In the midst of 2008 Presidential primary, Vicente Navarro published an article in the Harvard Health Policy Review discussing the “relationship between national health care systems and the policy process.” His paper has now been republished in the International Journal of Health Services and is now available on-line. In this article Dr. Navarro analyzes why, unlike most countries in the world, the United States has not adopted a system of universal health care coverage. What is particularly valuable about Dr. Navarro’s analysis is that he steps out of the US context and contrasts our system to that of Europe in Canada. Doing so offers an illuminating perspective on what is different about the US system.
The context for his discussion is the stunning failure of the current US system to provide any insurance to 47 million Americans and adequate insurance to an estimated 108 million Americans. This failure is costly in medical and financial terms. Medical bills are among the most common reasons for personal bankruptcy. As he notes: “None of the E.U. countries face this dramatic situation. It’s abundantly clear that this situation is not due to lack of resources. What then sets the US apart?
Navarro argues that our problems begin with the very nature of our private health care industry, financed – ironically enough – in the majority with public money. This creates powerful vested interests, among whom the most important are the insurance companies, who have an economic stake in perpetuating the status quo.
Navarro goes on to argue that not only has health care been privatized, but so has the electoral process in the United States. Paraphrasing Mark Twain he notes that “The U.S. Congress is indeed the best Congress money can buy…” and refers to an article he wrote in Counter Punch: “A Guide for Europeans: How to Read the US Primaries.” As a point of contrast he notes that “[m}any ministers of European governments have had to resign when it came to light that they had received private funds for the electoral process.”
The privatization of the electoral process explains why political candidates consistently raise lack of health coverage as an issue in campaigns, but then fail to address them once in office. And why increasing popular (and physician) support for a national system is ignored.
Navarro’s article is subtitled: “The Deficits in U.S. Democracy and the Implications for Health and Social Policy”. There is much evidence that democracy is ailing in the US. The 2000 Presidential campaign revealed serious problems with the voting process. The fact that the President is not elected by popular vote has not been addressed by the U.S. political class. The corporate domination of media has become ever stronger over the past decades restricting the bounds of acceptable political debate. Clearly, the fight for universal health care needs to re-invigorate the institutions of popular control over government.
Dr. Navarro is a Professor at the Bloomberg School of Public Health at Johns Hopkins University. He is also editor of the International Journal of Health Sciences. In the HHPR article he discusses a bit of his educational and academic background.
posted by Matt Anderson