On July 19th, an article by Chris Sacchim was published here titled “On American Healthcare – ‘Healthcare is Not a Human Right’”. As that title might suggest, it centered around the current American healthcare debate. The reason I feel compelled to write this response is because I believe the author’s argument fails to grasp the realities of American healthcare, and to properly engage with the arguments of those in favour of healthcare being a human right free at the point of delivery. You can read the whole thing here to make sure I’m not misrepresenting any of his positions.
Overall, his argument consists of the following six points:
- Healthcare providers are right to charge people with pre-existing conditions more because that resembles the way in which car insurance companies charge extra to cover higher risk vehicles and drivers.
- Provisions within the Affordable Care Act (Obamacare) which prevent Healthcare providers from discriminating based on pre-existing conditions increase costs for lower and middle income Americans, as those that are healthy are forced to subsidise those that are not.
- Charity is thus better than taxpayer funded social security at providing poor and vulnerable people with healthcare.
- The US federal government knows nothing about providing healthcare.
- If healthcare providers could charge their customers less, they would already have done so in order to beat off their competition.
- Preventing healthcare providers from discriminating based on pre-existing condition puts hundreds of thousands of jobs at risk.
All of the above are spectacularly absurd, but let’s start off with the first. To quote the author directly; “Pre-existing conditions should not be treated in any different way than a fancy red sports car being a higher risk to the car insurance company.” The obvious thing to point out here is that, to those who advocate for healthcare as a human right (and, I would argue, anyone with a properly functioning moral compass), healthcare is just that, a right and not a privilege akin to “a fancy red sports car.”
This is precisely what I meant above regarding the author’s failure to properly address his opponents’ arguments. He retorts that healthcare providers should be allowed to discriminate against those with pre-existing conditions because that’s what you do “If you want to run a successful business,” however, the argument which proponents of socialized healthcare make is that healthcare should not be run like a business. The author does nothing to engage with the moral side of this argument, perhaps because his position would stand out as distinctively amoral.
Funnily enough, the car analogy he uses is somewhat akin to what conservative commentator Ben Shapiro had to say in response to a tweet by Bernie Sanders arguing that people getting a diagnosis but not being able to afford the treatment is insane; “I go to a fancy store to check out a piece of furniture, can’t afford it. That’s totally crazy!” The response to both analogies is the same – preserving human life is rather more important than owning a ferrari or a swanky wardrobe.
On to the second point; Obamacare increases healthcare costs for lower and middle income Americans by forcing them to subsidise people with pre-existing conditions. There are two things to be said in response. First, that statement is simply untrue given that Obamacare specifically subsidises people on lower and middle incomes. Medicaid also exists to insure low income people as well as those with disabilities. Both Medicaid and the aforementioned Obamacare subsidies have received drastic cuts under the Trump administration, so if you’re looking for someone to blame for rising premiums it’s certainly not the Democrats who are at fault.
Second, the author’s argument that the individual mandate renders those on low incomes worse off curiously omits the terrifying fact that approximately 30 million Americans still do not have health insurance, up 3.2 million in the first year of Trump’s presidency. Meanwhile, it is estimated that 20 million Americans gained insurance under Obamacare. Contrary to what the author claims, the program has helped tens of millions gain access to healthcare and (despite the best efforts of Republican lawmakers) continues to subsidise those on lower and middle incomes.
The author then attempts to preempt what he believes will be the typical response to his last point: “Well, I’d gladly pay higher taxes if it means that some of that will go to helping sick people.” I’m somewhat confused by the fact that he is now talking about taxes, given that his previous point revolved around higher insurance costs, but I’ll give him the benefit of the doubt and assume that he takes the latter to be a form of tax given that Obamacare requires people to buy healthcare (it’s a strange way to frame the debate, but whatever).
Regardless, the argument that subsequently follows is that if one is generous enough to subsidise the healthcare costs of those less fortunate than themselves they should donate to charity, as opposed to advocating for a form of socialized healthcare whereby everyone is forced to contribute. This is another instance of the author seemingly failing to grasp reality. More specifically, the reality that charity is a remarkably bad way of providing healthcare. Indeed, the sheer amount of Americans taking to GoFundMe to finance emergency medical costs has long since become somewhat of a sick joke.
Ultimately, like all libertarian fantasies, the “just use charity to fund healthcare” argument does not stand up to the most elementary of scrutiny. According to the Giving USA Foundation, just over $38 billion was given to health organisations in 2017. Meanwhile, the Medicaid budget alone stands at well above $500 billion. Even if we accept that charities are as a whole more efficient as opposed to state and federal healthcare providers, these numbers just don’t add up. Americans are certainly generous, but they’re not that generous.
For every GoFundMe page which manages to secure its desired funds, there are many more that don’t. It should hardly surprise anyone then that a 2009 study found that over 40,000 Americans die every year due to lack of access to healthcare. In every other developed country on Earth, that number happens to be 0. Say whatever you want about the NHS, but no Briton has ever had to sell their house due to a medical bankruptcy. Earlier this month, a Massachusetts woman was reported begging strangers not to call an ambulance as she lay bleeding on a Boston subway platform. Personally, I think the fact that such a thing can even happen in the world’s richest country is utterly disgraceful. I suppose the author might have a different moral outlook on the issue.
Moving on, he then proceeds to claim that “the field of health care” is something which the federal government “clearly doesn’t know a thing about.” I won’t spend too long on this one, only long enough to point out that Medicare, the federal health insurance plan for Americans over 65, is also the most popular healthcare plan in the country. Combined with Medicaid and the Veterans Administration, it amounts to approximately one third of total US healthcare spending. Both are facts that the author chooses to omit, or simply does not know.
Fifth, the claim that, if insurance companies could charge their customers less they would have already done so due to market competition. Muh free market! Unfortunately, there are two problems with this line of thinking. First of all, just like with American broadband, the US health insurance industry is increasingly monopolised. In some states, a single insurance company controls almost the entire market. A 2012 study found that 99% of the healthcare market had become “highly concentrated” by 2006, up from 68% in 1998. This also correlated with a 7% increase in premiums over that period.
Secondly, the author yet again ignores the actual argument made by proponents of healthcare as a right – if the “free market” cannot provide healthcare to everyone that needs it, then healthcare should be taken out of the realm of the free market. It is a well known fact that drug prices in America are far higher than in other countries. A 10mL bottle of insulin costs approximately $450. In Canada, it costs about $21. What is perhaps most absurd is that a lot of these drugs are produced in America in the first place, and state healthcare providers across the world negotiate for lower prices – another reason why the “they just can’t afford to make care cheaper” argument holds no water. Last year, the US Senate killed a bill that would allow Americans to import cheaper drugs from Canada. Politicians who continue to take millions from America’s drug cartels voted to maximise profits for their paymasters. Finally, it might be worth mentioning that a recent Koch funded study (oh the irony) found that a medicare for all system would save the United States trillions of dollars. Clearly, the free market is not quite as efficient as some would have us think.
Finally, on the subject of potential job losses, as we have seen, there are more than enough funds to go around. Unitedhealth Group, the largest US insurance company, recorded a massive increase in profits last year. Moreover, the author’s prediction of job losses can be most easily disproved by the fact that, since Obamacare forced insurance companies to stop discriminating based on pre-existing conditions, the amount of people employed by the industry has only increased. I honestly don’t understand why he didn’t check this before writing his article, since it alone completely destroys his last point.
Furthermore, the author again fails to address the case which progressives are actually making – private insurance companies would not be cutting jobs if there were no private insurance companies. Under a national healthcare system, the government can allocate funds where it sees fit in order to prevent job losses and alleviate pressure.
I look forward to the author’s response, should he decide to write one.