Written by Jory Gomes ’18
In my sophomore year I took a class entitled “The Politics of the Affordable Care Act.” Little did I know, this class would change my life.
I had always been interested in the systems of health care and government, but it wasn’t until taking this class that I realized just how these two systems interact with each other. We have been having a national conversation about the role of government in health care that started with the establishment of Social Security in 1935, followed by Medicare and Medicaid in 1965, then most recently with the Affordable Care Act in 2009.
Now, after graduation I will be going onto a research assistantship in health policy to engage in this conversation on universal coverage, health care, and the role of government even further—so I feel that dedicating my last Hiram Health Blog article to this subject is only appropriate. To help illuminate this debate, I enlisted the help of the professor who started me on this path in the first place—Associate Professor of Political Science Douglas Brattebo, Ph.D., J.D..
In our first conversation in his class, Brattebo laid out a foundation to the universal health care debate that has helped inform my thinking on the issue since. In our discussion, he proposed that in the United States there are people who believe it to be morally reprehensible that the government doesn’t yet have a universal health care system like those found in France, Japan, the United Kingdom, Germany, or Canada. There are people who believe that the government intervening in health care represents the breakdown of democracy, freedom, liberty, and everything the United States is about, and lastly there are the majority of people who are somewhere in between.
Admittedly, I am stubborn in my support for universal health care upon the basis that I believe health care should be a right. Because of this, it has been instrumental to my learning to try and understand the full spectrum of arguments for and against the various forms of “universal” health care. As such, the rest of this article will be dedicated to Brattebo’s thoughts on the issue, and my subsequent reflections.
When I asked Brattebo what the universal health care argument is about for most Americans, he told me that for a large portion it is “fear of ‘big government’ and all of the bogeymen some citizens attach to that phrase in the field of health care.” He furthered this by saying that “some people fear that universal health care will expand the reach of government into citizens’ lives (and thus oppress them), cost too much (and thus require burdensome taxation), or result in restrictions on choice (of doctors) and/or quality (of medical services).” He further explained that these are themes that carry on from the Social Security, Medicare, and Medicaid debates of yesteryear—and that despite the current “mainstream embrace” of those programs, people feel the same fears.
I want to add to his thoughts on this by saying that for many Americans, health care is already perceived as a right. When people are rescued by emergency services, they are taken to a hospital without question of insurance coverage or ability to pay. In many respects, we already treat health care as a human right. Yet, while we already see health care as a human right in these regards, I don’t think that we have fully decided whether or not we think the government should be in the business of guaranteeing this right. Now, my view that universal health care is a right that should be guaranteed by the government is not one that comes without its shortcomings—as Brattebo is such an expert at pointing out.
He has oft countered that proponents of universal health care or universal coverage often fail to see that a transition into this system will have plenty of bumps. Brattebo believes that “the implementation of such a system will inevitably be achieved in phases, and the phases altogether would take several years; this is partly because of the scope of the task but also partly because there always are unforeseen challenges in making large social reforms.”
Furthermore, Brattebo has said that “it will take a good number of years for scientific studies to demonstrate that access, treatment, and prevention have changed the trajectory on this or that measure of public health.” What he means here is that universal health care cannot be sold as a quick fix to the myriad of health disparities seen in the United States—much as I and other proponents of universal coverage might want to. What Brattebo impressed upon the other students and I was that while universal health care definitely has that possibility, it cannot be sold as a guarantee—because it isn’t.
As for Brattebo’s thoughts on the flaws in arguments made against universal health care, he contends that “the notion that universal health care coverage will somehow break the bank does not seem to be borne out by the experience of other developed democracies.” He explained that “The United States spends a great deal per capita on health care, but gets spotty results as measured by many indicators.” He also added to this by saying that “the worry that universal health care [will] end up being ‘oppressive’ [has often] given way, in other countries, to the realization that citizens are more free when they have access to health care.”
It is my view that the main argument that those who are against universal health care have not reckoned with yet, is that universal health care has the potential to actually make people feel free from the ineffective, expensive system that they currently deal with.
Lastly, I asked Brattebo to give me his approximation of how universal health care could look in the United States given our divisions. Having studied different models of universal health care for my classes in sociology, public health, and biomedical humanities, I was anxious to get a political science professor’s opinion on what is passable in the United States. He started by saying that “Medicare, and particularly Medicaid, are huge programs that provide health insurance to a great many millions of Americans. They are also platforms that can be modified and extended to help achieve universal health care coverage for the United States.”
Brattebo finished by saying that “in the end, though, the precise model of health care coverage that is devised for America will take cues and lessons from the health care systems of several other modern democracies.” It has become clear to me through Brattebo’s comments that universal health care is eminent and that it will have to be a combination of our collective ideals. I vehemently believe that any universal program will have to be uniquely American in order to be successful—that’s why I’ll be spending the next year studying this issue as a research assistant.
So, with that, you’ll have to excuse me. Hiram has given me so many opportunities—like writing a weekly column on health issues—and for that I am forever thankful. Now I’m off to make the change I so desperately want to see in this beautiful, beautiful world of ours.