KRWG

Has the time for single-payer healthcare arrived in the U.S.?

Sep 29, 2017


  Commentary: According to an old maxim, if the headline ends in a question mark, the answer is generally no.

 

To see that question entertained in Congress, however, is a sign that the parameters of what is possible are under review. There are reasons to celebrate the “Medicare-for-All” bill introduced in September by Senator Bernie Sanders of Vermont, even if its prospects of passing the current Congress are dim.

 

At its introduction, 15 Democrats in the Senate, including several potential candidates for president, had signed on to the Sanders bill as co-sponsors, and a companion bill in the House has earned the support of a Democratic majority for the first time.

 

Opposition to a single-payer system has been bipartisan, with Democrats (a pro-capitalist party despite the Republican rhetoric) defeating efforts to establish single-payer systems in California, New York, and Vermont. The newly-elected President Obama along with Democratic leaders declared single-payer insurance “off the table” in 2009 and fought instead for mandated, subsidized private health insurance that imposed some consumer protections on insurance companies and a tax on the wealthy.

 

Belling the cat in exchange for forcing more customers onto private insurance expanded coverage and industry profits, but a study by the Commonwealth Fund found that in 2016, 63 million Americans still had deprived themselves of care because of the financial cost.

 

During a long trip to Italy in 2012, I made a point of asking everyone I met about their national health insurance. As an advocate of national health insurance, I wanted to hear about the deficiencies and failures of their system. Italians were happy to give me a reality check, sharing their horror stories and criticisms, mostly bureaucratic. When they spoke of interacting with their health care system, there were sighs and impatient facial expressions; yet I did not hear of anyone going bankrupt, crowd-funding medical expenses on the internet, or dying because they could not afford treatment. That was an “American” thing.

 

One evening in Florence, performing a choreographed fight with stage weapons, a stray rapier cut a gash into my thigh. I cleaned the wound myself and declined a ride to an urgent care facility, saying I would be fine, though I knew I needed stitches and worried about an infection. The Italians thought I was insane and several yelled at me. Even as a foreign traveler, I would be cared for. They lived in a system where, however imperfect and irritating, if someone was hurt or sick you saw a doctor, full stop. It was then I realized how, despite having been a critic of capitalism and private health insurance all my adult life, I still had internalized the logic of a system that rations care by ability to pay. I didn’t have money; therefore, I didn’t deserve medical care.

 

A younger generation of voters is resisting that kind of mental conditioning, and the Democrats hoping to lead their party’s future have noticed. A transition to a national health insurance system would be a long-term project, difficult to accomplish and expensive, requiring a major overhaul of the economy and defeating a health insurance industry that would fight for its life.

 

A future in which the money we spend to purchase the mercy of a predatory insurance industry, its bureaucracy, and its denials of care, may not be at hand this year, but the day may be coming. Since funding such a system would certainly require less wealth to be squandered in endless foreign wars, that could mean better days are ahead for much of the world.

 

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Algernon D’Ammassa writes the Desert Sage column for the Deming Headlight and Sun News papers. Share your thoughts atadammassa@demingheadlight.com.