Healthcare Conspiracy
There’s something very sick at the heart of America. Something that in 2016 cost us $10,345 per person, and got us next to nothing in return. It’s a healthcare system three times as expensive as most, and achieves a life expectancy no higher than many third world countries. It is a conspiracy of profit and predatory Capitalism, driven by Adam Smith’s invisible hand.
“U.S. health spending per capita is often more than three times higher than in other rich countries, yet the populations of countries with much lower health spending than the U.S. enjoy considerably longer lives,” reports Our World In Data. “In the most extreme case, we see that Americans spend more than 5-times what Chileans spend, yet the population of Chile actually lives longer than Americans.”
The proof is everywhere, from Chile to Japan. And it stretches back to the 1880s, according to Smithsonian Magazine, when Germany’s legendary “iron” chancellor and industrialist, Otto von Bismarck, introduced the first socialist healthcare.
Bismarck did this with his landmark Sickness and Accident Insurance Laws in 1883 and 1884, in reaction to rising socialist fervor produced by factory injuries. It’s strange to reflect that socialized medicine, in many cases, was a reaction to industrialization and capitalism themselves.
Yet in the United States, where capitalism and industrialism have ruled for a century and a half, we are still asking ourselves if we can afford universal healthcare, whether it would really work here, and whether a system introduced by one of history’s most famous conservatives will turn us into socialists.
The question of affordability itself is a strange one. We already have a healthcare system that is drastically less efficient with every dollar spent than every single-payer system that exists. The $10,345 per person we spent in the U.S. totals to $3.35 trillion, as reported by PBS. For this expenditure, we live to be an average of 78.8 years old, according to the Center for Disease Control and Prevention.
Since the 1990s, politicians and insurers talked about the the American healthcare system as top notch. Meanwhile, Japan reached a life expectancy of 83.33 years old in 2013. It was for a per capita expense of just $3,951.95, again according to Our World In Data.
As if to pile onto this corruption and profit protectionism, until recently news agencies have insisted on ignoring all 11 developed countries in the world, according to Newsweek, that have cheaper and better healthcare systems than we do. They insist on conflating healthcare funding with disaster scenarios, when these questions have been reliably answered elsewhere for over 60 years.
The British National Health Service began between 1946 and 1948. The German system takes its roots from Otto von Bismarck’s 1884 Sickness Insurance Law. The Canadian system began in 1947 in the province of Saskatchewan, and spread across the nation. Japan first achieved universal coverage in 1961.
Around 1910, nearly 30 years after Bismarck’s laws, American medicine was finally moving from the home to more formal settings. As with other industrialized nations, America’s gearing up as an industrial and military power also spurred the first universal health insurance proposals, according to the Pittsburgh Post-Gazette. But they weren’t popular with those involved in insurance and medicine.
“Doctors worried then, as now, that health insurers would have too much control over prices and practice methods; insurers worried that a system of “compulsory” health insurance would interfere with their lucrative life insurance business.”
With the 1920s came the rise of Blue Cross and Blue Shield, which were “essentially nonprofit health insurers who served local community organizations,” according to this article on Slate.com. Their success convinced commercial insurers that healthcare was profitable, and the situation worsened during World War Two as employers offered health insurance to “get around wartime wage controls.”
In came President Harry Truman, who in November 1945 introduced the Hospital Survey and Construction Act, referred to as the Hill-Burton Act, according to NPR.
“Hill-Burton provided construction grants and loans to communities that could demonstrate viability — based on their population and per capita income — in the building of health care facilities. The idea was to build hospitals where they were needed and where they would be sustainable once their doors were open.”
You might notice that Truman’s emphasis was not on bringing healthcare to those who had the most difficulty accessing it, but to those who could pay the most for it. Again, we see the primacy of profit over coverage, but then it took yet another turn for the worse.
President Richard Nixon passed the Health Maintenance Organization Act of 1973. And for awhile, Health Maintenance Organizations (HMOs) did a decent job of slowing the unsubstantiated inflation of costs as private insurers developed the lucrative sector. But as pointed out in Michael Moore’s 2007 documentary, Sicko, the purpose of this bill was, primarily, to make for-profit healthcare legal in the U.S. on behalf of Nixon’s friend, Edgar Kaiser, of Kaiser Permanente.
This can be heard in Nixon’s own voice, speaking to his counsel and Assistant to the President for Domestic Affairs, John Ehrlichman. Ehrlichman would later be jailed for activity surrounding Watergate.
“I had Edgar Kaiser come in…talk to me about this and I went into it in some depth,” said Ehrlichman in a 1971 tape with Nixon. “All the incentives are toward less medical care, because the less care they give them, the more money they make.”
“Fine,” mumbles Nixon.
By 1980, the U.S. was spending over $1,000 on health expenses per person. And things only got worse with Clinton’s failed initiative of 1993. The subject became politically stigmatized.
This continued roughly until 2009, when Obama’s public option failed, according to NPR. The economic crisis was in full swing, and the price tag was too much of a risk. So we got Obamacare.
Even with per capita costs exceeding $10k annually, we’re stuck explaining how we’ll pay for it, and how we can make it work. One popular claim is that no country with our geographic size and population has ever achieved socialized medicine. And this is true, primarily. However, since 2014, China has increasingly guaranteed coverage for at least 70 percent of healthcare costs, according to Xinhuanet.com. Their system now insures 95 percent of Chinese citizens.
The question isn’t whether we can afford or operate a system which, by all relevant examples, will be cheaper per capita and more effective than what we already have. Other countries have done it.
The question is this: do Americans have the courage, the ingenuity, and the resources to design the best affordable universal coverage system in the world? We must find the courage to stand up to those profiting from our misery, because we have very little to lose. This is an engineering problem that can be solved, in part because there are many well-designed examples. Americans will figure it out.
