Why Americans still don’t get it about health insurance


Watching the fight over Obamacare from a safe distance, in my case Austria, which has had universal and compulsory health insurance since 1889, I can’t help thinking the problem  is that most Americans don’t understand what it is and how it works.

Republicans seem to fear it’s a socialist plot to force Really Big Government on everybody. In fact, historically, healthcare was dreamed up and implemented by conservatives. Bismark, a reactionary if there ever was one, worried about the rise of the Social Democratic movement in Germany at the end of the 19th century, and for him things like health and unemployment insurance were ploys to put a lid on the kettle of social unrest. Give the little guy something so he will think he’s a stakeholder, then the filthy rich can go on exploiting the working classes without fear of being strung up on the nearest lamppost.

Health insurance is basically a solidarity pact: Everybody pays into the system, even (and especially!) if they are young and healthy. That way there’s enough money in the common pot to pay for those who are old and/or sick.

That‘s why it has to be compulsory, because if not, young, healthy people will probably opt out until they reach middle age, when they start worrying about the aches and pains, so they quickly join the healthcare system and almost immediately start pulling benefits without having paid up previously. Unfair! You bet. But that’s how it works in America, land of the free to do whatever I want.

The United States is the only developed country in the world that does not consider healthcare a basic human right, and so maintains a system to guarantee everybody gets it. Okay, some of the systems in Europe work better that others, and all of them struggle with rising costs. The fact that people in these countries live longer than Americans (because they have healthcare, stupid!) is also a huge problem, because as people reach high ages than ever before, the cost of keeping them alive climbs, but hey, nobody wants to pull the plug on granny’s life support. Or at least they don’t talk openly about it.

Obamacare is better than Nocare any day, but the system Obama finally managed to herd through Congress is a poor compromise between American individualism and the European solidarity system. For one thing, it isn’t really universal or compulsory, but instead lets insurance companies sort of compete, except they don’t really. Hence the 25% hike in premiums they’re talking about now.

If Hillary gets elected, I sure hope she will win by a landslide big enough to ensure congressional support for a major overhaul of the system. It’s time American got a taste of what health insurance can really look like.

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