Healthcare and its affordability has been an omnipresent issue in the United States and beyond since the ascension of Obama. To have reformed the system to a collectively funded one would probably have had implications far outside of America. In Europe, health services funded in-part or wholly by taxation have been constantly and gradually eroded and ‘reformed’ over a 30-year+ period; Obama’s hijacked plan is like a green light to the European privatisation lobby.
In England particularly, the previous and the current government have had to conjure a lot of PR to try to make it appear that the NHS is still more-or-less the same service that people rely on, whilst at the same time engineering as many budget cuts or part-privatisations as they can possible achieve.
In one sense, England is a lot better-off than many other places. America’s swathes of uninsured are a ubiquitous phenomenon, the internet is filled with forums requesting and offering medical advice for people with no insurance or people with bad insurance hoping to save a few dollars. Dentistry is notoriously expensive, and since regularity of care is a must in preventing problems, regular, comprehensive care simply stands outside the affordability of many families.
The Dutch system operates on a private insurance system, much along the lines of the American system. The system is very lightly regulated, so that the ruthlessness of insurers is tempered somewhat, but not by much. Of course the succession of centre-right governments has never presented any real obstacle for the insurance companies. In 2005 a nationwide push tried to make sure everyone in the Netherlands was insured; not by increasing affordability or widening coverage capabilities, but by sending out ‘checkers’ to make sure people were buying insurance, and to fine them for not doing so. These people turned up at places like homeless hostels to find out who was insured. They enquired at a charity medical clinic I was supervising, asking how many were insured – an odd question for a place offering charity care for the uninsured.
Beginning this year the dental provision offered as part of the insurances packages will disappear. Previously insurers would pay ‘part’ of the costs, something which seemed to turn on its head the very point of having insurance. This latest move amplifies that absurdity. So now individuals will be expected to pay out-of-pocket for costly dental treatments; and it is costly. Molar removals, with added costs, easily amount to 250,- euros, and check-ups can be as much as 70-80 euros. Whomever can afford it gets treatment, those who can’t won’t – it’s another view of the tiered health system between the haves and the have-nots. Richer people have an emergency pot of money, the poor and the working poor generally live from month-to-month, with no emergency funds. They have two choices: bad teeth, or health debts, often eventually paid to a debt-recovery agency, with interest.
Health insurance is undoubtedly a racket. But if healthcare is to be a privately purchased commodity, and increasingly so since the coverage insurance offers is shrunk down further, then unaffordable insurance offering scant coverage ought to disappear, since it is poor financial investment. It is of course maintained through a mixture of politico-legal and economic ideology, maintained by corporate interests. Health is not really a purchasing choice in the same way electronics and other consumer durables are purchased. Like food and shelter it is a captive market that operates on fear or peace of mind. Just as the housing markets are dominated by neo-liberal swindling and financial speculation, so the health industry has its own money speculators, with a captive customer base, some bullied and cajoled or legislated into providing an endless supply of money for international money markets.
Their aim appears to be a situation where insurance premiums constantly rise as coverage constantly decreases in proportion. In 2010/2011 the Dutch will see another rise in insurance premiums that will leave tens of thousands either in healthcare debt or completely uninsured and in ill-health, facing unfair prosecutions as ‘wanbetalers‘ (people who don’t pay their bills), rather than people who simply can’t pay their bills.
Incomes are not rising, they are freezing or shrinking. So we reach a typical point of absurdity in neo-liberal economic policy: people actively lose spending power, but are asked or coerced into purchasing the ever more, and ever more expensive, commodities (including ‘services’) that keep the neo-liberal economic merry-go-round turning. Since the collapse of the banks and financial markets there has been a constant discussion about the levels of personal debt and the near-complete absence of a culture of saving money. The culture of ‘living on credit’ was initially wheeled-out as a contributing cause of mass indebtedness, yet health insurance is itself a contributor to indebtedness that cripples the very extra spending power the neo-liberal machine desires to keep it going. So at the bottom end it comes apart at the seams as the poorer sections of society live in a constant cycle of debt, credit-fuelled debt, forced payment of impossible living costs through the filter of debt-collection and all its resulting misery and poverty. The architects remain untouched.
Britain’s Con-Dem coalition have been talking big this week. Vince Cable has been dubbed “red” for his attack on the ruthlessness of capitalism left-to-its-own-devices. Danny Alexander talked about rectifying the enormous tax gap created by super-wealthy tax-dodgers. No matter how well-meant, the Lib-Dem critics are allied with a senior partner committed to preserving neo-liberalism by making the little taxpayer suffer for little in return.
They will privatize the Post Office and push through the budget-cuts, criticised by the Institute for Fiscal Studies, among others, as unfairly targeting the poorest sections of the society. And health will not go unscathed. The trajectory of the Post Office has not followed British ‘national’ policy, it has followed the policy of the European Union’s commitment to economic liberalisation, and within this the UK’s NHS is viewed as an obstacle. It doesn’t matter that it is funded without requiring a tax rate any higher than the Netherlands or France or Germany. It is simply a target because it does not fit in with economic ideology. An ideology where national well-being and even ‘customers’ come last in order of importance.