Most Europeans don’t understand the U.S. healthcare debate. They don’t understand it because the opposition to it, and its breadth and depth, runs so counter to the experience of almost every European born since World War Two. It’s an experience so deep, so vigorously underpinned by government action and social teaching, that it has become a moral credo. They think healthcare is and should be a public provision. Most Americans don’t seem to.
The Europeans, who think of their unions as stubborn defenders of public provisions, don’t understand why a bunch of U.S. union leaders have come out against some of Obamacare’s central elements, arguing in a letter that it will “shatter not only our hard-earned health benefits, but destroy the foundation of the 40 hour work week that is the backbone of the American middle class.” (They worry that the thresholds for employers to provide health insurance will mean employers shift full-time employees to part-time work.)
The Europeans also don’t understand the visceral opposition of the right to the proposed system. Harvard economist and Obama advisor David Cutler looked at Mitt Romney’s 2012 campaign and said, “Never before in history has a candidate run for president with the idea that too many people have insurance coverage.” Yet Romney got a respectable vote. To oppose universal healthcare in Europe would be to guarantee instant political oblivion.
West European states have cradle-to-grave medical care for all of their citizens — and the residents of all the West European states go to their graves, on average, later than Americans, even if only by a year or two. This isn’t a direct measure of the quality of the medical care, and there’s a sizable debate about the connection between life expectancy and quality of healthcare. But Europeans believe in it, because they see it as a crutch in their sicker old age and believe that the U.S. system is heartless to the poor. In every West European country socialized medicine has become a matter of sentimental attachment as well as practical assistance. (Remember London’s tribute to the National Health Service during the Olympics?)
Now, though, that belief in socialized medicine is under strain, for the health services of the rich European states are in various kinds of “crisis.” I put the word in quotation marks because healthcare is ritually said by journalists to be in crisis: it’s the word that cries wolf. But this time there is a wolf.