It’s the solidarity, stupid!

Maggie Mahar has an interesting post on why we don’t have national healthcare.

“[inequality], says Princeton economist Uwe Reinhardt, is what makes health care reform so much more difficult in the U.S. than in countries such as Finland, Canada, Belgium, the Netherlands, Switzerland, Sweden, France, Denmark, Germany and Norway. In these largely middle-class countries, the gap between the most affluent and the least affluent is much narrower… . When you compare the incomes of the top 20 percent to the bottom 20 percent in most developed countries, the ratio is less than 6:1 ; in the U.S. the ratio is roughly 9:1.

Why do narrower income gaps make it easier to build a universal health care system? In countries where most people are “middle class,” groups living on different rungs of the income ladder still identify with each other. Some earn more; some earn less—but they are not living in different worlds. As Princeton economist Uwe Reinhardt put it at the World Health Care Conference in Berlin earlier this month, in countries like the Netherlands and France, there is more “solidarity.”

By contrast, in the U.S, Reinhardt pointed out, the divisions are much sharper. “We have our fabulously wealthy ‘corporate aristocracy’—people who are not part of the U.S. They don’t participate in American life anymore; they have five homes all over the world.” Then we have a class of very affluent families… . Move down another rung or two and you find an entirely different world of middle-class Americans. This group covers a wide swathe of society ranging from those who are “comfortable” to those who worry about making the mortgage, sending their children to college, and paying off credit-card debt. Then finally, says Reinhardt, “America has its very poor—these are the people who were in New Orleans when Katrina hit, and who receive no services.”

Following his lecture, I asked Reinhardt whether he thought that, if we made a real commitment to healthcare reform, the U.S. could build a system that provided high-quality affordable care for most Americans. I pointed to Germany, where even though affluent citizens (earning over roughly $75,000 a year) have a choice between public-sector healthcare and more expensive private insurance, the majority of wealthier Germans pick the public system. It’s good enough that they are satisfied with the quality of care. Couldn’t we do something similar in the U.S.?

Reinhardt didn’t hesitate: “No, never.”

Why not? I asked

“Because there is no social solidarity in the U.S.”

And why don’t we have solidarity? The legacy of race and slavery is no doubt one reason. It’s possible to win elections in the US by pitting one ethnic group against the other and one economic group against another. Given the country’s ethnic diversity its not entirely hard to believe that solidarity would be hard to achieve. Still, the country was founded on the idea that all men are created equal, that they are endowed by their creator with certain inalienable rights…

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Filed under dignity, healthcare finance, junglenomics

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