I live in a country that purports to have “universal” healthcare. Like many countries that have such a system, there are problems. Availability of care, or rather difficulty in properly accessing care, is a major issue, as I believe I have already written about.
This evening, as I was fretfully trying to remember whether I had remembered to inject my evening’s dose of basal insulin (that is, the insulin that keeps working to keep my blood sugar from reaching orbit over a twenty-four hour period, called insulin glargine), I read some news that left my mouth hanging open for a moment. The Supreme Court of the United States basically ruled that the lion’s share of President Barack Obama‘s healthcare initiative was constitutional, legal, and therefore now apparently law. Whilst I have been disappointed in Obama for reasons that do not relate to this particular topic, I believe I should raise a tankard in toast to him. For if this law ends up being seen through to its logical conclusion, its ramifications will be felt not just in America for a very long time, but also in varying amounts around the rest of the world.
Americans who have no idea what goes on outside of their borders, or in many cases outside of their own street, like to kid themselves that they have the best healthcare system in the world. I think the number of Americans who genuinely believe this are a shrinking minority, but they are also a very vocal minority, so it is worth taking the time to examine a few facts about America, both in healthcare and social policy.
America has a space-age healthcare system, but only when you look at one aspect of it: the emergency healthcare system. That is, when a person is in a situation where they need to be cared for with drastic measures or they will die, America’s system excels. But what Americans either do not realise or do not want to acknowledge is that many other nations such as Australia or England also benefit from an emergency healthcare system that, whilst not quite as powerful as theirs, is almost always (think 99.99%) as effective. For what we refer to as preventative or maintenence healthcare, America is effectively still in the stone age.
There are two factors in why “socialist… waaaah!” (sorry, just saying it like an American) nations such as Sweden or Norway have far better health outcomes than does America. One is very easily relatable to the growing portion of the world’s population that suffers from diabetes or cancer, or both like I do. Simply put, all of Europe’s nations, as well as most of Asia’s, Oceania’s, and so forth, put all of their emphasis in healthcare terms on prevention. Although this reduces the level of profit experienced by workers in the healthcare industry, especially insurers and other top-level types, it also increases the level of profit to society as a whole. In this context, profit means less lost productivity, less money expended on preventable disastrous healthcomes such as amputation or prematurely-needed convalescent care, and the like.
I do not expect the faux tea party idiots to be capable of understanding this point. But healthcare is a total either-or proposition. One can pay a certain amount now, and get more bang for their buck, or one can pay a lot more later to do the equivalent of putting one’s finger in the dike. I will return to this point in a moment.
I doubt it will come as a surprise to a lot of more educated and / or intelligent (the two are not necessarily one and the same) Americans that there is another reason why Sweden and America have polar opposite outcomes in terms of the health of the citizenry. America’s Gini index, or Gini coefficient depending on the terminology you prefer, was quoted as being 0.450 according to this article on The Atlantic. This puts the United States Of America at near to the bottom of the world’s list. Granted, substantial portions of Africa, and a couple of nations in Eurasia and South-East Asia are listed as having no data available, but there is an eerie correlation between the reputation a nation has for lawlessness and whether its Gini index is better or worse than America’s. Frank Van Wensveen‘s LiveJournal is rife with tales of blatant, in-your-face corruption in South Africa, so it should come as no surprise to anyone that South Africa and every nation geographically connected to it, up to somewhere around the same parallel as New South Wales’ Northern border, is listed as having “greater inequality”. Nor is it surprising that almost the entire continent of South America, with three or four visible exceptions, has greater inequality than America. Again, this correlates with the reputation for corruption and criminal industry that each nation has, and does so quite well. Mexico having a greater rate of inequality than America, therefore, should surprise nobody. What is more worrying, however, is that according to this map, the massive bloc of Eurasia that used to be referred to as the Union Of Soviet Socialist Republics (or USSR), in spite of its reputation for corruption and rigged elections, is listed by this map as having less inequality than the United States.
Now, people have already noticed me invoking a lot of comparisons with Sweden in this writing. Good. According to the statistics used on the Wikipedia, Sweden’s Gini index in 2005 was 23. More recent data from the NationMaster website puts their Gini index at 25. The latter shows two nations, Denmark and Japan, as having lower Gini indices. But only by shavings: Japan at 24.9, Denmark at 24.7, which is still a very low level, but not as much as to make noticeable differences in the lives of citzens in these three countries.
Tea party in name only types will try to tell you in their “everything I say is automatically fact” manner that having lower or higher amounts of inequality does not matter. But the sad morsel of truth here is that it does matter. Through thirty years of living in a country that continues to try to emulate big brother/sister America, and often does so in income inequality statistics, I can testify that increases in income inequality do make a noticeable difference. In 1987, the idea that people in Australia would have to sleep in the street and basically die of neglect was absurd. It was considered an “America only” thing, albeit somewhat naïvely. By 1999, stories of people begging in the streets, and being visibly addicted, were commonplace. Australia’s Gini index is not nearly as high as America’s, granted, but the changes in social policy in both nations have resulted in worse outcomes for both.
There is a saying that morons in America like to use to try and justify the unjustifiable. That a rising tide raises all boats. But that is only true if none of the boats are being weighed down. Contrary to what pro-corporate propaganda will have you believe, unions in the past served a very important function to the workers of the democratic world. You see, in an economy where unemployment is kept at or above a constant rate for reasons that are beneficial to business, the entrance of more and more workers into the workforce (with no new starting businesses to create jobs) puts more and more downward pressure upon wages. And in the midst of a population explosion, suffice to say that downward pressure on wages is intense. So much so that in the absence of regulation, fiscal policy, and unionism to counter this pressure, workers’ wages are remaining stagnant compared to inflation whilst CEO and corporate owners’ salaries have exploded, increasing more than a hundred-fold during the 1980s and continuing along that trend in the two decades after that.
Add all of this up, and it is pretty easy to see one interesting effect that I hope takes place as a result of the so-called Obamacare laws. One of the provisions of Obamacare is apparently that insurance companies are now required to spend eighty-five percent of their money in “real health care”. Whilst the puff piece I read this from is not specific as to what “eighty-five percent of their money” means, this could bring about drastic changes not only in America’s healthcare industry, but in American society in general.
You see, America can invest as much as it likes in healthcare. In fact, from what I have read in some places, America invested even more in its healthcare system than other first-world nations during the 1990s (as a percentage of GDP), and it did not do one bit of good. So when the insurance companies are told they must invest eighty-five percent of their gross earnings (one way I interpret the wording) in actual healthcare, I think both the private insurance industry and commercialists as a whole in America are going to have to start asking themselves some very hard questions about why they are pouring ever-increasing amounts of money into the care of the poorest individuals on their roster to get diminishing results, and they are not going to like the answer.
You remember all of that yammering I did about how Sweden’s Gini index of income inequality (and indeed, most of Western Europe’s) hovers around half that of America? Well, there you have one of the hardest answers of all in the question. Those morons who are making the founding fathers rotate in their graves can bawl like babies about it until the sun weeps water, but the simple fact of the matter is that higher income inequality means higher healthcare costs and poorer healthcare outcomes. So the insurance industry is going to have a very compelling reason, assuming all alternatives involving more laws being passed by bribery fail, to reduce the level of income inequality in America. Which brings me to another point. People who want this legislation to pass and take effect are going to be afraid for a while that the astroturf party are going to take it away from them again. But once people who have had to care for themselves or others with things like diabetes, asthma, or other chronic conditions where the choices amount to pay for medicine or die become fully cognisant of the effects of this legislation, they are going to figure out what a shit end of the stick they have been in receipt of for all of these years. And they are going to be pretty upset about it.
Yes, there is a potential for this legislation to be abused in order to pay for curebie child abuse. But that is where activists like the autism civil rights movement come in.
And one last thing whilst I am on the subject. The real Boston Tea Party, a political protest in Massachusetts, was a political protest by the Sons Of Liberty. It was a protest against the British government and the monopoly known as the East India Company. It has nothing, not a stitch, not a yip, to do with “big government” or government intervention in anything. The Boston Tea Party was about protesting the imposition of a tax on tea that was imposed by British Parliament in 1773. The colonists objected to the Tea Act in the very correct belief that it violated their right to be taxed only by their elected representatives. Protesters had, prior to this event, succeeded in preventing the unloading of taxed tea in three other colonies. Massachusetts Bay governor Thomas Hutchinson, on the other hand, refused to allow the tea to be sent back to Britain as a protest. It is said that he was not expecting his colonists to board the ship, take the tea, and throw it into the Boston Harbour. He was a colossal idiot, in other words.
I have the following I would like to tell the faux tea party. Number one, what the hell is it that you think you are protesting? Government intervention, contrary to your belief, is the reason that in spite of multiple recessions, some of which have been quite prolonged (and they appear to be increasing in frequency), the last time we had a depression in the economic sense was during the 1920s and 1930s. The conditions for it, high income inequality, big business being taxed at lower rates than the poorest private citizens, and so forth, are exactly right. But the only reason the mini-recession of the early 1980s, and the recessions of the 1990s and 2000s have not worsened into depressions is because “big baaad government” intervened and prevented that from taking place. If you want to live in an economic depression and wait for it to ride itself out, go quit work, throw away all your possessions and personal savings, and sit and wait. Or move to a place like South Africa or Somalia. I think I speak for quite a number of your countrymen when I say that we do not want to let you drag other people and their families down with you.
Secondly, what is it with this “me, me, me” complex you have that makes you genuinely believe that you are being oppressed? Have you ever heard the expression “do not shit where you eat”? Your neighbours, your workmates, and your grocers, all suffer when you suffer from economic problems, and vice versa. That tiny little island you think you live on is a delusion. Stop thinking of only yourself. In other words, grow up.
And finally, speaking as a man who is suffering serious problems because diabetes care and cancer treatment in his locality are suffering due to government not intervening enough, if you wish to deprive everyone in America of the chance to have proper healthcare, fine. But have the courtesy to go to the family of a really sick child and explain to them why. I hope you have a better explanation than “save us from big baaad government”, because if the head of the family you address happens to be a bigger than me angry Powell type, you are going to need it.
So, in closing, I would like to congratulate the Obama administration for doing something right in the time you have had so far, and to thank you the Justices of the Supreme Court who upheld it. History, and future generations, will remember all of you fondly.