Time Has Come Today

Time has come today

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Can't put it off another day
I don't care what others say
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Time has come today¹

The time has come today for the United States of America to recognize an absolute right to health care.  In his 2020 campaign for the U.S. Presidency, Senator Bernie Sanders has urged America to “join every other major country on earth and guarantee healthcare to all people as a right.”  According to a September 2019 story published by NBC news, 27.5 million Americans or 8.5% of the population had no health insurance in 2018.  The article pointed out that the number of uninsured Americans increased by nearly two million people from the prior year.  One might wonder why, in one of the richest nations on the planet, do so many people not have coverage for health care?

The historic framework for healthcare systems was constructed in the aftermath of the Second World War.  America’s closest ally, England, chose to nationalize the provision of healthcare by establishing the National Health Service.  Though it was a Labour Party government that first established the NHS, that system has enjoyed wide public support by both Labour and Conservative led governments.  America chose a different path.

In contrast to the devastation wrought by the war in Europe, the U.S. mainland was barely touched.  As the American industrial machine geared up to respond to Europe’s need to rebuild, the U.S. labor market tightened.  Mindful of the hyperinflation that crippled Germany after the First World War, the U.S. government imposed wage and price controls.  Unable to bargain for higher wages, unions and employers turned to benefits as a means to attract and retain workers.  The U.S. tax code lent its full support to this development by allowing employers to deduct the cost of providing healthcare, while excluding the value of healthcare coverage from an employee’s income.

This system worked well for the veterans of WWII and their families.  Though initially a benefit of unionized employment, non-unionized companies followed suit to compete for workers who had come to expect healthcare benefits as an essential part of their compensation.  The main problem with a healthcare system tied to employment benefits was what happened when a person was no longer employed or employed in a low-wage job that did not offer healthcare benefits.  In 1965, this problem was addressed for persons retiring from the labor force by the enactment of Medicare.  Medicare established government provided healthcare benefits for those 65 and older. The law also provided government-sponsored healthcare benefits to the poor and disabled through Medicaid.

But for the rest of Americans, employment continued to be the key to accessing healthcare. Then, in the 1980s a number of factors caused America’s employment-based system to begin to unravel.  First, medical costs rose rapidly.  While this was happening, a wrenching recession, combined with fierce competition from Japan and Europe, resulted in American manufacturers closing factories, eliminating jobs and desperately looking for ways to lower costs.  As unemployment soared, employees reluctantly gave back hard-earned benefits.  Where health insurance had been a “free” benefit for more than 30 years, employees were now required to share its cost.  At the same time, as blue collar manufacturing jobs were lost, job gains in retail and service industries often came without healthcare benefits. 

By 2008, over 44 million Americans had no health insurance.  To address this crisis, President Obama and a Congress controlled by Democrats, enacted the Affordable Care Act.  After its provisions went into effect, the ACA reduced the number of uninsured Americans by roughly half.  But the legislation left the American system of employer-provided health insurance intact.  And that insurance was provided by a host of private insurance companies. 

Even though the ACA’s design borrowed heavily from health care models proposed by conservative think tanks, the legislation was passed with virtually no Republican support.  Since its passage, Republicans have tried repeatedly to repeal it.  Currently, the Trump administration is urging the U.S. Supreme Court to declare the law unconstitutional in its entirety.

Meanwhile, the United States is in the throes of a national health crisis where over 1.3 million people have been infected with the COVID-19 virus and over 80,000 have died.  The crisis is nowhere near its endpoint.  Cases will continue to increase; the number of deaths will be well over 100,000. 

Since there is no cure for this highly contagious disease or vaccine to stop its spread, experts have recommended measures such as quarantines and social distancing to slow its expansion.  These measures have had some success, but at a severe economic cost.  In the two months since states in the U.S. began imposing restrictions to contain the virus, the unemployment rate has gone from 3.4% to 14.7% - the highest rate since the Great Depression.  More than 20 million Americans are out of work.  Along with their jobs, these newly unemployed Americans have lost their healthcare.  That is how employer-based health insurance works – no job, no healthcare.

This crisis makes clear why the time has come for America to decouple health insurance from employment.  Every American should have healthcare coverage from cradle to grave, regardless of their employment status.

So, what should that healthcare system look like?  It should be comprehensive.  It should cover all necessary medical costs including vision, dental care and prescription drugs.  It should be available to all, whether young, old, rich, poor, working, unemployed or retired. 

Bernie Sanders’s Medicare for All plan is a good place to start, especially if the Trump Administration succeeds in getting the Supreme Court to kill Obamacare.  Wouldn’t it be amazing if you could get medical treatment if you were sick or injured and did not have to worry about premiums, deductibles, copays or whether your insurance company would deny coverage for the treatment your doctor prescribed?  That is what the citizens of most other developed countries have.  The time has come today for Americans to demand the same.

¹“Time has Come Today,” written by Willie and Joseph Chambers, originally performed by The Chambers Brothers