If you were to poll Kossacks, I'd be pretty certainly that almost all would support a system of universal healthcare for the US. (There'd no doubt be differences on salience and the type of plan to choose, but the principle would be generally accepted in the group - I'm surmising.)
But the difficulties that any campaign to legislate for US UHC would face are such that success would most likely come (if at all) after a long period of attritional fighting.
The key problems with the current system (an overgenerous term!) are threefold:
- Breadth of coverage.
- Depth of coverage.
- Cost of coverage.
The headliner is the 50 or so million Americans without health cover at any one time. (The number of those non-covered at some time in the previous year is a good deal higher.)
But it's plain (for instance, from the archive of nyceve) that even those with insurance - and good insurance too - are at risk of being denied cover for particular items or altogether at the whim of their insurance company.
However, the nation could only conceivably afford substantially to remedy these grievous faults if the unit cost of healthcare can be drastically reduced.
The main barriers to reform are
- The relative indifference of the voter who expresses itself satisfied with his own care even as he accepts that the system generally is not working.
- The power of the industry lobbies, such as AHIP and PhRMA, which is unlikely to have diminished since 1994.
- The need for large enough majorities in Congress (particularly in the Senate), as well as a Dem prez willing to lead on the issue.
- The fear of politicians who support UHC in principle: of the lobbies, of a repeat of Hillarycare, of voters' blaming them for a failed or botched scheme.
There are other, structural, difficulties.
Firstly, any scheme is liable to take a long time - several Congresses - to get enacted. If at any stage it loses momentum - because of some event that sucks the air out of the legislative world - getting it back on track may be impossible.
We need to find a group of pols willing to invest man-years of work (that might have gone into electorally sure-thing projects with a much shorter lead-time) into a Herculean task that might go phut at the last moment.
Secondly, the way Congress works (if it works at all) is by compromise. (Even in recent Congresses, to an extent!) It's symbolically important that, if one side gets less than their ideal result, so does the other.
So - what if single-payer is the best scheme of UHC? How do you compromise that? Yet it won't pass without compromise.
Thirdly, a natural mode of legislation is a succession of incremental improvements. Whereas, installing a particular system of UHC (such as single-payer) may only be possible with a Big Bang bill.
Indeed, one tactic of opponents of UHC would be to insist that only incremental change is possible, and that those supporting a Big Bang scheme are head-in-the air idealists; and then limit the increment to mere window-dressing.
Fourthly, there's the fact that, whereas the lobbies opposed to UHC are focussed and have bottomless pockets, those in favor are, and have, not.
For instance, we saw the AARP finally come round to supporting the Medicare bill, doughnut holes and all; if there had been a coalition of organizations against the bill, surely the AARP would have been a leading player. How bitter would have been the recriminations from the other members of the coalition?
No doubt some kind of umbrella lobbying organization of pro-UHC interest groups could be formed. But it would be unlikely to have the coherence or resources of the industry lobbies.
Lobbying Dem MCs would be one thing; affording the sort of paid media needed to deal with the barrage of Harry and Louise stuff would be quite another.
Supervening events may, of course, help as well as hinder the progress of UHC legislation. The only two periods of sustained liberal reform were juiced by depression and assassination respectively.
What might do the trick for UHC? The imminent collapse of Medicare? (How imminent is that really?)
Or a recession leading to employers' en masse pleading for relief from the crippling costs of employee health coverage?
So where do we start? (We in the lefty sphere, that is.)
I'd say the first thing is get a discussion going on the realistic prospects of getting UHC and practical ways that the cause might be best advanced - hence this piece.
Horror healthcare tales are useful to document, but reactions of (well-merited) disgust don't take us any closer to dealing with problems that cause them.