Socialized medicine or barbarism

The American Healthcare Act of 2017, the Obamacare replacement hastily flung together by Donald Trump, Paul Ryan, and a coterie of vampiric conservative policy wonks, died before it came to a vote last week. The plan would have thrown millions of Americans off their health insurance, allowed private companies to punitively charge people increased rates if they went without coverage for a while, and eventually rolled back Medicaid expansion. It was defeated by massive public opposition, as Republican constituents poured into town halls to tell their representatives they didn’t want to lose their benefits. Liberals and lefties alike are rejoicing at seeing an engaged populous hold the Republican party accountable for it’s terrible economic policy. This grassroots energy centered around saving the Affordable Care Act is an unequivocally good thing, and the defeat of Trump/Ryancare has saved thousands of lives.

Collective public action has forced Paul Ryan to concede that “Obamacare is the law of the land” after he’s spent seven years trying to kill the legislation. This is great. But the left can’t let this be the end of the healthcare debate. While the Affordable Care Act contains many provisions that are good and while the ACA is better than any pure free market system, it’s still a flawed bill. Many middle class Americans’ healthcare costs have risen under the Affordable Care Act, and in some cases, deductibles on insurance policies are so high that they’re effectively unusable. The left must capitalize on the grassroots energy built up against Trump and Ryan, and use this to pass legislation guaranteeing quality healthcare for all Americans as a right. Pushing for single-payer healthcare in the United States is a policy goal that would mobilize voters, but it’s also a moral necessity. Even under the ACA, millions people are uninsured and don’t have effective access to healthcare. We must have socialized medicine, because any other system is barbarism.

The right-wing argument against single-payer systems says that they are inefficient, bureaucratic and lead to the rationing of care. It ignores that the healthcare system in the United States also faces all of these problems, and that a free market system makes all of them worse. We have loads of bureaucracy and inefficiency in America, because insurance and billing are handled through a byzantine combination of state apparatuses and competing private companies. We spend more on administrative overhead in our healthcare industry than any other developed country. There’s also extreme rationing in the United States — it’s just done by price. In the United Kingdom or Canada, it’s true that sometimes patients have to wait for a few weeks to get certain scans or tests. In the US, if you’re rich, you can get the test immediately, but if you’re poor and your ACA deductible is too high for you to use, you likely won’t get it at all, or be forced to go into debt to pay for it. Any argument that can be made about the efficacy of a European-style healthcare system can also be made in reverse for the system in the United States. The healthcare debate really isn’t about which program is more effective, as many independent organizations rate America’s medical care as some of the worst in the developed world.

But what about freedom? What Ryan, Trump, Rand Paul, and other conservatives and libertarians tell you is not that they support a healthcare system that leads to vast inequality, sickness, and death, but that they believe in freedom. Freedom to choose a doctor, freedom to choose a plan: who doesn’t like that? It’s true that if the development of your understanding of liberty stopped in about the eighth grade this might be convincing. But the truth is that none of these people actually care about making anyone more free. Being thousands of dollars in debt to a private company making profit off your illness isn’t freedom, it’s the fucking sickest kind of oppression and coercion. On the other hand, having good, affordable healthcare guaranteed to you by the state actually makes you more free — free from want and burden. Conservatism isn’t about liberty, it’s about defending privilege and wealth. They want the rich to be ultra-free, and everyone else to be miserable.

This issue comes down to philosophy. Do you believe every person is entitled to good healthcare based solely on their humanity, or do you think some people deserve better care than others? For the left, the answer must be the former.

To some liberals, single payer may seem like an unrealistic goal, and it’s true it will take a lot of work. But in town halls around the country, Americans have been expressing their desire to go beyond Obamacare and see a universal system. Gallup has polled on the issue for years, and found a consistent bloc of 30–40% of citizens support some sort of government-run-or-funded healthcare system. It is not unreasonable or asking too much to want Americans to have more access to healthcare and for our system to be equitable and efficient. It’s unreasonable that we’re the only country in the developed world where this isn’t the case. It’s unreasonable that the largest source of private debt in this country is incurred by people taking out loans to pay to stay alive.

In a time when Democrats are struggling to find a winning message that will get voters to turn out in elections, especially midterms, universal healthcare could be a potentially great rallying point for them. After FDR passed the New Deal, his party controlled the House of Representatives for nearly six decades straight. Voters like social services and programs that help them, and have shown to be loyal to parties and politicians who pass such legislation.

There’s a Medicare-for-All bill in committee in the House right now, and it’s co-sponsored by a dozen or so progressive Democrats, including Keith Ellison, Barbara Lee, and John Lewis. That’s a good start. But this bill also needs to move to the Senate. I’d like to see moderate Democrats who are dismissive or unsupportive of single payer healthcare face primary challenges. In addition, I think leftists also need to consider the idea of moving beyond Medicare-for-all and creating a true system of government-run socialized medicine akin to the UK’s National Health Service.

Though the Democratic Party might seem unwilling to move left on this issue, especially considering how much money they take from the insurance industry, what we’ve seen in the past few weeks shows just how powerful public action is. If voters could stop a Batman villain like Paul Ryan from killing people with a shitty healthcare bill, they can certainly get someone like Nancy Pelosi to grow a spine and stand for something. The American healthcare debate has gone on for almost seventy years, and for too long, progressives have been told that single-payer is a unicorn. If that’s the case, why is its most prominent advocate the most popular politician in America? People are hungry not just for resistance to Trump, but for a compelling alternative vision to racism and austerity. In the words of an aphorism the Democratic Party censored from it’s Twitter page — Trump is the symptom, capitalism is the disease, socialism is the answer. Get markets out of medicine.