Advocates of universal health care have made an enormous mistake, one that more than anything else explains why most Americans are balking at adopting the kind of comprehensive health coverage present in every other advanced democracy. It is a failure to make it the top priority to communicate to the middle class the information pertinent to what they care about the most, their money. More specifically, the incredible amount of dollars each person stands to save if the United States makes the switch to a universal system.
The basic facts are these. When conservatives claim, as they are wont to do, that America already enjoys the best health care system in the world so why go to radical lengths to fix it they are, well, lying. We know this because it is no secret that America suffers from the shortest lifespans and highest juvenile mortality rates among the top twenty 1st world countries, American death rates are no better than seen in some 2ndst world countries have higher levels of both and the citizens are living longer. It is not possible to correctly claim that American medical care is the best when we have the worst mortality states despite a very high per capita income. Something has gone terribly wrong. Matters are getting so bad that the US is falling behind other prosperous democracies. Danes and Irish used to die younger than Americans but now live longer. In some states lifespans are actually decreasing, a shocking societal failure all too like the shortening lives of Russians. In the academic literature I have used technical analysis to show that this is not, as apologists sometimes claim, due to high levels of population diversity and immigration.
Liberals tend to focus on the practical and especially moral need for America to do what every other advanced nation is doing and provide high quality health care for every citizen. After all, Americans have universal access to largely government operated police and fire services (click here). If free markets are not good for police and fire protection then why is so great for health protection? Bill Moyers is a premiere example of a liberal who is prone to emphasizing how all good and decent Americans must embrace the moral call to care for every citizen. These arguments may be correct, but they are politically naÃ¯ve. NaÃ¯ve because most middle class Americans are self absorbed, and really care only about their own finances. As I and other researchers have shown, middle class Americans are under an exceptional level of chronic financial insecurity and stress, the American Way being the most Darwinian, survival of the fittest. And Americans also think that extending comprehensive care to everyone will increase costs overall and raise their taxes while increasing the national debt (documents.nytimes.com/new-york-times-cbs-news-poll#p=12). Appeals to the morality sensibilities of the American majority simply will not do the job. You have to appeal big time to their pocket books.
This brings us back to the statistical facts, financial in this case. It is well known that the same nonuniversal American system that is killing off the citizens is incredibly expensive. It's the worst deal in the 1st world. And this is where the pro-universal care crowd has missed the PR boat. On average people dwelling in other advanced nations spend $3000-4000 dollars a year on their health. In the US the average cost is around $7000, almost a sixth of personal income. Universal systems not only are efficacious in saving lives, they are far more cost efficient than the Rube Goldberg affair we have been stuck with so far. Universal systems are more rational, coordinated schemes that keep costs in line while delivering quality care.
Now, I will ask you the reader what I ask audiences during presentations on the comparative socio-financial situation of westerners. It is a question no one seems to know the answer to. It is a shocking lack of basic knowledge because neither the mainstream press and media, or universal care advocates have bothered to tell folks about this stunning fact. Do you know how much money Americans spend -- and in large portion waste -- for no good purpose over a lifespan on their own health?
Well, let's do the math. Average western European or Canadian spends $3500 a year, over a 75-year lifespan that's in the neighborhood of quarter million dollars. The typical American outlays $7000 a year -- right there we could all be saving a cool few thousand a year if we went down the universal care path. Multiply the $7000 by 75 and that's about half a million over a life. In other words, for the privilege of living shorter lives Americans are literally being ripped off to the tune to a quarter of a million bucks that they could keep if only we did what the Europeans and Japanese are doing!
That, dear supporter of universal health care, is the one thing that if all Americans knew -- that they could save up to six figures over a lifespan that could push enough Americans to opt for an all out universal system. Far from paying higher premiums and taxes if a full-scale universal system is put in place, or worsening the national debt America as a nation and especially most Americans as individuals would cash in big time. As it is we are already spending about as many tax dollars for medicine as do other westerners, the extra costs involve the private side of the cost equation. And the damage being done to the finances of the middle class by the transfer of wealth into that private side of health care is terrible. Every year about 8% of a typical American's income is being sent to the medical, drug, insurance and credit industries with no practical return in services, the money ending up in the pockets of the elite. It's a classic pyramid scheme. Charging hundreds of millions of Americans a few thousand beyond what is needed for quality medicine on a yearly basis -- and driving many into interest demanding debt in the process -- is one way the fiscal elite are transferring huge amounts of wealth up the economic pile as they absorb an increasing share of the national economic pie. It is nearly a trillion dollars a year. That average Americans are being defrauded of a quarter million over their lives helps explain why their wages are stagnating, why they are having trouble saving for retirement and for college, and why the regular family is feeling so hard pressed, with many going into bankruptcy in part because of overwhelming medical bills.
That Americans would save up to a quarter mil if the United States goes down the universal care road should be proclaimed at full and constant volume by its advocates. This is so obvious that one wonders why it is not already the standard procedure. The first item that visitors should see headlining the websites of the leading proponents of universality should be how Joe and Jane Doe stand to gain six figures. Yet Health Care Now!, Health Care for America Now!, Physicians For a National Health Program, and Single Payer Action fail to do so. Nor is it being explicitly pushed on Olbermann, Maddow, Stewart and Maher. Little is said in Newsweek, The Nation, Harpers, American Prospect, Mother Jones, The Progressive et al. Same for the Congressional Democrats who are for a comprehensive system. This particular example of lack of progressive political astuteness stems from the tendency of liberals to perceive and promote the absence of universal care as an ethical failure to care for the downtrodden, rather than as a key to solving the financial problems of the middle class. The result of this error is that the opponents to deep reform have been left free to be all too successful in deluding most into thinking that universal medicine will cost big bucks. It is not possible to overcome the political power and influence of the drug and insurance industry lobbies without convincing getting the middle class to vote them down. To win the political struggle will require progressives to emphasize the financial advantages over the moral.
Some additional points. Although an initial step in the right direction, the health reform that is likely to pass now that Democrats are opting for simple majority votes along party lines is not the fully universal system that will dramatically reduce costs whether or not a public option is included. And life saving, cost efficient health systems are not always single payer, in a number of first world nations insurance and medical suppliers are tightly regulated to achieve the low costs.
No medical system is perfect and all universal versions could use improvement. As T. R. Reid notes in his excellent comparison of national systems, The Healing of America, modest increases in funding would largely solve their problems, yet still cost far less than what we've got. Conservative claims that those poor Canadians have to come to the states to get needed treatments are grossly exaggerated. Few Canadians can afford American medicine; most who come to the states are covered by their system so they can receive treatments not available in the smaller system north of the border. Universal care enjoys strong majority support in Canada and other modern democracies, were there is far less controversy over health issues because what they have is working reasonably well. What anti-universalists do not mention is that increasing number of American live in Mexico in order to obtain the care they cannot get here, or travel to Auckland or Bangkok to undergo procedures at a small fraction of the expense -- they often still go into debt and bankruptcy, but at least they can cough up the funds to get the treatments beyond their reach in the states. It's called medical tourism.
The charge that the "death panels" supposedly integral to universal care terminate old folks' lives are absurd when the elderly enjoy longer lives after 65 in those systems than here in the states. The widespread absence of insurance, plus the denial of coverage by insurers, mean that rationing is at least as high in America. The tort reform advocated by conservatives is likely to have only a marginal effect on total costs. The same is true of drug and insurance company profits, as inflated as they are they make up a small percentage of the trillion going to waste per annum. It is the far lower cost of necessary medical procedures and drugs, the sharp reduction of unneeded treatments, and the diminution or elimination of outlandish overhead costs of insurance companies, that are mainly responsible for sharply reducing expenses in universal schemes. Claims that America is too big to apply a single system across the entire country can be dealt with the same way the Canadians do, on a regional basis.
Contending that the homeless must be able to receive quality care because it's the decent thing to do is the right thing to do, but it is not enough. Nor is explaining how the current arrangement is helping wreck the economy and leaving even some in the middle class uninsured, bankrupt, and occasionally dead. The rallying cry to the middle class majority that has the votes must be "Save up to a quarter million over your life with universal medicine!"