Dean Robinson’s “Health Politics and Inequality” class has taken some surprising turns. Jill Quadagno’s book, “One Nation, Uninsured” served as an efficient history of how we got the lousy system of health care that we have, so the questions of how and what kinds of alternatives we ca have were neatly dispensed with.
Basically, the “simplest” and fairest universal system would be to simply expand our already existing Medicare system to cover everyone. That would give us the Canadian “single payer” system (which, coincidentally, is also called Medicare). Of course, to fund the program, the government would have to institute a new payroll tax on employers. For employers who already pay around a quarter of an employee’s salary in insurance premiums, this would essentially replace those premiums and would probably lower their costs and improve their market position, as it would serve to “take health care out of competition” by equalizing their equalizing their costs with those of employers that do not currently provide health insurance for employees (and for whom such a payroll tax would be a new and unwelcome development). Business, being business, would likely seek to take the cost of health care off its ledger and dump it on the public in the form of tax income tax increases – which would naturally be controversial. Yes, polls show that Americans are willing to pay higher taxes for more social services. But, the millions of Americans who already receive health care through their employers do not want to pay for what they already have. This would not be a tax increase, as much as it would be a pay cut. The combination of such anti-business tax agendas with the fact that such a “Medicare For All” solution would necessarily be a frontal assault on the rich private insurance industry creates a powerful coalition of capitalist opposition to universal health care that is built in to the problem. This is to say nothing about the potential to energize the religious right over the issue of public financing of reproductive health services. Clearly, it will take a rock-solid coalition of “the good guys” if we have any chance, and the labor movement must take a leading role in forming such a coalition.
Where Dean’s class has taken an interesting turn is the presentation of Ichiro Kawachi’s research of the effects of inequality on health. The research presented in his book, “The Health of Nations: Why Inequality is Harmful to Your Health,” basically finds that the level of inequality in a given society has a direct relationship with average life expectancy, disease rates and infant mortality. Kawachi controls for income levels, access to health care and a host of other factors one might expect to explain these numbers. Holding all other things equal, a person who lives in a country that has a large gap between the rich and the poor is unhealthier than his direct counterpart in a more equitable country. This is the same for rich people as it is for the poor.
You might expect a socialist to love this report, but I find it troubling. The problem is that wealth redistribution is just so…un-American. In my past life as a teenage mutant ninja socialist, going on speaking tours and doing media interviews for the Socialist Party, I’ve always de-emphasized the Robin Hood aspect of socialism. What’s most important to talk about is, first, what we as working people need and deserve: Meaningful work at good pay; decent, affordable housing; health insurance, vacations and pensions. Second is what’s preventing so many of us from having these things: the capitalist system of production for profit and not for need. I’ve always differentiated between private property and personal property. What we want is to publicly own and control the basic companies and industries, not to share your toothbrush and wife. Taking away mansions and yachts from the rich is not crucial to the functioning of the economy, and would not be the first step of a socialist revolution. But I don’t talk about it because Americans don’t like the idea. They want to believe that anyone can “earn” such ostentatious wealth (as if the Waltons and the Hilton’s “earned” their daddies’ money!). But, if Ichiro Kawachi’s research is correct, those ostentatious displays of wealth are terrible for our health. Watching “MTV Cribs” could literally kill you (and the rich idiot with the air-conditioned display room for his hats).
In many ways this is a moralistic argument for socialism, and I hate those. I’m a materialist, and prefer to focus on jobs, peace and freedom. But, Robin Hood was right, and we need more people like him.