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Rx for U.S. Health (and Healthcare): A Politics of Solidarity and Equality

The same free-market politics that opposes even the conservative compromise of the Affordable Care Act lies behind policy shifts that have greatly increased inequality.
 
 
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The following article first appeared at Working In These Times, the labor blog of In These Times magazine. For more news and analysis like this, sign up to receive In These Timesweekly updates.

Only in America would there be the kind of legal and political battle now going on at the Supreme Court and in the presidential primaries about whether government could or should make sure that everyone has affordable health insurance.

The legal challenge is particularly odd, since conservatives like the Heritage Foundation embraced the idea of an individual mandate to buy private insurance as an alternative to such progressive options as single-payer plans or "Medicare for All," which could have easily passed constitutional muster.

But it's appropriate at this point to consider how the perversities of American politics, especially on the right, have left their mark on the health of Americans as well as their healthcare. Especially when we compare the records of the United States and other countries, we find that the U.S. overall does not have the best healthcare system in the world, even if it has some of the best researchers, doctors and facilities.

Rather, American politics has not only screwed up healthcare, it has also damaged our health and kills millions of our fellow citizen prematurely.

The country spent about $7,860 per person on healthcare in 2009, 2.5 times the average of all OECD countries (that is, most of the rich, industrial nations plus some developing countries). That amounts to 17.4 percent of gross domestic product, according to OECD statistics, about half again as much as any other country—with most advanced nations spending about 9 to 12 percent of GDP—and far more than expected even for such a rich country.

A little more than half of U.S. health spending is private—an unusually high proportion, but the public spending per capita is equal to or greater than public spending by nearly all other OECD countries.

Yet everyone is insured in those countries, but 50 million lack insurance here.

The OECD figures that American medicine in many ways provides less but costs more across the board, including drugs and hospitals. But costs are especially high for administration (mainly from practices of private insurers) and for care outside hospitals by physicians--about three to four times the average in those two cases of the costs in a small group of rich countries. Take the case of a coronary angioplasty: in the U.S. it cost about $14,378 on average; in Germany, $3,347.

At the same time, the U.S. rankss 26th to 29th internationally in the number per capita of doctors, doctor visits, hospital beds, length of hospital stay and other services (though it scores high on CT scanners, MRI unit, knee replacements and Caesarean sections).

The results of decades of a makeshift, disjointed system subordinated to private profit?  After indeed ranking near the top in health globally in the 1950s (number seven in combined mortality rates for men and women), the U.S. has not made progress since then at the rate of other countries and has fallen in the mortality ranks to number 34, according to a new study by University of Washington Prof. Stephen Bezruchka.

Conditions have declined in about a fifth of the United States, he writes, but "even the healthiest U.S. subpopulations suffer from suboptimal health....Both U.S. men and women had the greatest likelihood among developed nations of dying before reaching retirement."  Many indicators point to the conclusion, he writes, that "the United States is not a very healthy country."

Bezruchka concludes that neither the diversity of the U.S. population, nor personal behavior (despite a staggering rise in obesity), nor healthcare spending accounts for the poor health outcomes, and "the benefits of universal healthcare coverage in advancing  population health effects are similarly of limited effect."  (Even if true, there are still profound arguments for universal healthcare, including both moral and economic justifications.)

What, then, does account for the failure of our expensive system to deliver health? Bezruchka says we have to look at "structural, economic and political factors that govern the level of inequality tolerated in society....Income and economic inequalities are important factors in a wide range of social and health outcomes....[O]ne-third of all deaths in the United States can be linked to inequality," which in turn leads Americans to report more stress than people in other countries. And stress kills, exacerbating many conditions.

The same free-market, devil-take-the-hindmost politics that opposes even the conservative compromise of the Affordable Care Act lies behind the policy shifts that have greatly increased inequality, which was near its nadir in the period when Americans' health ranked its best internationally.

Even if the Affordable Care Act survives, argues Deborah Burger, co-president of 170,000-member National Nurses United, one of the labor movement's staunchest advocates of a single-payer system, "we will not have universal coverage, medical bills will still push too many Americans into bankruptcy or prompt them to self-ration care, and insurance companies will continue to have a choke hold on our health."

Even if a single-payer system were introduced, reducing inequality is required to improve Americans' health. Working for real social solidarity through such a comprehensive, universal healthcare system can help overcome the political forces that both create inequality and resist healthcare reform.

David Moberg is a senior editor of In These Times.