What If We Cared More About the Health of Our People?

  • January 24, 2017

Eight years ago, I had a wonderful opportunity to do a fellowship with the Institute for Health Policy Solutions (IHPS), a non-profit consulting group based in Washington, DC.  It worked with the federal and state governments that were attempting to provide health coverage to a broader section of their citizens.  I sought out that opportunity because of my deep-seated conviction that adequate health care is a basic human right that everyone should be able to access.

While I was in Washington, Barack Obama was elected to his first term as president, and the Democratic-controlled House and Senate later approved the Affordable Care Act (ACA), pejoratively labeled “Obamacare.”  One of President Trump’s first official actions, on the day of his inauguration, was to sign an executive order directing government agencies to scale back as many aspects of the Affordable Care Act as possible, although without giving any specifics about which aspects of the law it was targeting.  In addition, the new President has called for immediate repeal of the ACA, to be replaced with an as-yet undetermined Republican plan.

Universal health care has long been a topic considered by the US government, beginning in the Progressive Era of the early 1900s.  Several European countries had initiated forms of social health insurance in the late 1800s.  In the absence of government-sponsored health insurance in the US, the employer-based system that forms the basis of our current system came into being almost by accident.  During World War II, the federal government was deeply concerned about the possibility of hyperinflation, and placed wage and price controls on many parts of the domestic economy.  Workers’ unions, at that time much more powerful than today, threatened massive strikes to protest the wage controls.  To avert work stoppages, the War Labor Board “temporarily” exempted employer-paid health benefits from wage controls and income taxes.  Companies then provided health coverage in lieu of wage increases.  Thus, the basis of our current system of health care coverage came, not from a well-planned, rational approach, but a quick response to crisis in the midst of a major world war.

Largely because the US health care and insurance systems have evolved organically, many inefficiencies have grown, also.  Comparative studies regularly show the US spends more per capita and has worse health outcomes than many other countries.  One of the things I learned at IHPS was that the primary goals of health care reform are threefold: 1) expand coverage to include more people, 2) improve health care outcomes, and 3) control or reduce costs.  In any sane world, those three goals could not be accomplished simultaneously.  Unfortunately, the US health system is so inefficient those three goals can realistically be pursued contemporaneously.

Another lesson I learned at IHPS is that even the countries that first instituted national health coverage are still changing provisions to adapt to current scientific and economic realities, and have been for well over 100 years.  No one should have realistically expected the ACA to operate perfectly.  Thus, the zeal to repeal Obamacare seems to indicate motives other than simple concern about its efficiency and effectiveness.

Could it be that US citizens are less concerned about basic human rights than we profess?  The Constitution enumerates certain “unalienable rights,” including “life, liberty, and the pursuit of happiness.”  How are those achievable without health?  Why, if our government accepts the responsibility to defend our lives and liberty from enemies, foreign and domestic, to provide free public education for all, to protect free speech, and so on, does it not accept the responsibility to ensure the health of our citizens?  Why is access to health care considered a privilege available only to those who can afford to pay for it?

The economics of providing health care to all is certainly a legitimate concern.  But other countries, including many much poorer than the US, have long ago committed themselves to doing so.  Just one quick example—about two years ago, my wife and I were traveling in a rural part of India, a place where low levels of income and wealth were painfully obvious.  My wife had a health issue that needed relatively quick attention.  We asked around and were soon directed to a small, local health clinic.  The building was small, without air conditioning, and had dirt floors.  But after waiting a few minutes to see the doctor, my wife was examined, given medicine for her condition, and we walked out without incurring any cost—and she recovered quickly.  If India (and most other countries in the world, for that matter) can figure out how to provide universal health care, surely the US can.

What if we viewed universal health care as primarily a moral issue, rather than an economic one?  What if we actually cared about people’s health and wellbeing?


The views and opinions expressed are those of the author and do not imply endorsement by UNIBusiness or the University of Northern Iowa.

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