Recently, when the Supreme Court ruled on the Affordable Care Act, I found myself in the perfect laboratory of national opinions, surrounded by families, businesspeople and gay flight attendants all passing through Atlanta's Hartsfield-Jackson airport. As CNN announced the breaking news that the Supreme Court had left the Affordable Care Act standing, passengers waiting for flights started speaking out:
"There goes the middle class," groused a guy behind me.
"Now we know what we need to doget that guy [President Obama] out of office," snorted a woman sitting with her elderly mother.
"This is why our forefathers left England. It's socialism!" insisted a history-challenged senior.
Right now, more Americans have come around to accept gay marriage than are in favor of the Affordable Care Act. What's behind this virulent hatred of a national healthcare program?
Now, I'm not saying that there aren't legitimate concerns about the ACA in its current form. We can have a good debate about the details of its roll out. But first let's put some common arguments to rest.
"The U.S. has the best healthcare in the world."
Not if you agree that healthcare should prevent untimely deaths. The U.S. is in eighth-to-last place in the industrialized world when it comes to life expectancy. The only relatively developed nations we outlive are the Czech Republic, Estonia, Hungary, Mexico, Poland, Slovakia and Turkey. We rank dead last amongst highly industrialized nations. Not exactly what you would expect for the third wealthiest country in the world with the "best" healthcare.
"We just can't afford universal healthcare."
We're already paying the price tag for universal healthcare, just not getting its benefits. The United States pays two-and-one-half times per person as much for healthcare as the average for all other industrialized nations. Pre-existing condition exclusions blocked many Americans from getting health insurance, and high premiums still block others. So many of the 50 million uninsured Americans use the emergency room as their primary healthcare provider.
The average emergency-room visit costs $1,318, or $1,565 for patients over age 45. Worse, by the time uninsured people get to the ER, their conditions are much more costly to treat. For example, we spend more than any country in the world on hospital admissions for preventable diabetes. When patients can't pay, you and I are already picking up the tab through increased insurance premiums, and increased taxes as hospitals write off their losses.
"Well, we don't want to be like Canada, with its rationed healthcare, or socialist like France!"
Agreed: We're an innovative capitalist country. But since we're paying more and getting less for our healthcare dollar, just saying "no" to "socialist ObamaCare" isn't good enough. Let's borrow a better business model from one of the industrialized nations that has a successful healthcare system without resorting to universal healthcare. Have you got a country in mind? If you do, you must have gone back in time, because ever since Israel changed its system in 1995, we're the only nation in the industrialized world that does not have universal healthcare.
That's right. It's not just Canada and France that have universal healthcare, but also Australia, Austria, Bahrain, Belgium, Brunei, Cyprus, Denmark, Finland, Germany, Greece, Hong Kong, Iceland, Ireland, Italy, Japan, Kuwait, Luxemburg, New Zealand, the Netherlands, Norway, Portugal, Singapore, South Korea, Spain, Sweden, Switzerland, the United Arab Emirates and the United Kingdom. And they all pay less per person, and all live longer, on average, than we do.
Not a single American I've spoken to who is opposed to the Affordable Care Act knew this most basic fact. Too often, they're getting their news from the same sort of polarizing instigators who also warn about the evil "gay agenda."
The truth is, we can't afford not to have universal healthcare. Among those employed, medical expense is the number one cause of household bankruptcies in the U.S. You can sock away savings all of your life, but when genetics, age, bad habits or bad luck bring a major medical issue to your home, too often all financial reserves are lost.
So go ahead and call universal healthcare "socialism." I believe government has two core functions. Defend the nation's people against enemy attack, and defend citizens from unnecessary death. No town buys its own tank and jet fighter for a possible war, and very few households could save up enough for a medical catastrophe. This is why societies have governments in the first place, not just socialist governments.
Take it from Mitt Romney, who supported an individual mandate to establish universal healthcare in 2006: "Folks, if you can afford health care, then, gosh, you'd better go get it. Otherwise you're just passing on your expenses to someone else. That's not Republican, that's not Democratic, that's not Libertarian. That's just wrong." Sticking stubbornly to our broken, privatized model is just plain wrong.
©2012 Stephen J. Fallon
Stephen Fallon is the president of Skills4, a healthcare consulting firm that provides services to CDC and HRSA funded providers, primarily gay- or minority-based agencies and clinics. Visit www.skills4.org .
53% of Americans support gay marriage: ABC News/Washington Post.
Strong Support for Gay Marriage Now Exceeds Strong Opposition. May 23, 2012. abcnews.go.com/blogs/politics/2012/05/strong-support-for-gay-marriage-now-exceeds-strong-opposition/ Accessed July 1, 2012.
Only 37% of Americans support the Affordable Care Act: The Affordable Care Act by the Numbers. USA Today. June 29, 2012. P. 3A. www.usatoday.com/money/industries/health/story/2012-06-28/health-care-ruling-whats-next/55900370/1 Support figure shows only in print edition.
Eighth to last place in life expectancy for 2010: Organization for Economic Cooperation and Development (OECD). Health Data 2012. www.oecd.org/document/16/0,3746,en_2649_37407_2085200_1_1_1_37407,00.html Accessed June 30, 2012.
U.S. is third richest nation per capita for 2009: Luxembourg, Norway, Sweden rank higher per capita. OECD Gross national income per capita, USD, current prices and PPPs. www.oecd.org/document/0,3746,en_2649_201185_46462759_1_1_1_1,00.html Accessed June 30, 2012.
(Forbes magazine ranks the U.S. seventh for 2010, possibly due to the recession. However, figures use simple division, and do not reflect that many top-ranked countries are oil-enriched monarchies that do not distribute wealth equitably. In median economic terms, U.S. citizens typically rank higher.) Qatar, Luxembourg, Singapore, Norway, Brunei, United Arab Emirates, United States. Greenfield B. The World's Richest Countries." Forbes, February 22, 2012. Note: www.forbes.com/sites/bethgreenfield/2012/02/22/the-worlds-richest-countries/ . Accessed July 1, 2012.
U.S. spends 2.5x the average of all other developed nations: OECD Total expenditure on health, /capita, US$ purchasing power parity. Accessed June 30, 2012. stats.oecd.org/Index.aspx .
49.9 million Americans currently uninsured: Smith E and Stark C, CNN Library, By the numbers: Health insurance. June 28, 2012. www.cnn.com/2012/06/27/politics/btn-health-care/index.html .
Costs of average emergency room visit: Medical Expenditure Panel Survey (MEPS) Emergency Room Services-Median and Mean Expenses per Person With Expense and Distribution of Expenses by Source of Payment: United States, 2009 tinyurl.com/6o7mcpy .
Highest cost for preventable hospital admissions due to diabetes: OECD. Diabetes acute complications admission rates, population aged 15 and over, 2007. Last updated data.
60% of U.S. Household bankruptcies caused by medical expenses; rate of medical bankruptcies doubled since 2001. Himmelstein D, et al. "Medical Bankruptcy in the United States, 2007: Results of a National Study." American Journal of Medicine, Aug 2009.
U.S. is only first world nation without universal healthcare: World Health Organization data compiled in List of Countries with Universal Healthcare.
Not shown: New Zealand initiated universal healthcare in 1938.
Bramhall S, MD. Physicians for a National Health Program. The New Zealand Healthcare System. January 9, 2003. tinyurl.com/7erdcg8 .
Accessed June 30, 2012.
ADAP cost to taxpayers is $1.8B per year: Kaiser Family Foundation. United States: Total AIDS Drug Assistance Program (ADAP) Budget, Federal and State Sources, and Percent Change in Total ADAP Budget, FY2009 to FY2010. Accessed October 5, 2011. tinyurl.com/c6bklj8 .
Romney on healthcare: Quoted in "Health Care in Massachusetts" NPR.org, Feb 13, 2012