A Broken Health System Is a Threat to Freedom - The Atlantic - 0 views
www.theatlantic.com/...616898
health care universal tyranny authoritarian US trump crisis policy pandemic inequality
shared by Javier E on 01 Nov 20
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the United States is not a normal democracy. Untreated illness and uncertain care fill our politics with unnecessary fear and rage. Our president pushes this logic by offering insecurity instead of security as the aim of politics
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This is not inefficiency or neglect. It is a pattern evident all across the Trump administration: Governing is not about problems to be solved, but emergencies to be magnified.
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Health care is always political, but the politics can confirm or deny democratic norms and practices. A democratic country that handles a pandemic well generates trust in government, and even national pride. If care is not universal, then the political equation, especially during a pandemic, is entirely different.
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When citizens cannot imagine security, politics becomes the distribution of insecurity, the allocation of fears and anxieties that push us away from an idea of common citizenship and toward authoritarianism. What is lethal for Americans is also lethal for our democracy.
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I am an American historian who has seen the pandemic from both sides of the Atlantic, and who has just written a book about health care in the United States. When journalists from other countries ask me why so many Americans have died during the coronavirus pandemic, they phrase the question actively: “What have Americans done to bring about such needless mayhem?” And that is the right way to think about our COVID-19 policy. It is not a blundering, but a bludgeoning.
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In other rich nations, it is easier to see a doctor and harder to die than in the United States. As I write these lines, I am sick in Austria. That means that if I call a doctor, I see her the same day, get tests right away, fill out no forms, and pay no fees. Without worries about access to care, I am a freer person. On the scale of a whole society, the gain in liberty is extraordinary.
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Lost to us are the political consequences: If we take for granted radical inequality and repeated emergencies in the realm of health, we are primed for authoritarianism in the realm of life.
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Our babies and their mothers die at rates that Europeans find unbelievable. American Millennials will likely pay more for health care yet die younger than their parents and grandparents did. Life expectancy peaked here in 2014, even as it continues to rise elsewhere.
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Americans pay twice as much per capita for health care as the citizens of peer countries do, for the privilege of dying years younger.
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Those of us with insurance think about how good our insurance is, and where it will get us. Those of us who get access believe that we deserve it. It does not occur to us that the less-bad access we have is worse than what everyone has in countries with universal health care.
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Too many of us take for granted that health and freedom are somehow in contradiction—and so we exclude our own bodies from our notion of rights. We treat as normal a system of commercial medicine in which decisions about life and death are made on the basis of profit.
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Many white Americans regard their own suffering as virtuous, while maintaining that public health care would only be abused by Black people and immigrants. In other words, suffering is normal so long as others suffer more
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In the health-care debate in the United States, proposals to extend coverage to all are decried as government overreach, socialism, even outright tyranny. But the lack of health security is what makes Americans vulnerable to demagogues and authoritarians.
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Racial inequality brings unnecessary death. It also brings a sentiment that an authoritarian leader can exploit: Namely, that those who suffer the most are themselves at fault. When racism is a preexisting condition, the disproportionate death rates of Americans of color during a pandemic seem normal.
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America’s only hope of stopping the COVID-19 pandemic was to do so at the outset. Such efforts have been mounted before. Under George W. Bush, the number of SARS cases in the U.S. was limited, and no one died. In 2014, the Obama administration took the fight against Ebola to West Africa, a prudent step that was normal then but that seems like science fiction now.
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Before the novel coronavirus arrived in the U.S., the Trump administration dismantled the institutions that were responsible for early warning and early action
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By telling Americans in February what they wanted to hear about the virus—that it was not serious, that it would disappear, that everyone could get a test—Trump ensured that death would be widespread.
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By failing to institute a regime of testing, he made it normal for us to follow our own guesswork and emotions rather than dealing with facts.
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The Trump administration announced a kind of new federalism, in which governors would have to show their loyalty to get federal assistance, and in which the Democratic ones would be blamed regardless of what happened
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The bluster shrouded the basic decision, which was not to launch a federal response to the pandemic. No nationwide lockdown, no national testing initiative, no national contact-tracing initiative, no nationwide signaling on wearing masks and washing hands. This set the United States apart from every other comparable country.
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After first blaming Democrats for not doing enough, Trump switched to blaming them for doing too much.
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This is America’s basic problem: Health care is not a promise for all, but rather an expectation of the rich that they will do relatively better than the poor, and of white people that they will do relatively better than Black people
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Yet a democracy can become suffused with suffering, to the point where many voters do not even expect that policy might help them or loved ones stay well
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An aspiring authoritarian such as Trump knows what to do: provide the emotional jolts of pleasure that distract from the general decline. “Winning” is no longer about gaining something for oneself, such as a healthier or longer life, but about taking pleasure in the suffering of others. This is a sensibility—the strong survive; the weak get what they deserve—that favors authoritarianism over democracy.
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In this election, Americans face a choice not between individuals, but between regimes: between tyranny and a republic as forms of government, and between suffering and happiness as its aims. If Trump is defeated, our democracy should be reinforced by universal health care. Health and freedom collapse together, and they can be recovered together. We would be much freer as a people if we accorded ourselves health care as a right.