"Haha! Americans don’t have free healthcare!"
Yeah it’s actually a serious problem people are literally dying can this stop being a silly nationalistic insult?
This is very fair! Do us folks really feel so insecure about our national identities that we need to shit on poor folks in America to make ourselves feel better?
People tend to believe that the reason countries like Australia have universal healthcare and America does not is one of cultural difference. America’s individualistic culture, the story goes, encourages them to disdain a government service we have the good sense and decency to embrace. Americans themselves are wont to embrace this explanation: it satisfies their innate belief in American exceptionalism; for the left, it is a cautionary tale about the downside of capitalism*; and, for the right, it demonstrates that socializing healthcare is not worth doing because it is innately incompatible with the American psyche.
[*It also allows the American left to do one of its favorite things: use other countries that they have no real interest in learning anything about as a political stick with which to beat their fellow citizens.]
Those of us In Australia, at least, should consider that we perhaps are not too different from the United States in terms of our cultural relationship to government provided health care. Australians tend to have little understanding of the political history of our system of universal healthcare and how we have the Medicare system we consider to be yet more proof of our apparent superiority to the United States. We forget how ferocious the political opposition to universal healthcare was here, and how extraordinarily difficult it was to implement.
Australia’s universal healthcare system began in 1974 when Gough Whitlam’s Labor Party established the Medibank system. The ALP had taken power in 1972 for the first time since 1949, and set about introducing a number of reforms — it’s policies like universal healthcare that are the reason Whitlam is remembered as a prime minister who tried to do too much too quickly.
Whitlam was unable to pass universal healthcare into law due to a hostile Senate — his party only had a majority in the lower house. He passed the bill eventually not because Australians have any particular fondness for helping the misfortunate, but because the Australian constitution has a mechanism for overcoming gridlock that the American one does not: the double dissolution. Having had his Medibank bill twice rejected by the Senate, Whitlam called a double dissolution election. Even after Labor was returned in the 1974 poll, it still did not have a Senate majority, and it could still not pass its health insurance bills. Whitlam could only enact universal healthcare in Australia thanks to the constitutional option of a joint sitting of parliament, in which the rejected bills could be considered in a single chamber that united the far more numerous House of Representatives with the Senate. This is the only time in Australian history a government has passed legislation in this manner.
It is instructive to compare this to two instances in American politics. The first is in 1971, when Richard Nixon tried to negotiate a healthcare bill with Ted Kennedy. This was not a universal system, but it did look something like what we know today as Obamacare: a mix of subsidies and employer-provided private insurance. Kennedy and his fellow Democrats rejected the deal — which he would later regret — expecting that they could implement a more progressive plan when they regained the White House. If Democratic tactics had been different in the early ’70s, America would be, at minimum, four decades further along the path to universal healthcare than it is today.
Alternately, consider the recent fight to implement Obamacare. Democrats had been campaigning on health care reform for years, and, in 2006 and 2008, they won, successively, majorities in the House and the Senate, and the White House. On the basis that election-winning parties implement the policies they took to the election, they set about expanding coverage of the US healthcare system. Activists hoped for a single payer system — which is what Australia’s Medicare is — but they lowered quickly their sights to a private system with a public option in a bid to gain bipartisan support and to neuter opposition in the Senate.
Note that, unlike Gough Whitlam in 1974, Democrats did have a majority in the Senate. In Australia, health care was consistently opposed by a Senate majority; in America, even the fall back of the public option had to be excised because Republicans — and some centist Democrats — filibustered the bill. Note that the filibuster isn’t a flaw in the American system as set out in the constitution: that document makes no mention of this method of legislative roadblock. The filibuster, which was so effective in making Obamacare as modest a reform as it was, is an accident of history. In Australia, Whitlam could overcome stronger opposition because he could use a double dissolution. The United States has no such provision; Nancy Pelosi was not permitted to dissolve the House and the Senate and call for an election, then ram through the bill in a subsequent joint sitting.
Let us now recall what happened after Whitlam passed Medibank into law. Conservatives repeatedly attempted to shut down the government (in the form of rejecting supply bills), then conspired with the representative of a foreign nation to overthrow the prime minister and have the opposition leader installed in power. They were successful. After winning a subsequent election, new prime minister Malcolm Fraser dismantled Whitlam’s universal health care system.
Labor was returned to power in 1983 and in 1984 it again created a system of universal health care — Medicare — which still exists today. It survived conservative opposition this time only because Labor held power for twelve further years, during which time Australian citizens came to view the system as a fundamental component of the welfare state and conservatives had to abandon their opposition to it to reassure the public they could be trusted in government.
Today, the Liberal Party is again trying to limit Australia’s system of universal healthcare. Australians, having had 30 years to get used to the benefits of universal healthcare, are aghast. Perhaps they will succeed in opposing the government’s planned reforms. But this is not the result of any cultural superiority Australians have over Americans. It’s because of differing constitutional and legislative quirks between our nations, and the whims of individual politicians.