Good sense seems to be breaking out all over in the race for the Democratic Party presidential nomination. Elizabeth Warren has shown her political acumen and practicality by backing-off from her previously-held Medicare-for-All position this week. Pete Buttigieg, who has demonstrated a mature pragmatism beyond his years by championing the insurance industry and opposing any possibility of a national, single-payer healthcare system, is experience a surge in the Iowa polls.
National healthcare reform defies an easy solution, and everyone apart from the Canada-and-Scandinavia-obsessed “Democratic Socialist” Bernie Sanders seems to know it. The important thing in this election, everyone but the Bernie Bros knows, is the defeat of Donald Trump, and the preservation of all that is good in America. And we know that a universal healthcare system is not only impossible, but that it is a political non-starter. Democrats need to be practical, and that means that the Democratic Party needs to turn the clock back to the pragmatic neoliberalism embodied in the Affordable Care Act of 2010 and, at all costs, to avoid rushing headlong into a reckless future.
Sen. Sanders often makes a big deal of the fact that the United States is the only industrialized country in the world – indeed one of only a handful of countries including Syria, Turkmenistan, and Indonesia – that does not have some kind of universal healthcare system. He argues that countries like Canada, Sweden, and even the ever-troubled United Kingdom are able to provide their citizens with public health care services, so the United States should be able do the same.
The argument is specious, indeed patently absurd. The United States is not Canada or Sweden; this is an exceptional country that requires exceptional policies rather than off-the-shelf solutions from Ikea. Americans are fiercely individualistic people, protective of their rights and, above all, their access to choice. This is embodied in the very political system in which the healthcare debate plays so large a part; as many as 55 percent of eligible voters regularly exercise their right to a political choice in presidential elections, and almost 50 percent in midterm elections.
Choice is the main healthcare issue for Americans. As a report from the Department of Health and Human Services recently noted, “free-market competition produces the most efficient production and distribution of goods and services. When consumers have choices, the incentives and information needed to optimize value, firms have the incentive to improve quality and lower costs through innovation.” That element of consumer choice has made the United States a healthcare leader, even if we spend more than twice as much per-capita as Canada, with poorer healthcare outcomes in key metrics like life expectancy and infant mortality rate.
The key point is that our neighbors to the North simply do not have the right to choose how they receive their healthcare coverage, as that is determined for them by their national and provincial governments. In contrast, Americans can choose which insurance, and which plans, meet their specific needs, from the cost of premiums, to what they pay in deductibles and co-pays. Although most employer health insurance plans do not offer this choice, employees have the autonomy to opt out and shop for a different plan on the open market, or choose no coverage – and no costs – at all.
Admittedly, the fact that many Americans donot receive coverage through their employers has resulted in a significant proportion of the population that does not have health insurance. The ACA was intended to offer 44 million uninsured Americans the ability to choose insurance coverage ranging from inexpensive, high-deductible plans to more costly plans with lower deductibles and co-pays. And the ACA worked admirably, allowing about a third of all uninsured Americans to buy coverage, while still preserving consumer choice and guaranteeing the insurance industry profits that are so critical to a healthy economy.
The fact remains, however, that almost 30 million Americans are still without health insurance of any kind, and this has created a crisis that progressive ideologues like Sen. Sanders and – at least until she saw her error – Sen. Warren were able to exploit to destabilize the historical centrist alignment of the Democratic Party. There are a number of reasons why so many Americans remain uninsured, of course. In many cases, they are people who have simply exercised their democratic right to opt out. More often, however, it is because they work in occupations that do not include employer insurance, or they are independent contractors, or even artists, or they are unemployed. And the reality of the insurance marketplace is that even the most basic, high-deductible ObamaCare plans can run as much as $6,000 or $7,000 per year.
It is an axiom of American history that freedom always comes at a cost, and this is as true of freedom of consumer choice as it was of the brave Minutemen who stood up for their liberty at Concord and Lexington in 1775. It is regrettable that someone earning $25,000 per year in a service sector job might find the prospect of spending a third of their take-home salary on a basic health insurance plan under the ACA too daunting to even consider. It is a tragedy that an artist must often choose to forego the kind of employment that might provide coverage in order to pursue their art.
Yet, it is the nature of life that even they will inevitably become ill, old, or feeble, no matter how they try to avoid it, and this is the real tragedy. Should they or their dependents develop an illness like cancer, Alzheimer’s disease, emphysema, or many other chronic and terminal ailments, the choice they face will be between bankrupting their families or suffering a lengthy, agonizing death.
Americans are decent, caring people. The misery of others affects all of us deeply, and we are always ready to to do what we can to prevent or alleviate suffering, event among non-human animals. The American Society for the Prevention of Cruelty to Animals has more than 1.2 million members, and receives more than $160 million in charitable contributions annually; Americans gave more than $141 million to the Humane Society last year.
One of the most stressful experiences in anyone’s life is caring for a terminally-ill companion animal. And it is in facing this impossibly difficult moment that many of us – indeed, most of us – are willing to make the hardest of all decisions: to end our beloved pet’s suffering. It behooves us to show at least as much humanity to those of our fellow human citizens who lack insurance coverage and face either bankruptcy or death.
We should put them down. What could be more decent; what could be more humane? What could be more American?
As choice is the single most important consideration in delivering healthcare, and since a universal healthcare system implicitly undermines choice and would be, after all, impossible to achieve, the Democratic Party must propose a system of end-of-life services for the uninsured. What could possibly embody the importance of healthcare options better than offering uninsured Americans a painless way out from the Hobson’s choice between financial ruin on the one hand, and an agonizing, untreated illness and inevitable death on the other? If death is inevitable, it is only sensible to make it quick and easy.
Admittedly, such a plan faces formidable obstacles. It is not a crime to take one’s own life – such a law would be unenforceable – but providing services through which uninsured individuals can have themselves humanely put-down would certainly constitute assisted suicide, which remains illegal in forty states. Realistically, it will be extraordinarily difficult to overcome the political, moral, and religious objections of lawmakers to pass assisted life-ending legislation. But it is important to remember that that this will only be difficult – universal healthcare is impossible.
Democrats should emphasize how end-of-life services will greatly enhance the range of options for the uninsured. By offering Americans the opportunity to decide between catastrophic financial ruin, an agonizing and drawn-out death, and a quick, humane suicide, this proposal will increase the choices available by a not-inconsiderable 50 percent. It would be very much like adding RC Cola to a restaurant menu that previously only offered Coke and Pepsi.
Moreover, providing end-of-life services for the uninsured would have significant economic benefits, quite apart from obviating the need for the increased tax revenues made necessary by a universal healthcare system. Such services could be easily integrated into both the healthcare.gov website maintained by the Department of Health and Human Services, as well as into state healthcare exchanges. More importantly, implementing end-of-life services for the uninsured through the ObamaCare model would directly benefit America’s insurance industry. It would also realize enormous savings in Medicare and Medicaid costs.
Such a system would defend against the criticism that a Democratic administration was seeking to impose direct government control over, and responsibility for the deaths of uninsured Americans, and it would offer insurance providers an additional, lucrative revenue channel. It should go without saying that end-of-life services for the uninsured could not be offered at no cost. An assisted-death system still comes with a price – specifically the expense of the assistants, end-of life facilities, the means of providing the services, and the disposal of uninsured bodies. However, as this will not require ongoing treatment, insurance providers could offer coverage for end-of-life services as a single, relatively modest payment while still accruing profit. Faced with the other choices – tens of thousands of dollars of medical bills, or suffering an agonizing illness – it is likely that insurance providers would be able to charge for services at a significant profit while keeping fees at levels attractive to the uninsured.
At the end of the day, it is not only the most humane thing that a caring nation can do for the millions of uninsured Americans, but a proposal to provide end-of-life services makes both economic and political sense for the Democratic Party in the 2020 election. It will allow the party to go backward to embrace the the Affordable Care Act’s vision of decade ago, while embracing the full Malthusian implications of the neoliberal ideology that brought America to this point in the first place. Most importantly, such a policy will protect the profits of the $867 billion insurance industry and provide a new channel for expansion just as the Democratic Party can most use its support for the 2020 election.