Spending More to Die More
How America's failures in health reveal a failed state
In my post Mirror, mirror on the wall, why does the USA have the worst health of all?, I wrote:
The starkest failure is worth stressing. The USA is the only high-income country in the world without universal health care coverage. Most high-income countries have had those systems for more than half a century. Many middle- and low-income countries have those systems today. But the USA does not.
Its peers as failed health policy states are countries like Yemen and Afghanistan. But the USA cannot excuse its failure on the grounds of invasion, bombardment, and sabotage by an external power. It only has itself to blame.
Yet the USA seems incapable of fixing this basic problem of twentieth-century government.
The question that demands an answer is: Why?
In that post I emphasised institutional failures in the USA’s health system:
The health insurance patchwork, full of holes, that does not protect the uninsured or underinsured
The longstanding failure to establish universal health care, even in Obamacare
The administrative inefficiency
The gouging by insurers and providers
The poor outcomes for patients, other than the wealthiest
The rampant inequality in access and outcomes based on income, race, and geography
The failed systems of pharmaceutical drug regulation
The excessive power of corporate interests
The poor prevention and management of chronic disease
The high rates of incarceration, and
The absence of protective factors, such as a modern welfare state.
Readers have added to this list of defects. Charles Powell mentioned key factors in public health: diet and exercise. Kathy Grossman pointed to the excessive costs of pharmaceutical drugs. Lorenzo Warby emphasised American distrust of government and collective public action. Andrew Pesce, a health practitioner and former leader of the Australian Medical Association, noted:
The US has consistently designed a health care system based around non health related ideological holy grails and sacred cows. The results speak for themselves.
Among the ideologies that Andrew noted are:
‘Free markets and private enterprise’, which undermines the social welfare system and stymies drug regulation as shown in the opioid epidemic
‘Personal liberty’, which chafes at any collective action to improve the health of the society that restrains individual behaviour, however ill-judged
‘Freedom to carry guns’, which contributes to mass-shootings and personal injuries and is the constitutional symbol of reckless liberty
‘The death penalty’, which together with the high incarceration rate affects too many Americans
‘Significant opposition to abortion on demand’, which poisons American politics
‘Opposition to socialised health care ( or socialised anything)’, which has left America incapable of developing basic institutions of health and social care that are taken for granted now across most of the world, rich, middle-income and poor.
With these ideas driving politicians, private enterprise and the public, America has walked into the health policy trap that snares its citizens today. Andrew noted:
Is it any wonder that in trying to reconcile all of these strong elements of US political culture, there isn’t much room for a successful system of health care?
In my original article, I expressed scepticism that the USA government and the Trump administration are up to the job. They have cunning slogans, like ‘Make America Healthy Again’, but no common sense.
If the US leadership elite had any ‘common sense,’ the USA government would have remained inside the World Health Organization, that it helped to found in 1948. Indeed. the USA was also pivotal to the establishment of WHO’s predecessors, the International Sanitary Conference (in the 1920s and 1930s), the Health Organisation of the League of Nations (1919), and the International Sanitary Bureau (1902), which became the Pan American Health Organisation (PAHO), the oldest international health agency in the world.
If they were serious about making America healthy again, they would have asked WHO to intervene, like the IMF, and prepare a health rescue plan for the USA’s catastrophic health system failure.
In this piece (in full below the paywall) I examine the question of why the ‘greatest democracy on earth’ failed the ultimate test of a successful nation, improving the health and lengthening the life of its people?
First, I will look first at a recent history of health care in America
Then, I will look at the centrality of failure on health care to Emmanuel Todd’s argument that the USA is run by a liberal oligarchy, and sickened by a nihilistic culture
Finally, I will share my thoughts on how America’s shrivelled domestic governance has trapped the USA in health policy failure.