American attitudes towards universal healthcare insurance have long baffled the rest of the world. Only in the U.S. is serious illness a ticket to bankruptcy and the food bank. How is this conducive to healing?
The Republican party has always insisted that Americans would rather die free than depend on socialist medical care. One result is that the American infant mortality rate is a "national disgrace," according to the Washington Post. And Americans seemed okay with that--until lately.
Many presidents have attempted to introduce a universal state-run healthcare system similar to Canada's or Europe's. Bill Clinton won the 1992 election after campaigning heavily on health care. Hillary Clinton introduced a national health care plan in 1993, when she was still a very popular First Lady.
Her policy ran into trouble immediately. U.S. conservatives, libertarians, health insurance and pharmaceutical industries furiously rejected anything that smacked of universal health care, saying patients would be stigmatized by having public rather than private insurance. They also launched vicious personal attacks on Hillary Clinton that destroyed the proposal and permanently damaged her reputation.
In the 2008 U.S. election, Barack Obama campaigned again on health care reform. He managed to pass the Affordable Care Act (ACA) during the two-year window (2008-2010) when the Democrats held the White House, a majority in the House of Representatives, and a Supermajority in the Senate. The ACA expanded Medicare and expecially Medicaid, the existing public health insurance programs.
Since the president signed the ACA into law in August 2010, House Republicans have introduced Bills more than 60 times to repeal it, knowing the president would veto any such Bill, even if the Senate passed it.
Part of the current President's 2016 election triumph was the GOP's opportunity to introduce yet another Bill to repeal the ACA, in full expectation that the majority Republican Congress would whisk the Bill through promptly.
Wrong! When Speaker Paul Ryan counted votes in advance, he had to tell the President that enough Republicans opposed the motion to defeat it -- a public rejection he did not want to risk. They withdrew the motion instead, which was still a humiliating defeat.
Remember the old bumper sticker, "My karma ran over my dogma"? Between 2010 and 2016, U.S. public opinion on healthcare changed dramatically. As with affirmative action programs, once people actually had to live and work with another option, they found the situation more congenial and less threatening than they ever expected.
While the greatly expanded Medicaid included 20 million more people, the catch is that each state has to sign on to the program and design its own system. Thirty-two states joined Medicaid, each with its own version and requirements.
As the New York Times editorialized, "Medicaid now provides medical care to four out of 10 American children. It covers the costs of nearly half of all births in the United States. It pays for the care for two-thirds of people in nursing homes. And it provides for 10 million children and adults with physical or mental disabilities...
"The program is so woven into the nation’s fabric that in 2015, almost two thirds of Americans in a poll by the Kaiser Family Foundation said they were either covered by Medicaid or had a family member or friend who was...."
Maybe not two-thirds of Americans, but plenty of them, resisted the attempt to take away their health care. They contacted their Republican Congressional reps to protest this was not why they voted them in. Their vocal opposition forced their representatives to back away from Trump's ill-conceived plan.
More than push-back, the Republicans' plans were run over by a parade marching in the other direction. Pew Research found that by February 2017, a majority of Americans (54%) supported Obamacare. In 2010, only 40% approved of the Act, and 44% disapproved of it. Ten percentage points is a lot of growth in seven years.
Medicaid has won over participating state Governors, several of whom moved quickly to expand their Medicaid programs just as soon as it was clear Trumpcare had failed. Kansas and Missouri moved to expand; reluctant Governors in Virginia, North Carolina, and Georgia finally have indicated interest in joining Medicaid to get health coverage for their poor people.
The NYT notes that "The A.C.A. offered a tempting deal to states that agreed to expand Medicaid eligibility to everyone with incomes up to 138 percent of the poverty level--$16,400 for a single person--mostly low-wage workers like cooks, hairdressers and cashiers.
"The federal government would initially pay 100 percent of the costs of covering their medical care, and never less than 90 percent under the terms of the law. Over the past three years, 31 states and the District of Columbia took the deal...."
Remember, many states are facing twin opioid and suicide epidemics now wracking the U.S. In addition, disability benefits rates are at an all-time high, although critics charge that Social Security uses a very loose definition of "disability."
(Lifetime limits on welfare benefits have pushed many people to apply for disability benefits. There's evidence that cash-short state governments are encouraging welfare recipients to apply for federal disability funds instead.)
As I've written about elsewhere, the U.S. National Institutes of Health estimate that 40% of the US population live with chronic pain -- a level at least twice as much as Canada. Those people have been clamouring for access to affordable medical care.
Some states have signed Medicaid agreements for convenience or out of desperation. Since those political leaders found they were saving money and producing goodwill among voters, now they want to expand their participation.
Despite conservatives' warnings, patients who speak up about how Medicaid changed or saved their lives, don't seem to worry about any social stigma in receiving free medical care.
Medicaid patients love that they bring home healthy babies. They brag about taking their children to the doctor. People with disabilities show off the new steps they were able to take, thanks to Medicaid, which supplied adaptive equipment and physiotherapy.
In short, just as Canadians have come to love our Charter of Rights as much as Americans love their Bill of Rights, now it seems that Americans have come to embrace universal health care the way that Canadians do (and most of the rest of the world.)
Maybe, if Clinton had won, she could have expanded Medicaid into universal health care without much fuss. Everybody would just have taken it for granted.
The GOP never would have endured the public wrath that fell upon them for trying to kick 20 million people off Medicaid rolls. As Joni Mitchell sang, "You don’t know what you’ve got" until somebody tries to take it away.
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