Wednesday, July 05, 2017

Why is health care a privilege for some rather than a right for all?

When EP and I worked in unreformed South Africa in 1990 on anti-aparthied newspapers, we discovered something astonishing: contrary to the conventional wisdom among our leftie friends, it wasn't quite true that the United States and South Africa were the only developed countries which didn't provide universal access to medical care for their populations. In fact, South Africa did had a rudimentary public health system that covered everyone, awful and segregated as it was. Somehow, the rich United States really was the only country that didn't provide health care to all its citizens.

This peculiar status is not some mysterious, incomprehensible accident. Like so many aspects of our society, the U.S. healthcare non-system is the inequitable, inefficient, and wasteful mess that it is because of our death grip on white supremacy. Vann R. Newkirk II has delved into this history.

... As German Prime Minister Otto Von Bismarck’s Health Insurance Bill of 1883 created the first modern national health-care system, and as many other countries moved down the path to truly nationalized, universal health care, America instead largely expanded the existing segregated system of local private providers and religious-based charity care. In essence, the United States’s peculiar private-based health-care system exists at least in part because of the country’s commitment to maintaining racial hierarchies. ...

... In 1965, just a week before also passing the Voting Rights Act, Congress passed the amendment to the Social Security Act that authorized Medicare and Medicaid... The law’s effects on segregation were felt immediately. Since Medicare’s universal coverage of elderly people brought federal funds to about every hospital in America, it also bound them by Title VI’s nondiscrimination clauses, which essentially ended segregation in those hospitals—some of the last public arenas in which Jim Crow legally held sway. Medicare was the final federal legal blow for de jure segregation, and without it, there would still be few legal mechanisms to force hospitals to integrate. It’s hard to overstate how much Medicare and Medicaid themselves did to end formal segregation.

By the same token, it’s hard to overstate just how deeply that waning segregation had mattered in health outcomes. From the end of slavery onward, American health-care has been deeply bifurcated along the lines of race, and that bifurcation was always reflected in how well people lived and how early and often they died. ...

The Affordable Care Act -- Obamacare -- was passed as a compromise with a private system that privileged the well-off and white, while extending care mostly via federally funded Medicaid to the poor, many of whom are non-white. The Supreme Court allowed states that wished to do so to opt out; no one should be surprised that the states which refused to get with the ACA's more generous plan were largely in the unrepentently white supremacist South and the homogeneously white upper Mid-West and Mountain states.

The current Republican Senate bill (the BCRA) is a tax cut for the rich masquerading as health policy.

But in addition, the BCRA is about Making America White Again with a vengeance, pushing our most vulnerable citizens out of the medical system where our white supremacist history never meant them to have a chance anyway -- except perhaps washing bedpans.

In essence, the BCRA not only erases the ACA’s market-oriented experiment in health equity, but also strikes a blow at the previously established elements of “socialized medicine” that were longtime objectives of the civil-rights movement. In this—as is true of other civil-rights victories that were the bedrock of the 50s and 60s liberation movement, like education and voting rights—a central tenet of American freedom now finds itself in danger of simply vanishing. The country cannot follow through on its commitment to equal protection for life and liberty under the law without addressing fundamental inequalities in mortality.

It’s worth noting that much of the animus behind the opposition to Obamacare is tied to race. Studies have shown that racial prejudice is a good predictor of opposition to the bill, and its central policy of Medicaid has always been subject to implicit racial biases in public opinion. A recent Kaiser Family Foundation study found that Republican voters tend to view Medicaid as welfare, with all the attendant stereotypes and dog whistles. ...

H/t to Jamelle Bouie for interviewing Newkirk on Trumpcast.

1 comment:

Rain Trueax said...

In the US, unless someone works for the government, a college or somewhere that the insurance is part of the employment package, it's not a right for anyone here. We pay for it. Even with Medicare there is a premium and if you want more coverage, a supplemental plan to buy. I do not know anything about what Europeans have set up and whether taxpayers cover it all. It's not free though-- and somebody pays.

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