Why is universal healthcare such a polarising issue in the United States?

Why is universal healthcare such a polarising issue in the United States?

As a British national—with the notion of universal healthcare so intrinsic in the fabric of society—it can be difficult to comprehend the resistance it receives across the Atlantic. Since its inception in 1948, the National Health Service (NHS) has been fundamental in championing the welfare of all British citizens and has earned its pride of place in the country’s collective consciousness. Founded on the principle of healthcare as a human right, many British people find the prospect of privatising the health sector to be a violation of our core morality. In fact, a survey conducted in 2017 revealed that 84 percent of participants believed that the NHS should remain public.

It is a somewhat different story in the United States, however. While government funded schemes do exist for the elderly and disabled (Medicare), and for those with a low income (Medicaid), the majority of Americans must either rely on health insurance, or go uninsured. Insurance is often provided or subsidised by employers as part of an employee benefit plan, but many also purchase insurance independently for themselves and their families. It is a largely private sector that costs Americans thousands of dollars every year, and yet it continues to perform poorly when compared to other developed countries. A report by the World Health Organization (WHO) concluded that the United States’ healthcare performance ranked 37th out of 191 countries despite spending the highest amount per capita. The United Kingdom, by comparison, placed 18th. Although this is still not the most impressive figure, it certainly seems to suggest that the British system of universal healthcare functions more effectively. Why then does it attract such vehement opposition across the pond?

One of the most plausible arguments relates to the concept of American exceptionalism. This refers to the idea that the US is unique in its liberties, democracy, and values, and presents a fitting brand of patriotism for the leader of the free world. Made evident by the creation of the Declaration of Independence in 1776, the United States has historically held a relatively anti-authority stance. In gaining their rights and freedom from the British, these burgeoning American colonies cemented their self-rule and positioned themselves as a nation that marches to the beat of its own drum.

The potent and idealistic ethos of the American Dream is one such defining characteristic, and is integral to the view of personal liberty in the United States. The opportunity for upward mobility and economic prosperity that defines this philosophy creates a climate of self-reliance and individual responsibility for one’s successes and failures. Thus, Americans tend to place less value on their nation’s collective wellbeing than other comparable countries such as the United Kingdom. In terms of healthcare, this is significant in explaining why many American citizens and lawmakers struggle with the notion of universal care. It essentially defies the belief that people are accountable for their own welfare, and that hard work can absolve adversity.

This kind of rugged individualism exists not only in the private sphere but extends to the framework of federal governance with the predominantly Republican preference for decentralisation. The limitation of federal control over state issues signals a general scepticism towards big government, and enables us to better understand why universal healthcare may seem inherently un-American. The atmosphere of distrust in the federal government would render centralised control over healthcare inconceivable. The principle of individualism is so tightly bound to the American spirit that any hint of socialism sends shivers down their proverbial spines. This is undoubtedly a residual effect of McCarthyism and the Red Scare of the 1950s which saw a heightened paranoia surrounding the spread of communism reach fever pitch.

The unmistakable hostility towards the socialist persuasion in the United States is a necessary facet of the American Dream as it generates the perfect breeding ground for capitalism: the antithesis of communism. The idea that America’s citizenry can strive to prosper forms the basis of the capitalist economic structure and paves the way for private enterprise. The commercial health industry is a direct result of this system and has spiralled into what is often described as the Medical-Industrial Complex, which refers to the thriving network of for-profit medical establishments that treat health as a business pursuit. Kingpin of the global health industry and the largest provider of health insurance in the U.S., UnitedHealth amassed an astonishing $201 billion in revenue and an operating income of over $15.2 billion in 2017. Companies across the medical and pharmaceutical industries who enjoy these vast rewards often harbour an unjust political influence and have a vested interest in upholding the status quo.

It is hardly surprising, then, that the prospect of losing these monumental profits by surrendering private control to a centralised system of government is less than appealing. In addition, the publicisation of the industry would most likely prompt a tax increase in order to adequately fund its continued operation. Once again, many Americans, and Republicans in particular, view this as an unwelcome imposition, maintaining the belief that individuals should not be required to pay for other people’s medical treatment. Under Obama, the Affordable Care Act, also known as Obamacare, endeavoured to increase Medicaid coverage and eliminate discrimination against pre-existing conditions. Since the inauguration of Donald Trump, however, the Republican congressional majority has been attempting to dismantle these provisions.

Meanwhile, on the other side of the spectrum, the voices of America’s left wing call for what Senator Bernie Sanders labels as Medicare for All. There appears to be a reasonable groundswell of support for universal healthcare amongst Democrats, despite the historical emphasis on individualism. In actual fact, a recent Reuters poll indicates that 70% of Americans favour this ambitious plan as the current system’s shortcomings become increasingly apparent. After all, there are numerous benefits to a centralised structure such as the NHS. Cost regulation would minimise the drastic overspending that pollutes the industry and drives fees through the roof, while a standardised level of care and synchronised codes of practice would ensure all citizens receive equal treatment, regardless of circumstance. The biggest issue facing this expanding movement now involves reaching a consensus on how universal coverage would function, and how a smooth and harmonious transition would occur in the face of substantial resistance.

The American Dream has its steadfast roots buried deep within the American psyche. It constitutes the foundation of the nation’s collective character and acts as the guiding force behind their appetite for success. It is easy for outsiders to pass swift judgement and attack the morality of the American healthcare system, but it is important to acknowledge the significance of the status quo. Fear of the unknown holds humanity in a powerful embrace and the possibility of such disruptive change poses a real threat to societal stability. For most Americans and Brits alike, our respective structures are the only systems we have ever known. In an environment that profits extensively from the prevailing situation, the fight against the healthcare revolution is palpable. As former president Jimmy Carter stated in an article for Time Magazine, the ‘concepts that are commonplace in almost every other industrialised country are portrayed as outlandish and dangerous’ in the United States. Socialised medicine is simply an alien abstraction. Yet a virtuous thread weaves its way through the American machine, en route to its epicentre, carrying the honest belief that healthcare is a human right, and that it is fundamentally unconscionable to monetise a person’s survival.