The fact that the U.S.’s healthcare system is the worst-performing among similarly wealthy nations is well-reported at this point. It’s a bit depressing to hear it, and say it, over and over again. But it is still worth reporting, along with public discontent with that system, if only so that we can provide policymakers with solutions they will certainly ignore in favor of empty promises that probably would not have worked anyway.
Post-pandemic, these solutions, or at least, opinions, abound. Support for some kind of a universal health-care system appears to be popular, especially when that system is not a requirement for all Americans. Yet state governments have seemed content to always block such plans, with minor exceptions. The GOP has quietly ended its crusade against the Affordable Care Act, focusing instead on offensives in a “healthcare culture war,” such as opposing “special” care for LGBTQ+ people and racial minorities. Congress had prepared to allow Medicare physician pay cuts as high as 8.5% to pass before the American Medical Association got involved, and so on.
In general, such proposals focus on the healthcare system itself as the issue. However, if we’re going to be serious about getting it right this time, we as a nation need to acknowledge the broader problem: The way this country treats its workers is directly connected to and puts undue strain on its healthcare system. Worker exploitation is a public health issue, and if we want to fix the healthcare system, we have to consider how to fix work in America as well.
Some of these connections are relatively obvious. Healthcare providers are, of course, also sometimes workers subject to exploitation, and the tendency toward burnout among frontline workers in particular is well-documented. Include the facts that health workers without the letters MD or DO after their name are routinely underpaid and that their concerns are often silenced behind myths of “healthcare heroism,” and it becomes obvious that this system was designed to fail.
But these concerns go deeper: They are connected to the very heart of our attitude toward work as a nation. It is a well-chronicled fact that, especially during the pandemic, people often come to the hospital too late. For unvaccinated patients in particular, there was a tendency among liberal Americans to portray them as exemplars of cockiness: They were seen as totally unwilling to even admit they may have gotten Covid-19, and their eventual hospitalization represented comeuppance for their shameful actions. Not only was this rhetoric unnecessary and harmful to the cause, it also ignored a more fundamental problem with the link between most citizens and healthcare.
The idea that health insurance and, by extension, healthcare access should be broadly tied to employment might have seemed, at first, like a good idea. It results, however, in a catastrophic catch-22, in which the act of leaving work to obtain necessary healthcare results in the possibility of losing what allows someone to have insurance in the first place: a job. Stories of people choosing to work or pay rent instead of going to the doctor are plentiful. It is disingenuous, or at the very least ignorant, to feign surprise that people only go to the emergency room once it is absolutely necessary, which in turn strains the healthcare system, when our system of providing workers with healthcare actively encourages this practice.
In addition, the current American realities regarding worker safety and (un)paid leave also contribute heavily to a strained healthcare system. Whether Americans are “overworked” is up for (some) debate, but what is clear is that American workers suffer more workplace injuries than workers in other developed countries and that increased working hours in America is putting physical and mental strain on the beneficiaries of its healthcare system. In addition, the federal government’s reluctance to mandate paid leave, whether medical-related or not, exacerbates all of these issues by preventing workers from being able to recover. The American dismissiveness of the trials of the working-class has resulted in a system that actively harms its workers more than other developed countries.
These issues are obviously not unique to the United States. No country has truly mastered healthcare. Reports out of the United Kingdom, France, and Canada are evidence of that. That being said, the U.S. is unusually ill-positioned globally on this issue, in spite of how much money we throw at it. But these problems are also not isolated. They are connected to and exacerbated by broader issues regarding how, how long, and for what reasons Americans work. If we want to fix American healthcare, changing how Americans work needs to be central to the solution.
Image by Ashkan Forouzani is licensed under the Unsplash License.
