The decades long healthcare debate in America has been contentious and turbulent, from Obama enacting a penalty mandated opt-in system, to Trump’s subsequent attempts to appeal Obama’s affordable care act, and a partial reversal of ACA that resulted in at least a million more uninsured Americans, to the left’s (particularly Bernie Sander’s) insertion of “Medicare for All” into the 2020 election discourse. This is undeniably a long, contorted public conversation that has been taking place for years, but the rhetorical argument hasn’t been made for the accountability and interdependency that accompanies a state-funded healthcare system.
First, let’s be clear about a corpus of terms that essentially denote the same thing: nationalized healthcare, “Medicare for All”, socialized medicine, and universal healthcare. All of these terms are what the left employs when discussing healthcare, and they all mean approximately the same thing—with varying connotations attached to them—a healthcare system that is accessible to every citizen of a nation-state. The only distinction between a single payer system like “Medicare for All” (also referred to as universal healthcare) and nationalized healthcare or socialized medicine, is that a single payer system is communally funded health-insurance for every citizen. While nationalized healthcare is the entire health care system (that includes health insurance, doctors, nurses, hospitals, prescription drugs, and other workers) that is funded from a single source: the federal government. “Medicare for All” allows for privatization of hospitals and doctors; nationalized healthcare or socialized medicine de-privatizes all aspects of healthcare.
This effectively renders healthcare free at the point of service, meaning when you visit the doctor and are administered necessary medicine, or have essential tests, or undergo compulsory surgery, or go for a check-up, you are not charged. This service is free and premium free, because it is state-funded, and this means that it is tax-payer funded. There is no set re-distributive template that funds nationalized healthcare, different countries have dissimilar templates that pay for their healthcare. Bernie Sander’s has recently proposed a progressive tax rate to pay for Medicare-for-All that increases the income-tax cap from 37% to 52% (the 52% tax rate being applicable if you make over 20 million dollars a year).
So, to not delude anyone or seem disingenuous, nationalized healthcare isn’t “free”, but many lower-income individuals and families, and most middle-income individuals and families will save thousands by paying for it via taxes rather than paying for insurance (or paying for medical bills out-of-pocket, which could mean impending bankruptcy to many). To put it succinctly and to return to the point of the article: tax-payer’s money is allocated to fund nationalized healthcare (which will likely rise taxes on the middle-class but will ultimately save them money) and this would give us a literal monetary incentive interest in one another’s health (hopefully preluded and accompanied by a general ethical interest in one another’s health).
Since healthcare would be communally funded, everyone’s health matters, not just to themselves and those in immediate proximity to them (family, friends, co-workers), but to every single tax-payer in the country. If someone is unhealthy, it simply costs the healthcare system more, which is a toll on everyone, as everyone would not only fund the system, but would be utilizing that same system for their own healthcare needs. This is different from health-insurance companies’ pseudo-care in the health-status of those they insure, those people they consider “liabilities”, namely those non-preventable illnesses and diseases that someone is pre-disposed to, that makes their insurance rates higher or makes them ineligible for insurance. Those things must be accepted as they are by the public under nationalized healthcare: non-preventable. The country would rather have to focus on health concerns that are preventable or that unhealthy choices have a role in and would likely correspond to legislation that heavily taxes, limits, or makes the consumer more aware of products and choices that enable someone’s health to decline.
Those products would include alcohol and cigarettes and sugary drinks and foods, the laws against them could include higher vice taxes, consumer awareness (like Europe’s cigarette packages that must have a pictorial and text warning that is mandated to take up at least 65% of the package) and limits like the New York’s (very temporary) sugary drinks portion cap rule that prohibited New York businesses to sell sugary drinks in containers larger than 16 ounces. These things contradict the American mode of consumption, free and unregulated, as is evident by the repeal of the sugary drinks portion cap rule in 2013. The consumption autonomy/ consumption regulation argument is complex in its relation to rights and I won’t get into that now, but consumption regulation is something that everyone would collectively have a greater interest in since it could reduce the superfluous financial strain on the healthcare system and could potentially save lives.
Other countries that have implemented some variation of nationalized healthcare can be looked at to indicate what would have to happen in America: banning certain additives and artificial colors, synthetic hormones in beef and milk, and ceasing the sale of genetically modified fruits and veggies. Aside from outright prohibiting certain unequivocally unhealthy foods and additives, consumer awareness is another facet of healthy consumption that countries with nationalized healthcare has prioritized, from the aforementioned pictorial and textual warning (normally featuring pictures of black lungs, amputated limbs, and dissolving jaws to make the potential harm of cigarettes explicit) to changes in the manner sugary and high cholesteryl foods are marketed to children.
In many countries that have nationalized healthcare, such as Britain, there are no longer cartoonish mascots on sugary cereal boxes, after the country applied pressure and threatened to ban the mascots. This is meant to deter children from being drawn to these cartoonish cereal mascots and the sugary contents (these cereal mascots are still on boxes in the U.S.).
America is not legislatively or socially engaging with these issues because healthcare is an atomized issue; American’s only worry about those that we love or are in some sort of immediate proximity to us. That’s why when I choose from the corpus of terms relating to universal healthcare I choose nationalized healthcare, because healthcare is rendered a national issue when we all rely on it.
Many of these actions taken by other countries to combat health-related issues may be opposed by Americans even if healthcare was nationalized, especially limiting and regulating consumption which seems to be contentious with many America’s conception of individual rights. Despite this apprehension, nationalized healthcare would illuminate the interdependency that a nation of individuals has on one another, the country would have to concern itself more with the health of its citizens (as every other country that has implemented universal healthcare has) and widen that immediate proximity of concern from the familial unit to the entire nation.
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