Just over three years ago, New York City reported its first confirmed death from COVID-19. Many more followed, with more than 20,000 New Yorkers dead in the devastating first wave alone. They were our relatives, friends and neighbors.
Like so many other health workers, the memories of that time – the unimaginable suffering and tragedy – are forever etched in my brain. Freezer trucks used as portable mortuaries; the chaotic din inside the hospital, juxtaposed with the eerie silence of the streets; and the troubling fear we felt, for our patients and families.
Starting this week, about 15 million people will start lose their health coverage, as the COVID-19 public health emergency comes to an end.
But during the darkest days of the pandemic, an idea brought me relief: that finally, we would muster the will to change our broken healthcare system. That seeing how your health affected mine — the revelation that we were bonded together — would change the dialogue about universal health care. That with a society shaken to its foundations, we would be shaken from our complacency.
Needless to say that didn’t happen. In fact, starting this week, around 15 million people will start lose their health coverage, as the COVID-19 public health emergency comes to an end. And a U.S. District Court judge just struck down the part of the Affordable Care Act that provides free preventive care for a range of services, such as cancer screenings, affecting 150 million people. We are missing the opportunity to consolidate the coverage gains made during the pandemic – and instead we will move away from the aspiration for universal health care.
Although universal health care is the norm in nearly every other wealthy country, it remains a remote possibility in the United States. A divided Congress means bold health care proposals are unlikely to advance this year or next. Yet it also opens a window for crafting a new political approach, particularly one that rises above the rhetorical ruts of socialized medicine and fearmongering around fictional “death signs.”
How can we advance the public dialogue on universal health care? As a practicing physician and former New York City Health Commissioner, I have pondered this subject for years. And despite the aforementioned political challenges, there are some openings in public discourse to move the idea forward.
It starts by shifting some key narratives that have held us back. For example, the idea that only certain people deserve health care. This narrative Particularly plagues the Medicaid debate, seeking to draw distinctions between the deserving poor, who want to work, and the idle poor. Such a distinction ignores evidence from recent Medicaid expansions that policies such as work requirements do not lead to higher employment rates and that health coverage makes it easier find and keep a job. Or like The Economist, which is not a magazine known for its leftist views on human nature, said bluntly: “No, health insurance is not a hindrance to work.”
Even President Richard Nixon agreed that people who are unemployed or disabled need help getting health coverage. Fifty years ago he argued that there was “a need to ensure that every American has financial access to high quality health care”. Clearly, conservatism can be compatible with universal health care, both historically and today. When Medicaid expansion goes straight to the ballot, it wins, including in conservative states as diverse as Idaho, Maine, Missouri, Nebraska, Oklahoma, South Dakota and Utah. Utah. North Carolina’s Republican Legislature also recently agreed to the expansion of Medicaid, covering an additional 600,000 people statewide, in pair it with reforms designed to increase competition in health care.
The example of North Carolina shows how a breakthrough in coverage can help us achieve other policy priorities. The amount of oxygen taken in policy debates over coverage has narrowed the dialogue from health policy to health care policy to health insurance policy. Yet the two main concerns public in 2022 would strengthen the economy and reduce health care costs. Universal health care offers elected officials a pathway to address both.
Indeed, workers and companies both benefit from universal health care. Notably, the intertwining of health insurance with employment in the United States leads to “job lock“, which puts a damper on the labor market – as well as on the future prospects of workers themselves, whether they seek a better paid position or become independent contractors. Unions for low-wage workers as well as companies struggling to fill vacancies both benefit from reversing this status quo.
About two-thirds of adults already agree it is the government’s responsibility to ensure that all Americans have health care coverage. Given the impasse in our political systems, an even higher proportion will need to be persuaded to make universal health care a reality. changing minds requires focusing on the values that move people, or what Jonathan Haidt calls “moral foundations“: Prejudice, Fairness, Loyalty, Authority, and Sanctity. While the areas of Prejudice and Fairness are more important to those with liberal political leanings, conservatives place more emphasis on Loyalty, Authority and sanctity.
Loyalty (as a moral foundation) can be summed up like the feeling that it is “one for all, and all for one”. It was the impulse that drove us to walk away and put on masks at the start of the pandemic. While this notion of selflessness for the group may have faded during COVID-19, it also points to the right message for a movement around healthcare for all. Fundamentally, it must invoke our sense of human connection, especially with those who are currently excluded from coverage.
The road in the United States is rocky, but it is not impossible – and there are multiple policy approaches that could begin to galvanize momentum.
The faces of the uninsured, many might be surprised to learn, include Veteransfamily Farmersnew moms postpartumAnd children. More than 6 million children are at risk to lose coverage when the COVID-19 emergency ends, potentially doubling the uninsured rate for children. Because our identities as parents, grandparents, and caregivers are often stronger than our political identities, centering children is an important way to reset the national dialogue on universal health care.
In other countries, the path to universal health care doesn’t always been simple. Australia adopted universal coverage, repealed it, then re-adopted it years later – only to be met with widespread strikes by doctors that lasted several months. In the United States, the path is even more arduous, not least because of entrenched and politically powerful interests in the health care sector. But it’s not impossible, and there are several policy approaches that could begin to galvanize momentum: adding a public option to insurance exchanges, allowing currently ineligible people to enroll in Medicaid or Medicare, or radically simplifying and automating registration processes for those already eligible. but not registered.
All of these approaches depend on sufficient organizational strength to overcome political headwinds. There is a latent power to be tapped into disaffection that so many clinicians feel in today’s healthcare system. Nurses’ unions, for example, have already raised successfully tackled the problem of widespread staff shortages – and they since a long time supporters of universal health insurance.
Martin Luther King, Jr. titled his latest book, “Where do we go from here: chaos or community?” As we reflect on the past three years — and consider every human being who will lose health coverage in the months ahead — America’s healthcare system must wrestle with the same question. King challenged the premise that the community serves the economy, telling us it’s exactly backwards; that education, housing and health care are ends in themselves. From this perspective, universal health care is about common dignity, the idea that each of us believes in the fundamental value of the lives of others. We may not have reached that standard yet, but there is a way from here.
on universal health