmental intervention overshadow the importance of implementing reforms that would benefit the population as a whole?  This debate brings to the fore the fundamental questions of whether there is a place in the American socio-political psyche for the role of human compassion and what the concept of humanity actually represent for Americans.

For those who were raised and educated in industrialised countries outside the U.S. (e.g., Canada, U.K., Australia) and who see the role of government as serving its citizenry, as opposed to an entity against which citizens need to defend themselves, the crux of the American debate seems remarkably foreign. For all the similarities that might exist in the Anglo-Saxon world in particular, and the developed world more generally, America is distinct in its preparedness to accept social injustice and inequality as embedded elements in the very nature of the society it is so keen to protect.  Whereas no Canadian or Brit is naïve enough to think that societal gaps can be bridged fully they nonetheless value the attempts to make them as narrow as possible and to support the governmental and societal efforts to realise this aim. Unlike in America, the question is not whether or not to have universal healthcare but how best to implement it and how to improve on a recognisably flawed system. While the U.S. debates the question of whether healthcare is a right or a luxury, the rest of the world looks on in wonder and dismay at how a country so rich in financial and human resources can be so misguided when it comes to the value it places in raising the standard of living for the nation as a whole, which cannot be achieved until America’s healthcare issues are resolved.

The arguments in favour of and against universal healthcare are being addressed extensively in the media and the blogosphere is devoting a mountainous amount of space to the topic (one favourite is Ezra Klein). The energy and bandwidth that are being dedicated to communicating the basic assertions in support of universal healthcare, let alone its details, is staggering.  How many new, creative and value-adding ideas could be generated if these efforts were applied to healthcare implementation, medical ethics and best practices, reform of Big Pharma, advancements in medical education, etc.? Why are those whose interests do not lie in defeating the reforms nonetheless clamouring for the Pyrrhic victory that a failure will bring to the American people? To hear the under- or uninsured arguing against universal healthcare is perplexing. Even amongst the insured there seems to be a state of denial about how much the current system costs each individual, either directly through premiums, co-pays and deductibles, or indirectly through employers that pass along most of those costs to employees through lower salaries and fewer additional benefits. There also seems to be a refusal to acknowledge how easy it is for insurance companies to deny coverage, revoke it due to rescission or make it too expensive to be a viable option (see Ezra Klein and U.S. Department of Health & Human Services).

Behind the healthcare debate lies the question of how each nation views the social contracts that exist between government and citizens and amongst the citizens themselves.  Most developed nations recognise the value in cultivating a strong social contract that supports a system that is as inclusive as possible in raising the quality of life. This contract acknowledges that there will be those that contribute more and others less but that, despite this imbalance, society as a whole, as well as the individuals within it, benefit when everyone’s life is improved.  America, it seems, has an alternative social contract where a significant portion of its citizens are not prepared to commit the resources needed to create a more equal society, regardless of the real costs (social, financial, developmental) of this approach. What is perhaps most difficult to comprehend is that the Americans from the very socio-economic strata that have the most to gain are being driven by blind ideology and fear to reject the healthcare reforms that are in their own best interest (excellent piece by Jonathan Chait at TNR).

America’s global peers are watching this debate with great interest and not a small amount of wonder. A country that has such wealth and privilege is engaged in a struggle for how it wishes to mould its future and to define what it means to be a citizen of this particular democratic culture. America cannot assume that it can continue to ignore the deterioration in its societal fibre and the broadening gap between “haves” and “have nots”; the growing starkness of this reality will have an increasingly negative impact on the morale and development of the nation.  The solution to this problem is not to put up more walls and gates but to pull down the barriers that represent the insidious consequences of growing inequalities. Quality of life cannot be bought for the individual if the rest of his/her world is crumbling; a society based on inclusiveness can bear the weight of moderate inequalities if a basic foundation exists that allows every citizen the ability to live in dignity and without the fear of having an illness result in financial ruin.

If healthcare reform fails to pass in the United States it will be because of obtuseness and fear and the ability of their propagators to over-power the dedicated voices of reason and compassion. A failure will cause the world to ask what happened to humanity in the American formula for national strength, courage, prosperity and ascendency.  Our hope for all Americans and for America is that the President and his supporters will succeed and healthcare reform will pass… and we wish them health AND wealth.