The state of America’s health care system offers a case study in the power of money to set the agenda in Washington— usually to the detriment of average people.
It’s no secret that our health care system is astronomically expensive. It’s perhaps less well known that all the money we pour into the U.S. health care system, roughly 17 percent of the nation’s total Gross Domestic Product, is delivering health care quality that’s mediocre at best when compared to many other countries. In fact, according to the well-respected Commonwealth Fund, which has studied global health care delivery for years, the U.S. continues to rank dead last among the ten leading western, industrialized nations for the quality of its healthcare delivery, a position it’s now held for five years.
At the same time, America (as of 2014) was spending an average of $8,725 per capita on health care, a figure that topped over $9,000 in 2015. And we still leave 30 million Americans, or about ten percent of the population without health care access, other than a visit to the emergency room.
By contrast, Canada provides access to all of its citizens, while spending an average of $4,602 per capita, or roughly half of what the U.S. spends on health care. If the U.S. spent the same amount per capita as our friends north of the border, we would save about $1.3 trillion annually, and those savings would accrue to the government, businesses, and individuals and families.
Instead, we have a system that is incredibly burdensome to employers, to average people, and which threatens to swamp public health programs as a result of the continuing cost escalation throughout the health care sector.
When you hear politicians claim that America has the best health care system in the world, understand that they are performing the same exercise as the cheerleaders for an 0-10 football team. They may claim “We’re Number One!” but even they know nobody really believes them.
We can thank the power of money and the influence it buys in our nation’s capital for the sorry record of our 0-10 health care system.
Take prescription drugs, for example. Virtually every other country on Earth regulates the cost of pharmaceuticals, which have become a major driver of higher costs within the U.S. health care system. Go across the border to Canada, and drug prices average about 50 percent of what they cost here in the states. In Great Britain, the same drugs we buy here in the U.S. can be had for about one-third the price.
In the U.S., we supposedly rely on “market competition” to keep drug prices in check, but like most things in the health care field, the market doesn’t have much of a role to play when our health or our lives are at stake. Martin Shkreli may appear to be the world’s biggest jerk for jacking up the price of life-saving drugs, but that’s only because he was stupid enough to brag about it. In the end, while he faces prosecution for unrelated charges, what Shkreli did is perfectly legal, at least here in the U.S.
And that’s because in America, the money and political heft of the drug industry, like so many other powerful industries, controls what happens in Washington. It means we, as Americans, live lesser lives than our friends in other western countries, burdened by higher health care costs and living in the constant fear that a major illness will spell bankruptcy or long-term poverty for our families.
Consider our current system of private health insurance. No one in their right mind thinks that leaving the private system intact in the U.S. makes sense from the perspective of economic and financial efficiency. It’s a high-cost administrative nightmare for every player in the industry and it automatically siphons off 15-20 percent in unnecessary overhead costs. Then remember that at least 20 percent of every remaining premium dollar is taken off the top for corporate profit. That means the U.S. spends 35-40 percent of every health care dollar on cumbersome administration and corporate profits. That’s not the case in a single-payer system, which is one of the reasons single-payer health insurance can provide quality care for so much less.
But when President Obama proposed the Affordable Care Act, he left this cumbersome and inefficient system in place. It was purely political calculation. President Obama accepted the unwritten rule of Washington, namely that the interests of average Americans bear no relationship to policy outcomes in Washington. Rather than pushing back against what is, in effect, an oligarchic system of government, Obama chose to play the game, no doubt viewing himself as a “progressive who likes to get things done.”
A phased expansion of Medicare over a ten-year period, to eventually include all Americans, would have been a far more effective and efficient approach. It would also have been much more difficult for Republicans to demonize. Opponents certainly made “Obamacare” sound like a frightening government takeover of health care (which it wasn’t), but they could hardly have made Medicare sound frightening, because Americans already see it for the godsend that it is. Far from fearing it, most Americans who don’t already qualify are simply counting the days until they, too, can take advantage of what is already one of the largest single-payer health care systems in the world.
Obamacare accomplished some positive things, there’s no doubt. But it also left America chained to a private health insurance system that now has fewer incentives than ever to try to hold down costs. Some on the left see it as a political victory, but for many, it’s a symbol of an era of diminished expectations, a recognition that our political process is fundamentally broken— and no longer serves the interests of average Americans.
The anger alive in the land across the political spectrum today— from supporters of Bernie Sanders to backers of Donald Trump— is a reaction to this growing understanding by average Americans that the system is rigged in favor of those at the very top, who control our politics through hordes of lobbyists and billions in campaign contributions.
Sanders and Trump are both doing well because they’re refusing to play by the rules of the Washington money game— Trump through his ability to self-finance, and Sanders through the creation of an astonishingly effective grassroots funding system that could fundamentally undermine the political power of big money in Washington.
Pushing back is the political establishment in both parties, that is perfectly content with the status quo that allows wealthy interests to hold sway over the nation’s political agenda.
In many ways, it seems this country is at a crossroads in 2016. If Americans are comfortable with a future in which the limits of the health care debate are determined by the health insurance and pharmaceutical industries, rather than the public interest, or when young people face the choice between a college degree and years of debt servitude, or when a never-ending series of foreign trade deals continue to accelerate the disappearance of once good-paying jobs here at home, they can certainly vote for the status quo and go back to watching television, comfortable in the knowledge that absolutely nothing will change in Washington.
But if they’re not ready, quite yet, to give up on America’s experiment in self-government, and are willing to roll up their sleeves and engage in the hard work of democracy, now might be the right time. Minnesota’s caucuses are set for Tuesday, March 1, at a location near you. Why not do something revolutionary? Make the effort to show up, and say you’re not ready to give up on America’s future.