Politics

12.26.13

America Joins the Developed World, Thanks to Obamacare

For all its woes, real reform finally got underway in 2013. Some day in the future, this year will be remembered as the one when the U.S. recognized people’s birthright to health care.

I’m sitting here very early Christmas Eve morning staring at a chart from the Organization for Economic Cooperation and Development. You know the OECD—they’re the people who keep all those annoying stats about how the United States is 17th in this and 32nd in that, the kind that alas aren’t very surprising anymore except that they do make us shake our heads and wonder how we managed to come in behind even Belarus.

This chart is on an Excel spreadsheet, so I can’t provide a link, but it shows access to “health insurance coverage for a core set of services, 2009.” It then lists the 34 OECD member states, showing percentages of citizens with “total public coverage” and with “primary private health coverage.”

tomasky-insurance-chart

In 19 countries, 100 percent of the population is covered via public insurance. In 11 more, more than 95 percent are covered the same way. So all but four countries basically provide universal or near-universal public coverage. In Turkey, Mexico, and Chile, between 70 and 80 percent are covered—also publicly. In the United States, that number is 26.4 percent. That’s the seniors, the veterans, and the very poor who get direct public health care. We then add 54.9 percent who get private coverage. No other country even bothers with private coverage at all, except Germany a little bit (10.8 percent). Our two numbers add up to 81.3 percent, ranking us 31st out of the 34. The rest of the advanced world, in other words, with not all that much fuss and contention, has come around to the idea that health coverage is a right.

As I think back over 2013, in my sunnier moments, I try to think of it as the year that future historians will point to as the time when the United States finally and grudgingly started joining this world consensus. Sometime in the 2030s, after Medicare for all has passed and we’re finally and sensibly paying taxes for preventive cradle-to-grave care, people will note—with pride!—that the long process started with Obamacare (yes, conservatives: I’m admitting gleefully that the elephant’s nose is under the door, so spare yourselves the trouble of thinking you’re clever by tweeting it!).

There were of course other important stories in the year now ending. For my number two, I’d choose Iran and Syria; that’s certainly one to watch heading into next year. Barack Obama mishandled Syria with all that talk of red lines that ended up being unenforced, badly letting down the small-d democrats in the region who count on the United States to countervail Iran. On the other hand, those chemical weapons actually are being destroyed, evidently. On the other other hand, the slaughter continues, and we will do nothing. Even a deal with Iran on nuclear technology, certainly a thing to be celebrated in one respect, will also allow Iran to show the region (that is, Saudi Arabia, its main competitor for regional domination) that it’s in the big leagues now too. As is typical in that part of the world, no diplomatic development is all good or all bad.

But this has been the year of Obamacare first and foremost. And next year pretty much will be, too. I’m glad the website was fixed, and glad for the apparent surge in the enrollment numbers. But it’s still the case for the change to take root and really succeed, Democrats from Obama on down have to defend this policy on principled terms, not just practical ones.

Democrats from Obama on down have to defend this policy on principled terms, not just practical ones.

That is—right now, Democrats and progressive groups are mostly trying to get people to sign up for coverage by scaring them into thinking they might break their leg. But there are two problems with this approach. One, most people don’t break their leg. I’ve been on this planet 53 years and I’ve never broken a bone.

Two, it’s not completely honest as a selling point. Yes, liberals are concerned that people who face injury have coverage. But that’s not the main reason liberals support health care reform. We support it because we think health care coverage should be a right, and this is a big step down that road, or the best step we could make under current reality. Like any right, it comes with responsibility, so that’s why you have to buy it. But it’s a right. It’s not an extravagance or something you earn by having a better-than-Walmart-level job. You “earn” it by doing something a lot simpler than that—you earn it by being born.

This is one of those occasions where I wish desperately that Democratic politicians would just say what they believe without worrying how it’s going to be played in Politico or what those fat-mouth propagandists on the right are going to say about it. Obamacare isn’t just about getting people to fear illness or injury. It’s about changing people’s minds about what health coverage fundamentally is. And they’re not going to change any minds unless they’re willing to say that.

Hey, I’ve kept flipping through those OECD spread sheets and I’ve found some things we’re number one in. Male obesity—70.3 percent in 2011! Female obesity, too—56.1 percent! Infant mortality rate of 6.1 per 1,000 live births! Okay, we trail Mexico and Turkey there, but still. Income inequality—well, thank God for Turkey, Mexico, and Chile. Whoever let them in was really thinking ahead, so at least we’d look OK compared to someplace.

Something like reducing obesity can be best done through preventive care that kicks in well before a person has a BMI in the 40s. Obamacare already has started the process of changing this. More than 5 million Medicare recipients are getting free preventive treatments across a range of categories (PDF). That’s health care as a right. Democrats need to be unapologetic in talking like that.