47 million Americans do not have health insurance. In May, CBS news reported that 1 in 4 U.S. children go without healthcare. Inadequate medical care is one of the reasons the U.S. ranks low in quality-of-life indicators compared to other industrialized nations. Studies show that America has a shockingly high newborn death rate. Among first world countries, we rank near the bottom in life expectancy. America may have "the world's best medical care," as President Bush claims, but it's not available to many citizens.
In June, Michael Moore's documentary Sicko chronicled the problems with the American healthcare system and compared it to other countries. Moore noted the U.S. has the world's most expensive healthcare system: one that consumes 16 percent of our GNP and leaves half of our citizens with medical debt problems. For the average U.S. family of four, yearly health insurance premiums cost $10,880.
In his January 2007 State of the Union Address, President Bush regurgitated the standard Republican rhetoric about healthcare: there should be new tax deductions to encourage families to buy their own health insurance and states should be encouraged to do more. Bush concluded, "the best health care decisions are made not by government and insurance companies, but by patients and their doctors."
The leading Republican Presidential candidate, Rudy Giuliani, follows Bush's lead. Giuliani described Democratic healthcare initiatives as a "march toward socialized medicine." Giuliani claimed providing universal healthcare will inevitably "increase the cost of insurance and decrease quality." Instead he would encourage Americans to buy health insurance by giving them a $15,000 tax deduction. "Create incentives for people who buy health insurance, don't command them to do that."
Despite Republican warnings to the contrary, it's clear the United States has the wherewithal to provide adequate medical services to all Americans. The political issue is whether America has an obligation to do his. Republicans believers in "tough love" argue that we don't have this obligation because in an open-market economic system individuals are free to make choices about how they spend their money. Republicans contend that if an individual make an economic choice to go without health insurance and then gets sick, they should be forced to live with the consequences of their decision. Thus Republicans oppose universal healthcare on ideological grounds; they feel no moral imperative to care for their brothers and sisters. They view healthcare as an artificial entitlement that, according to conservative guru Bill Kristol, would "would signal the rebirth of centralized welfare-state policy [and] destroy the present breadth and quality of the American health care system, the world's finest." In addition, Republicans worry about who will pay for an expanded healthcare system. They argue America cannot afford to provide better medical services, because this would require higher taxes would hurt the economy.
Nonetheless, one does not have to be Democrat to see the obvious flaws in the Republican arguments. For example, 25 percent of America's children have no healthcare; it's difficult to argue that this is their fault, because they made bad economic choices, or that the richest nation in the world should not take care of its children. Similarly, social security is an entitlement; there is no longer serious discussion that providing for America's seniors means the U.S. has become a socialist society or that the Social Security system has destroyed the eldercare industry.
While no major Republican Presidential candidate has proposed an expansion of the Federal healthcare system, the top three Democratic candidates have announced major programs. The Clinton and Edwards' plans require coverage for all Americans. Obama's plan doesn't require participation except for children but, instead, focuses on making healthcare affordable for all Americans. Each plan places new restrictions on insurance companies so that no one would be turned away because of pre-existing conditions. Large employers would be required to provide insurance for their employees. For those Americans not employed by large companies, the cost of their health care would be publicly funded: most of the new expenses would be met by rolling back Bush-era tax cuts for Americans who make more than $250,000.
Despite Republican scare tactics, it appears the weight of public opinion has swung behind a national healthcare system. While Presidential elections are often decided by the public's perception of the personalities of the Democratic and Republican candidates, the 2008 election seems likely to be decided on the basis of issues. On the two most important issues, Iraq and healthcare, there are marked differences between Democrats and Republicans.