Unequal in sickness


Cosmopolis column in the Hindu Business Line (published 22 April, 2017)

Donald Trump’s recent sabre-rattling with North Korea, his strikes on certain targets in Syria, and his use of the largest conventional bomb in Afghanistan (whose delivery was greeted with an awful kind of relish here in the US) has allowed the American president to cast himself as a man of decisive action. Even some of his liberal critics greeted his foreign forays with appreciation. It’s a terrible reality that many Americans only seem to respect their leaders once they flex their muscles overseas.

But until this point, Trump has faced a remarkably troubled start to his presidency, from accusations of collusion with Russia to the bungling of executive orders. More than any other blow, he is still smarting from the setback he suffered over healthcare. Throughout his campaign and in the months following his electoral triumph, Trump promised to repeal and replace ‘Obamacare,’ the previous administration’s complex attempt to extend healthcare coverage to all Americans. But a replacement programme failed to secure enough support from the far-right of Trump’s own Republican party, resulting in humiliation for the president.

Obamacare is structured on the premise that Americans must buy private insurance to pay for medical costs, but insists that the government will help subsidise or, in the case of the Medicaid programme, fully pay for those who cannot. If not for Obamacare, over 20 million Americans would not have received healthcare coverage in 2016.

It remains a rather unequal and uneven mode of distributing care. As a graduate student and then a freelancer, I navigated through a range of health insurances during Obama’s presidency. While I have been lucky to not suffer any serious medical issues that required sustained attention, I was struck by the different levels of care I received — in terms of facilities, ease of access to doctors, and basic competence — depending on what insurance I had at the time. Those with more money get considerably better care.

A lot of people in the US and India, for that matter, are probably untroubled by the fact that economic means determine the kind of healthcare one receives. But healthcare is one of the main functions a society serves. For those who receive inferior coverage, it is invariably felt as a measure of the worth (or lack of worth) of their bodies, the poverty not just of their wallets but of their lives.

It saddens me greatly to see the vast gulf in standards in India between private care (which I imagine many readers of this newspaper enjoy) and the government-provided “care” extended to the poorest Indians. It remains one of the monumental injustices of Indian life, brutal proof that as a society we don’t value all members equally, that our lives are not worth the same.

The American right-wing believes ideologically that healthcare should be governed by the free market, deriding programmes for the poor such as Medicaid as luxurious “entitlements”. That position is increasingly out of touch with American public opinion. A 2016 Gallup poll showed that 58 per cent of Americans favoured a universal, federally-funded system referred to in the US as “single-payer” healthcare. Polls in general show an upward trend in support for the single-payer model. After seven years of Obamacare, Americans seem to increasingly think of healthcare not as a privilege or a good to be accessed on the market, but as a right.

In this way, Obama seems to have actually tugged the country closer towards northern Europe or Canada, countries where socialised systems of care deliver better health outcomes for less cost than America’s heavily free-market version. A universal system such as the National Health Service (NHS) in the UK also frees employers from the cost of having to provide their employees with insurance (as they do in the US), and it frees individuals to take risks and be more entrepreneurial, rather than resigning themselves to jobs they dislike because they need health insurance.

While working in the UK some years ago, I was registered with the NHS. The speed, efficiency, and quality of care I received astonished me. More importantly, I knew that the excellent level of medical care available to me was also available to those considerably poorer (and considerably richer). You could earn £100,000 or £10,000 or no pounds at all and still be treated the same.

The UK is beset by many problems — including threats to the NHS — but that remains a remarkable achievement of British society. It speaks to the real insight that the point of living together is to be responsible for each other, of insisting that everyone deserves to be treated with dignity.

I feel strongly that belonging to a democratic society means more than just having access every few years to the vote. It means partaking in a community that sees its members as equals, that insists on the value of everyone’s life. Americans are slowly waking up to this truth. One can only hope that Indians do the same.


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