¶ … United States and National Healthcare Insurance: A Winning Proposition?

Physical health and well-being are among the most basic needs and desires of human beings. We all hope that neither ourselves nor our families will ever be the victims of sickness, incapacitation, or any other malady. We hope too that if we ever do require the services of professional Healthcare providers we will not be bankrupted by the expense. Yet, it is a fact of life, that good Healthcare does not come cheaply. Especially in the United States, physicians hospitals, and other forms of medical care are extremely expensive. Like their counterparts in so many other fields, American medical practitioners are among the most highly paid in the world. A serious illness, especially one requiring hospitalization, can spell financial ruin. It is of course for these reasons that so many Americans have Healthcare insurance. Nevertheless even this insurance is very costly. While once typically covered by one's employer, the rising costs of Healthcare have meant that many employers now pay less and less of a share of the cost of this insurance. More and more, individuals are forced to take out insurance at exorbitant rates. And many more, cannot even afford to pay these premiums, preferring instead to go without insurance and hope that they, and their families, will never require the latest in expensive medical care. In other countries, it is the government that absorbs these costs, a system of national Healthcare insurance providing coverage to all citizens. This too, is costly to the taxpayer, and has frequently been blamed for lower standards of care. Indeed, in the early 1990s under the Clinton administration, a system of national Healthcare was proposed for the United States. It failed however. But the dream has not died. Many Americans still believe that they would be better off if the government paid for the costs of Healthcare. And perhaps as many, believe that the physician-patient relationship is not the proper province of government. So the argument continues -- is government-sponsored Healthcare insurance a winning proposition for the American people?

The nations of Europe, and Canada too, have had national Healthcare systems for years. In fact, it is often pointed out that the United States of America is the only major industrialized nation without a system of national Healthcare insurance. These national Healthcare systems arose as part of a general social welfare program. In many European countries, Labor parties were very powerful -- they served much the same purpose as America's trade unions. Their members advocated socialist schemes designed to promote the general well-being. The desire for improved public health grew naturally out of the improvement in material conditions that was experienced by all industrialized societies. Physical well-being was associated with physical comfort. As Alexis de Tocqueville observed more than 150 years ago in his famous treatise Democracy in America,

"In America the passion for physical well-being...is general.' He saw this passion for bodily comfort, for a sense of individual ease, as an inseparable part of a desire for material well-being. Benjamin McCready, in an essay written for the Medical Society of the State of New York in 1837, said much the same thing: 'the Americans are an anxious, careworn people.'"

(Titmuss, 1969, p. 133)

Thus the general improvement in conditions that characterized both America and Europe resulted, in Europe, in the eventual creation of national Healthcare programs. It was seen as the natural outgrowth of the growing concern for the well-being of all individuals, including the laboring masses. The increasing centralization of the means of production was paralleled by an increasing centralization in the means of administration and government. Much as Europe's captains of industry were creating larger and larger agglomerations of capital, their employees, subjected to intolerable working conditions, banded together to apply pressures at the highest levels to improve their own circumstances.

Political cultures are critical to the conception of policy solutions: policy innovation is guided by what is "culturally imaginable"; implementation is more likely to be guided by structural constraints and opportunities. Centralization of the state apparatus is a major factor in states' capacity to implement policies. A defining characteristic of state centralization is the decision-making autonomy of government officials, allowing policy implementation to proceed relatively smoothly once policy decisions are made. By the same token, "a complicated division of jurisdiction between a multitude of semi-independent government agencies and a federal stratification of state authority (as in the United States) tends to make policy implementation more cumbersome."

Even in the United Kingdom, whose traditions and methods of administration was closely resemble those of the United States, and where especially at the time of Margaret Thatcher there were increasing calls for government to "butt out" of people's lives, support for Britain's national Healthcare system remained strong.
Even today, after the introduction in 1991 of the so called internal market in health care ... The guiding principles of the NHS [National health Service] remain, at least nominally, those of its founding architect: Aneurin Bevan. These are a universal, comprehensive service, free at the point of delivery and -- very important to Bevan -- of the best available quality.

(1996, p. 100)

Equally astonishing to many, is the fact that the correlation between quantity and quality of Healthcare is not always so clear cut. Many Americans assume, incorrectly, that standards of Healthcare in countries with national health systems must be lower than in the United States with its seemingly endless choice of providers, caregivers, and even insurance plans. However,

In terms of national health systems, the United States is something of an "exceptional case" in a pattern that cuts across conventional expectations. It has by far the highest health costs in the developed world (or anywhere else for that matter). Yet, it scores quite poorly on infant mortality; and it has by far the most privatized system which would be expected to hold costs down. It also has a relatively low number of hospital beds per capita which suggests cost-driven efficiency, but it also has the lowest hospital bed occupancy rate in the developed world which bespeaks exactly the opposite.

(Clark & Mceldowney, 2000, p. 133)

Yet despite these apparent anomalies, a large number of Americans oppose the creation of the national Healthcare system that would be funded by the federal government.

Americans' reservations regarding public funding of Healthcare come from various quarters. To many, the implementation of what amounts to a socialist program is, in and of itself, "un-American." Americans have a long history of opposing government involvement in their lives. Though always lacking in any legally recognized classes, the United States has not been without its own elite, and its own underclass. Differences in wealth, religion, race, and ethnicity have often created conditions of profound inequality in the "home of democracy." We pride ourselves on the supposed equality of opportunity available to all Americans, and so close our eyes to such manifest injustices.

The goal of universal coverage offers a solid base for building a potent democratic institution. We know it cements social equality to have Americans attend the same schools and serve in the same army. What effect would it have if they used the same doctors? The experience might not be as intense as school or service, but it would be repeated throughout a person's life. Certainly health care seems to play a major socially equalizing role in Western Europe, where every country has some sort of universal national health plan. In most of them, the plan's egalitarianism is a matter of fierce national pride, "part of the cement that binds a people together as a nation."

(Kaus, 1995, p. 90)

It is as if to say that access to quality Healthcare is as much a measure of success as say, access to good schools, or even to a country club. Americans proclaim their social status equally through the cars that they drive in the physicians who may patronize. But is this really the American way? Have Americans always been so callous in attitude toward those who have less than they do? Does "America" really exclude, by its very definition, the concept of a helping hand?

Many Americans do in fact agree that the state should assist those less fortunate than themselves. For these individuals, the primary argument against the national Healthcare system is not social or medical, but rather financial. The federal government has been careful to affirm it is financial considerations, rather than any sort of social disability or prejudice, it lies at the heart of any perceived disparities in public health, or access to adequate Healthcare. A report released at the beginning of this year (2004) made note of just these arguments.…