There’s nothing like a flight back to the U.S. from a fortnight-long sojourn to Europe to make you think. In a pressurized aluminum tube 39,000 feet in the air, I ended my self-imposed vacation-long break from Twitter to view breathless commentary on the then proposed and now dead Graham-Cassidy bill. My European sensibilities strengthened from time in London and Madrid, I began to wonder: what kind of civilized, wealthy nation cannot guarantee access to healthcare for all of its citizens? How is this still a debate? How is it that every other developed nation understands that it is a truth universally acknowledged that a single country in possession of good fortune must provide healthcare for its people?
Part of the issue in this debate has been the GOP’s guiding principle of letting free markets provision resources and determine outcomes. While a free market approach works in many instances - spoiler alert - sometimes market failure occurs. Free market incentives and a lack of consumer buying power in healthcare reward treatment more than prevention leading to outrageously high costs. For example, the Epi-Pen costs $600 in the U.S. compared to $69 in the UK. The GOP correctly recognizes that government intervention can be an appropriate solution to market failure in the case of defense but does not extend this logic to healthcare. Maybe this is because there was no universal coverage in Atlas Shrugged. Maybe this is because they dare not oppose the will of Charles and David Koch.
Either way, it's difficult to argue that universal coverage undermines the free market orientation of an economy. Not convinced? Ask The Heritage Foundation - the leading conservative think tank in Washington - whose annual Index of Economic Freedom ranks countries based on freedom from regulation and free market emphasis. In the 2017 edition, the U.S. placed seventeenth. One thing that every country that was ranked higher than the U.S. had in common: some form of universal healthcare.
There is no shortage of other, more effective approaches to learn from. Universal coverage need not entail a complete government takeover of healthcare. Find the UK’s National Health Service too socialist? Maybe you’ll like Japan where a public-private approach sees the government cover 70% of healthcare costs and individuals’ insurance plans - either employer-sponsored or privately purchased - covering the remaining 30%. This approach produces superior outcomes to the U.S. in terms of life expectancy (83.7 vs. 79.3), infant mortality (2 per thousand vs. 5.8 per thousand) and does so at lower cost (spend per capita $3,703 vs. $9,402). If 70% public funding seems too high, consider the case of Singapore, where a public-private hybrid model is divided into five classes, with varying levels of quality, and government funding ranging from 0% to 80%, depending on the plan selected by patient 80%. Such hybrid models also help ensure that healthcare firms such as Aetna do not have their livelihood completely taken over by a government sponsored solution.
I’m from a country with socialized medicine and so am highly familiar with the flaws of this approach: hopelessly long waiting lists, patient neglect, complete lack of innovation, an emphasis on low cost (sometimes at the expense of quality) and society paying for the reckless actions of some poorly behaved individuals. Sadly the U.S. system offers some of the same issues but none of the advantages of universal coverage. For example, the U.S. performance in terms of wait times is average; behind countries such as Britain. This could help explain why the majority of Americans now support some form of universal coverage.
Universal healthcare ensures 100% of the population is covered 100% of the time and that your ability to pay does not affect the treatment you receive. What a beautiful thing. Still not convinced? Perhaps you’ll heed the words of a man who wrote that “we should not hear so many stories of families ruined by health care expenses. . . .we must have universal healthcare. . . we need...to re-examine the single-payer plan”. The author? Donald J. Trump. That’s the kind of Trumpcare I can get behind.