Some thoughts on ecology, evolution and economics

Caring for Americans

Shortly before leaving office in 1974, Richard Nixon proposed a universal healthcare bill that would have assured all Americans of health insurance coverage. Developed countries around the world were passing similar legislation at the time, using some mix of private and public insurance. It was also at this time that the American healthcare system began to part company with comparable countries in the proportion of GDP spent on health.  The fragmentary, employer-insurance oriented system would go on to become 50% more expensive than that of any other country. Whether Nixon’s package would have put health care onto a similar cost trajectory as other  developed countries is impossible to say but the higher costs of American healthcare have made it more difficult to consider a universal system now.

The key criticism of healthcare reform in the United States has been that it is “unamerican”, meaning that it undermines the self-reliant spirit at the heart of the American ethos. The American Health Care Act,  recently passed by the House of Representatives, redressed some of the “unamerican” aspects of Obamacare, repealing taxes, rolling back Medicaid for the poor and removing the mandatory requirements to buy or offer insurance. The Congressional Budget Office (CBO) agrees that this bill would cut the deficit and lower insurance premiums but it would do so at the cost of undoing the progress made under Obamacare towards universal coverage.  In addition to cancelling millions of americans’ insurance – remember that a good portion did not want to buy insurance in the first place – the decreases in premiums are only for the average american.  Many people, especially the old and sick, would pay much more for insurance.  It is not clear how “american” these reforms really are.  The complete picture would see a revitalized economy with more people working and more people using subsidized health savings accounts to prepare for health costs in the future.  The CBO could not take in this optimistic picture and ultimately the Republicans will have to face the voters long before their preferred self-reliant outcome develops.

Canada and the U.S.  do not compare well with other developed countries in the quality of health care they receive, routinely finishing on the bottom of the heap in such comparisons. However, one aspect of american self-reliance – the inequality of incomes –  is particularly correlated with poor health outcomes.  Life expectancy declines in unequal economies like that of the United States and Mexico. This is an effect of social tension, not poverty.  The insecurity and fear that result from having very different incomes lead not only to higher murder rates but generally poorer health. Yet America has led the world in medical innovation. The current system, as expensive and dissatisfying as it is for many, is still the envy of the world with regards to the great majority of americans who are insured.