“The reality is that, with all of its infirmities and difficulties, we have the best health care system in the world. . . . I said jokingly in one debate, if we go in the direction of socialized medicine, where will Canadians come for health care?”
In a January presidential debate, Rudy Giuliani offered this impression of the American health care state – unaware, perhaps, that Canada ranked fifth and “the United States dead last in providing timely and effective health care to its citizens,”1 according to a recent Commonwealth Fund report. In analyzing the impact of preventable deaths in nineteen industrialized countries, the study concluded that, had the US performed at the levels reached by other countries, more than 100,000 American deaths could have been averted in 2007 alone.
Politics aside, the weaknesses of our health care system are now felt by a majority of the American population. The current construct simply doesn’t fulfill the needs of those it is supposed to serve. According to a 2006 report by the US Census Bureau, 16 percent of the population — almost 47 million Americans — lacked even basic health insurance in 2005. And that number is only increasing. The ranks of the uninsured have risen by nearly 7 million since the year 2000.2
The system’s dependence on full-time, salaried employment means that a turn of professional fortune can prompt a correlative gap in health coverage – a gap that can have dire consequences for those affected. And even among those who do hold insurance policies, many find the cost of care to be too expensive, its scope too limited. In September 2007, US News & World Report pointed out that “the annual survey of employer-sponsored plans, conducted by the Kaiser Family Foundation and the Health Research and Educational Trust . . . found that the average family policy cost $12,106, a 78 percent increase since 2001.”3
These numbers are not typical, and they are not good. From a macroeconomic standpoint, the United States spends far more on its health care system than any other nation (16 percent of its gross domestic product), while its residents enjoy a narrower degree of coverage than those of other industrialized countries.4 The mounting evidence of this system’s weakness has given momentum to the voices calling for a change in policy. The perception of economic squeeze for the middle class, as well as expansive media coverage of the health care crisis – exemplified by Michael Moore’s latest documentary, Sicko – have fueled a new level of awareness, and a new demand for change.
But is this awareness enough to drive reform? We have seen such efforts defeated before. One of the principal arguments of the counter-reform camp, successfully brandished in the face of past initiatives – most recently with the Clinton plan in the early 1990s or, further back, when President Truman first advanced the notion of universal health care in 1945 – is the idea that a universal system would effectively minimize choice. A mandate for private insurance or a single-payer socialized system would, they say, represent an imposition on individual rights, as well as a reduction in the number of options available to each person.