Map of life expectancy at birth from Global Education Project.

Friday, January 23, 2009

A bit more on the politics

I'll try to answer one question briefly. Why do the other members of the United Federation of Planets have some form of universal health care, but we don't? It has a bit to do with accidents of history, and more to do with our political culture.

The accident of history is a bit paradoxical. The present system which is largely based on insurance provided by employers got established during WWII, actually before most of the other countries set up their universal systems. It happened in part because of wage controls imposed during the war, in the middle of a tight labor market. Employers couldn't raise wages, but they needed to offer perks to attract and retain employees, so they padded the benefits, of which health insurance was a particularly nice one. Unions liked this system because it gave them something they could bargain for and win for their members as well.

Remember that back then, health care didn't cost nearly as much as it does now, but on the other hand it wasn't as wonderful a thing. Most of us are too young to realize that it wasn't until WWII and really the post-war era that doctors actually had a decent clue what they were doing. Antibiotics were developed during the war and became generally available afterwards. That was the biggie in itself, and it led to the possibility of reasonably safe surgery. Then came a growing understanding of heart disease and cancer, orthopedic surgery and devices, and so on. Until then, doctors did at least as much harm as good. (That balance is still a lot closer than we'd like it to be, but it has certainly tipped.)

So, when England established its National Health Service in the 1950s, and as the Canadian single payer system developed over the decades through the 60s,
medicine was just coming into its own. The vested interest represented by the pharmaceutical companies and the medical establishment was not as powerful as it is in the U.S. today, and health insurance companies in those countries were minor players. Even so, the Canadian single payer system had to overcome considerable resistance from doctors. In fact, the doctors in Saskatchewan went on strike in 1962, but they kind of lost steam when the death rate immediately went down.

Harry Truman tried to introduce a national health program in the U.S., but the American Medical Association was an implacable opponent, and the doctors' lobby was too well funded and too powerful to defeat. Meanwhile, since many workers already had insurance through their jobs, and health care wasn't all that expensive anyway, the pressure for reform wasn't all that powerful. By the time John Kennedy became president, however, the plight of uninsured elderly and low income people was obvious, and he proposed creating programs to address their needs. So the AMA had Ronald Reagan make a recording called "Reagan Speaks Out Against Socialized Medicine," which was sent out to the Ladies' Auxiliary of the AMA (yep, doctors were presumptively male and their wives formed an Auxiliary), to be played at garden parties. Reagan said, famously, that if Medicare passed, "one of these days you and I are going to spend our sunset years telling our children and our children's children what it once was like in America when men were free."

Lyndon Johnson ultimately got Medicare and Medicaid passed in 1965, but in the larger picture, that took off much of the pressure to create a truly comprehensive system. Meanwhile, even as the AMA shifted its position, the power of the drug and insurance companies grew. So, the bottom line is, we've had both bad timing, and a deep-seated cultural resistance to anything that can be labeled "socialism." No, Medicare didn't turn the U.S. into a totalitarian dungeon, but the drug peddlers are still screaming and yelling that a single payer system will. And enough working class people believe it that we don't have a unified constituency in favor.

Why do working class people in the U.S. fear government intervention to promote the general welfare? That's a longer story, but I'll try to tell it soon. All I'll say for now is that the election of Barack Obama could change that, if he's bold enough. So far he doesn't appear to be, but we'll see.


kathy a. said...

thanks for the background. i knew that kaiser steel was groundbreaking in providing medical care for employees during WWII; did not know that england and canada adopted national programs so early. and although i know antibiotics changed everything, i hadn't really placed their general use so close to my birth.

we had no health insurance while i was growing up; the first time i was covered was as a college student in the mid-late '70's. my baby sister was born prematurely in 1965; costs were lower then, but i really do not know how my parents managed that financially. i think their church and friends must have pitched in, and know at least the ob/gyn and pediatrician did not ask for payment. everyone thought my sister would die [2.5 lbs.], but she didn't.

i hope circumstances may be different enough now that many doctors would favor an overhaul. GP's and specialists who serve old and/or poor people are struggling to make ends meet; medicare reimbursements are awful, the paperwork is awful, and there are too many patients with too many needs.

kathy a. said...

also, dang. ronnie reagan shilling for the AMA, telling the garden clubs of america that the commies would come get them if they gave into universal health care. why my parents voted for people like that is a question i'll never be able to answer.

C. Corax said...

Why do working class people in the U.S. fear government intervention to promote the general welfare?

I'm looking forward to the answer to this! Obama hasn't inspired me with great confidence where health care is concerned. Health insurance is NOT health care.

kathy a. said...

c.corax -- i suspect that many people are afraid they will lose some of what little they have, if limited resources have to stretch farther.

that is definitely a political theme that has been exploited over decades. the myths of welfare moms pumping out more kids to get more benefits; food stamps for beer and drugs; cadillacs owned by project residents. blah blah.

a major factual problem with the theme is that the genuinely rich have continued to get way richer, over those decades of "trimming fat" and "reforming" social programs and "free market" policies and "returning to family values." there has been so much political BS dominating for so very long.

i wish we could bring ronnie back and take him out to some trailer parks and projects; he was stupid and easily manipulated, even before the dementia, but maybe not so mean as to condemn people he met in person. people who keep trying and losing.

don't we need something fairer and more comprehensive than what's been going on? don't the folks affected in their daily lives deserve better?