'We can't afford it': the ruse that denies ordinary people basic public services

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Image: Can Pac Swire/Flickr

It is unprecedented: for the first time since 1918, life expectancy for Americans has declined three years in a row. In no other wealthy nation has such a trend occurred in modern history.

In their forthcoming book, Deaths of Despair and the Future of Capitalism, economists Anne Case and Angus Deaton identify three main causes for this trend: suicide, opioids and alcoholism. 

The three year rise in early deaths is in part a result of health-care costs being out of reach for many U.S. citizens, explain Case and Deaton. The authors are scandalized by "a rapacious health-care sector that redistributes working-class wages into the pockets of the wealthy."

Senator Bernie Sanders, campaigning for the Democratic nomination for the 2020 U.S. presidential election, is calling for "Medicare for all." His critics respond that he wants to take Americans' health insurance away, or invoke the favourite ruse: "we can't afford it."

It is nonsense to argue that medicare for all is unaffordable. Specialists writing in The Lancet estimate medicare for all would save $450 billion annually and save 68,000 lives each year.

As economist Robert Reich, former secretary of labour under Bill Clinton, points out, the costs of inaction are much greater than the costs of medicare for all.

American health-care expenses represent the equivalent of 17 per cent of GDP, up from five per cent in 1960. This far exceeds the 9-11 per cent of GDP equivalent costs for health care in other wealthy countries. 

Public health insurance would lower administrative costs, and cover the 37 million Americans who have no health care access and benefit another 41 million currently with poor coverage. 

Case and Deaton decry U.S. private health care costs: "It is like a tapeworm we swallowed accidentally years ago," they write.

In effect, the stiff and rising costs of health care diminish the ability of Americans to pay existing bills for food, housing and other essentials, let alone new services. Medicare for all would be the most direct way to give salaried Americans a big raise.

That is why Sanders wants the U.S. private insurance system to be replaced by a European or Canadian health-care model. 

Meanwhile in Alberta, the Jason Kenney government just introduced a budget designed to undermine the public health system and facilitate the "privatization" of health services, which amounts to imposing American-style health care on Alberta.

Invoking the familiar, wrongful refrain of "we can't afford it," Kenney wants Albertans to believe the costs of government services are too high to maintain at current levels and need to be cut back.  

The Parkland Institute recently published an analysis of the Alberta government's finances, finding that, on the contrary, if Alberta were to adopt the tax structure of any other province, it would generate at least an additional $14.4 billion in revenue. That figure would be enough to wipe out Alberta's projected 2019 deficit and deliver a surplus of $6.9 billion. 

Instead of looking at ways to increase government revenue, the Alberta government is tearing up government employee contracts.

As part of his attack on public health care, Kenney threw out the fee schedule for physicians. Doctors responded by withdrawing services provided to emergency wards at hospitals, and participating in the large public protests organized in response to the budget.

Alberta doctors have options. Moving to another province is one avenue being considered by those who do not have family reasons for staying.

The sharp increase in Canadians begging on the streets, the rise in homelessness, the removal of the Canadian social safety net, the erosion of public health care and the rise in student debt can be traced to Paul Martin's "we can't afford it" federal budget in 1995.

This piece of unnecessary, destructive public policy was a classic "manufacture a crisis" strategy, described by Linda McQuaig in her 1996 book Shooting the Hippo. McQuaig showed how generating deficit hysteria allowed New Zealand finance minister Roger Douglas to cut public expenditures quickly, then create a retrospective consensus around the need for austerity. Other governments elsewhere followed suit.

In Canada, the 1995 budget that killed the federal government's commitment to providing welfare payments to anyone who needed it, slashed funding for post-secondary educations and ripped up federal-provincial funding arrangements was followed in 2000 by the introduction of massive tax cuts costing $100 billion over five years, benefiting mainly wealthy Canadians and corporations.

The Liberals had joined the Clinton Democrats and Tony Blair's New Labour in attacking governments' capacities to provide services to citizens, while currying favour with corporations.

Last year, the Canadian Union of Public Employees estimated that restoring Canadian government tax revenue to 2000 levels would make another $75 billion per year available for government services.

In the name of "we can't afford it," Canadians have been cheated out of democratic rights to adequate income, generous health care and affordable public education.

The biggest ruse worked: for the rich and powerful. 

Duncan Cameron is president emeritus of rabble.ca and writes a weekly column on politics and current affairs.

Image: Can Pac Swire/Flickr

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