The Case for Medicare for All: What the US Can Learn From the UK, and Taiwan

As the number of coronavirus cases in the US continue to rise, even with a serious lack of tests, it is becoming ever more clear that America is in dire need of a nationalized health care system. This reality has been obvious for years, and overwhelming public support in recent times, along with the growing bevy of evidence showing that Medicare-for-all is not only less expensive than the current bloated monstrosity, but would prevent tens of thousands of deaths every year, show that cries against such a system ring increasingly hollow. It is true that passing such a system through congress would be extremely difficult. However, history shows us that this pandemic could plant the seed to make it happen. 

One needs only to look to the creation of the UK’s National Health Service (NHS). The system has become one of the best in the world, even while under constant assault by austerity. 

The system began after World War II. Even armchair historians are aware of how hard the UK was hit during the war. Around 380,000 UK soldiers were killed in the fighting, with around 70,000 civilians also left dead. There were hundreds of thousands of others that were injured in the numerous bombing campaigns that ravaged the area. 

This of course left the country in a rough position after the second World War. This cleared the path for the decades of long work of health professionals and social reformers to implement a national health system to improve the lives of UK citizens. 

Some of the early reformers were individuals like Beatrice Webb. Webb was a socialist and a reformer. In the first decade of the 20th century she was a member of the Royal Commission on the Poor Laws and Relief of Distress. She was the lead author of the Minority Report, which was a dissenting opinion against the final report by the conservative government in 1909. The report drew a rough outline for what would become much of modern social policy. 

Webb was certainly not the only reformer who helped build the foundation for what would become the NHS. Another example is a physician from Liverpool, Dr. Benjamin Moore. Moore helped found and lead the State Medical Service Association, which created the foundation for the eventual creation of the Socialist Medical Association (now the Socialist Health Association). This group initially started as a group to fight against doctors putting money before care, and would slowly evolve towards a push for, and eventual creation of, the NHS. 

Both Webb and Moore are great examples of how literature can help shift the narrative and understanding of a populace. Webb wrote and co-wrote a number of books. Most of them were academic works designed to contribute to either telling the history of, or laying out the goals and strategy of social policy and the situation of workers. Moore also wrote a famous explanation of the health system, its metamorphosis and its defects titled The Dawn of the Health Age. 

Another example of writing that helped to shift the narrative and is often credited with bringing about the NHS was A. J. Cronin’s novel The Citadel. Unlike the works of Moore and Webb, however, Cronin’s book was likely much more digestible for the everyday person, being less of an intellectual tract, and more of a narrative driven story. 

The Citadel was a controversial work at the time of its publishing (1937), right before WWII. The book tells the story of a young doctor that begins his medical career in mining country. He is idealistic and outraged by the conditions he encounters. He later moves to London and begins to let his morals lapse as he descends into a life of relative luxury chasing easy money from rich patients. His practice and relationship with his wife begin to fall apart. To avoid spoiling a newly century old book, we’ll end the synopsis there, however this is the main crux of why this book was so simultaneously influential and contentious. Like in America now, many in the health care industry at the time valued profits over the populace. The book effectively took on the medical industry of the time, during and after the destruction of the second World War, these critiques would become even more poignant. 

It comes as no great shock then that the medical industry was one of the greatest enemies of the creation of a nationalized health care system in the United Kingdom. The situation is similar today in the United States. “Health care” corporations spend billions every year buying politicians. They do this to assure that they are going to vote for and against bills that will pad their already bloated bottom lines. They freely advertise on TV so the “consumer”, which should simply be a patient seeking the advice from someone who should be an enlightened physician, instead demands specific fad drugs. This also ensures that TV news pundits and media conglomerates don’t think to question medical practices, pharmaceuticals, or perish the thought, suggesting implementing policies that would save tens of thousands of lives and billions of taxpayer dollars every year. 

Doctors are not much better. During the transition to the NHS system after WWII, UK doctors were some of the most vehemently opposed to making the system free at the point of service and streamlined. This makes sense when one thinks about how in countries that have only private health care like the UK prior to the war, and the US now, doctors, generally speaking, have luxurious lives. Of course this is not true for every physician, though through a self-regulating structure with many opportunities for what in any other industry would be corruption and legalized fraud, opportunists can certainly attain high wealth and status while generally doing quite little work, simultaneously exploiting the supervision loopholes created by AMA lobbying to allow doctors to collect the full fees while subordinate care workers, such as nurses and physicians assistants see patients.

While the AMA has taken a public stance in support of a medicare for all type system, the quality and remuneration of physicians are two issues most often invoked by opponents. In truth, physicians, like police officers and firefighters are, in effect, public servants. The federal and state governments fund the majority of health research in the US, subsidize more than half of medical school education, and pay around a fifth of all healthcare costs in the US, and yet physicians still make the claim that they can self regulate and have no obligation to the taxpayers. Without their work, society would collapse, and their industry should be regulated as such and not as an open market free for all where those who lack the funds are left to die. If this coronavirus outbreak has taught us one thing, it is that profit will trump public health concerns every time. We must take back control.

The lessons we can take from the UK’s long push for, and eventual creation of, a national health care system shows us that it is obviously possible in the US. This should be clear from the fact that dozens of countries, including every industrialized nation, have already implemented such systems, nearly all of which display significantly better health outcomes than the badly trailing United States. It also shows us the institutions and individuals that we need to be cautious of. However, simply knowing who will be against the fight to make health care free at the point of service is only part of the battle. Having a solid plan and evidence for it is also critical. 

Directly following the war Sir William Beveridge rose to do just that. He was commissioned to create a report, Social Insurance and Allied Services, that would propose policies that would help rebuild the shattered UK in the wake of WWII. His propositions were, at least to his opponents, a bit radical. But Beveridge knew that they were exactly what the situation called for. 

A revolutionary moment in the world’s history is a time for revolutions, not for patching.

His words seem perfectly befitting the current situation in the US. America is currently facing a global pandemic and not handling it very well. The coronavirus is ravaging the world. Medical personnel are unable to attain equipment that would ensure their safety, this includes masks, gloves, and hazmat suits. Nurses and doctors are literally wearing trash bags in some instances. At one hospital where this was taking place, an assistant nursing manager recently lost her life due to the virus. 

US citizens are also at great danger. There is a disastrously low number of ventilators at American hospitals. This has been an unaddressed issue for decades stretching back to the George W. Bush presidency. It has not gone unnoticed or mentioned either, there are at least a dozen reports warning of this danger. 

This is not to say the federal government has done nothing in the past. Some saw the warnings and created plans to fill the gross ventilator deficit in the US. Project Aura was hatched in the US to create a new surplus of affordable new ventilators, many currently in the US stockpile are old, bulky, and difficult to use. The project eventually made a deal with a manufacturer based out of California named Newport Medical Instruments. 

The Japanese manufacturer was a relatively small company that only made ventilators. They came to an agreement with the US government and began developing new prototypes. After a few years they were nearly ready to begin mass-producing the new machines. In 2012 however, Covidien (yeah the name is ominous, bought out Newport for a little over $100 million, the same year they bought numerous other medical device companies. 

Two years later not a single ventilator had been delivered, the US agreed to give Covidien over a million more dollars, then agreed to cancel the contract. In 2015, as the medical device industry became even more monopolized, Covidien was purchased for $50 billion dollars. Until last year there was no new contract to buy more ventilators to fill the massive ventilator deficit the US still currently has, and that was only an order of 10,000 units, far below what is needed. New York alone will likely need 30,000 to 40,000. So now American citizens must rely on the generosity of regular Americans 3D printing ventilator parts on their own dime, though that may not be too foreign due to the fact that millions already rely on crowd-funding sites to pay their medical bills. Though it does seem that the Trump administration may now be doing the very least possible to save people in the US. 

American President Donald Trump has finally agreed to use the Defense Production Act to compel companies, namely General Motors, to produce these ventilators. While it is technically progress, it is far behind what should have happened. Other countries began taking action far ahead of mass outbreaks within their countries. Taiwan is an excellent example of this. Taiwanese leadership began using existing infrastructure to manufacture much needed medical goods, namely face masks, before the global pandemic started spreading from China.

They also proactively closed borders and introduced intensive airport screening, made easier because of Taiwan’s existing wariness about imported disease from China, following their uncontrolled outbreak of African swine fever over the past 2 years.

It must also be remembered that China constantly lies, including about the virus, one of the major contributing factors to the deadly spread, and has also effectively barred Taiwan from the corrupt WHO, making the expert handling of the outbreak in Taiwan even more astounding. 

Another issue where the US should be taking notes from Taiwan, and also the UK, is in the realm of its national health care system. The American system has been failing its citizens for decades and providing a perfect environment for rapacious for-profit health care companies to gouge American citizens and buy off politicians. 

Beveridge created his plan for healthcare based on the idea that no citizen would have to pay for health care when they went for treatment. Something Americans, unfortunately, have no experience with. 

Take the example of a woman who was recently tested and treated for the virus, only to return home to find a $34,927.43 bill. With research showing around 40 percent of Americans unable to afford a $400 emergency, this is untenable. A system like this means many will avoid treatment, not to mention avoid testing altogether, making the unstoppable spread all the more likely.

Even aside from all the disgusting unscientific rhetoric of many US politicians causing many to ignore this global pandemic as merely an overblown panic, and it’s not, Americans are unlikely to seek treatment even if they’re sick, exacerbating the already dire situation. Even before the coronavirus, hundreds of thousands of Americans were taking their own lives, committing suicide after getting serious diagnoses, simply because they didn’t want to burden their families with medical debt. This is unacceptable in one of the richest countries the world has ever seen. 

The NHS was finally realized in the UK after Winston Churchill was defeated in an unexpected election result following WWII. This led to Nye Bevan being appointed as the Minister for Health. He quickly moved to implement the NHS, which finally came to fruition just over 5 years after the end of the war in 1948. 

The UK’s journey to supply health care to its citizens through taxes, along with the stories of a myriad of nations throughout history, shows us that a crisis can be the catalyst for radical changes to improve and save peoples’ lives. 

The US has many of the pieces already in place: A large group of people desire change (in some polls even a majority of the country), progressive leaders are fighting for the right policy, and piles of evidence showing that a Medicare for all style system will not only improve, but save minimum tens of thousands of American lives per year – these things are all present. Now is the time to seize the moment and take, not only the intelligent, but morally correct, action and create a universal health care infrastructure in the United States, today. 

 

Staff writers: Ari B. and Jordan F.