Why is America so opposed to universal health care?
Chris Gay says while the rest of the developed world has largely accepted the government’s role in ensuring affordable health care, the US remains stuck in an endless debate full of misinformation perpetuated by rich interest groups
Americans like to indulge the notion that we are exceptional, a conceit that understandably sends non-Americans up the wall. But we are indisputably exceptional in a way that must baffle the rest of the developed world: our failure – or refusal – to implement universal health care.
Even Hong Kong, often and erroneously portrayed as a laboratory experiment in hands-off government, has what amounts to universal health care. The US has never had anything like universal coverage, yet even “Obamacare” – a piecemeal measure that narrows but does not close the uninsured gap – is often vilified as a kind of Bolshevik plot to collectivise medicine.
How is it that such an advanced society is so averse to an idea that’s elemental in most of the developed world? The answer has to do with the individualist and anti-intellectual political culture that Donald Trump has ridden into the White House, and with the political power of a health care industry heavily armed to protect its own interests.
Of course, that’s not the narrative you’ll hear from the sort of people who despise not just Obamacare but the whole notion of a social safety net. They explain our gap-ridden health care by way of a healthy cultural aversion to big government. It’s an interesting storyline, but it doesn’t quite square with national programmes like Social Security (an 82-year-old system comparable to Hong Kong’s Mandatory Provident Fund), Medicare (universal “single-payer” health insurance for people over 65) or Medicaid (government health insurance for the poor). Or with the fact that three-fifths of Americans would prefer a universal system.
If, by cultural aversion, conservatives mean cognitive dissonance, they may be on to something. The Tea Party – a populist antecedent to Trumpism – held feverish rallies in the early Obama years where inevitably some faux live-free-or-die insurgent in a tricorn hat would hold up a placard reading, “Keep your government hands off my Medicare”.
Even today, people who are sure they hate Obamacare – essentially a system of government-sponsored exchanges where people buy private insurance – aren’t quite sure what it is. A recent survey by the polling firm Morning Consult found that 80 per cent of Republican voters strongly disapproved of “Obamacare”, while only 60 per cent strongly disapproved of the “Affordable Care Act”. The punchline: They’re one and the same. The very name “Obamacare” helps explain the confusion. It’s a term of derision ginned up by the Great Right Wing Noise Machine that tends to dominate the national conversation.