By Nicole Hassoun
The killing of UnitedHealthcare CEO Brian Thompson has set off soul-searching among many Americans. Part of that reflection is about the public reaction to Thompson’s death and the sympathy the suspect received online, with some people critical of the insurance industry celebrating the assailant as a sort of folk hero.
As many observers have pointed out, frustrations are no excuse for murder. But it has become a moment of wider reflection on health care in America, and why so many patients feel the system is broken.
Philosopher Nicole Hassoun researches health care and human rights. The Conversation U.S. spoke with her about the deeper questions Americans should be asking when they discuss health care reform.
We’re seeing an outpouring of anger about health care in the United States. Your work deals with global health inequality and access – can you help put the U.S. system in perspective?
If we compare ourselves to other rich countries, we don’t do very well. We spend much more money – about double per patient, on average, compared with other OECD (Organization for Economic Cooperation and Development) countries – and get much less in return. In a study of 10 wealthy nations, including New Zealand, Sweden and Canada, The Commonwealth Fund – a private foundation for health care research – ranks the U.S. last overall.
About 90% of Americans have some kind of health insurance. Still, 10% lack insurance entirely, and even some of those who are insured can’t afford the co-pays or medication costs.
And there is a great deal of inequality in the U.S.: both disparities in access to health care and disparities in outcomes. Black infants die at a rate nearly 2.5 times higher than white babies do, for example, and diabetes rates are 30% higher among Native Americans and Latinos than white Americans. People of color tend to have lower rates of coverage as well.
Before the Affordable Care Act, the situation was really dire. It’s likely many of us will get some terrible health condition like cancer during our lifetime, even when we’re relatively young. And what that meant before the ACA was that, if you got sick enough to lose your job – and so, your health insurance – new insurers could charge high rates because of your “preexisting condition.”
You’ve argued there’s a universal right to health. What does that mean, and what would it look like?
I think that people everywhere should have a legally enforced right to health – and in many countries, such as Germany and Norway, they do. In about half the world’s countries, that right is spelled out in the constitution.
But the United States has not ratified the International Covenant on Economic, Social, and Cultural Rights, which includes a right to health. Morally, I think that the U.S. ought to have signed on to that. People should be able to live minimally good lives, and health is really important to do that. Countries should protect their citizens’ human rights, and health is fundamental to other human rights, like the right to life.
When I say people have a right to health, I mean they have a right to the socially controllable determinants of health. This includes a clean and safe environment, health care and adequate food, water and social support. I am not saying that they have a right to be healthy, because you can’t guarantee that for anybody.
What I mean is that society should do what it can so that everybody has health care at a reasonable cost. Good governments and their social support systems help everyone secure the health they need to contribute to society.
The alternative is costly for everybody, not just people who are sick. Nearly half of the health problems in the U.S. stem from preventable diseases. As a wealthy country, we should have the resources to address those problems – including steps as simple as making sure people have high blood-pressure medicine, or regular primary-care visits. Everybody should be getting that kind of care, because otherwise, people certainly end up in the emergency room. Even ER visits that do not result in hospitalization cost an immense amount of money, ratcheting up the costs for everyone in the system, and often patients still don’t get the care that they need. According to a 2020 study published in The Lancet, a single-payer system could save the U.S. 13% savings in health care spending or US$450 billion each year.
It’s a matter of how we want to be as a country. We can make health a right, but that is a decision that the American population has to make. We’re all in this together. We’re all trying to make this country work. And it’s a lot harder to do that when you’re sick.
You mentioned an interesting phrase: the idea of the “minimally good life.”
I just wrote a book on the minimally good life, and the main question it grapples with is this: What do we owe each other as a basic minimum? What kind of social safety net will suffice for everyone?
I argue that respect for humanity requires people to help others live “minimally good lives” when that help does not sacrifice our own reasonably good quality of life.
But how should we define that minimum? How should the country decide what kind of social welfare system to have? The basic idea is this: Put yourself in other people’s shoes and think, “There but for the grace of God go I.” What would I need to live a good-enough life as that person? What would I need if I were them?
Maybe you don’t have cancer right now, or heart disease, or anything else. But someday you might. Empathy lets us think about how we can create the kind of security that will help us all flourish and live good lives.
It’s also part of being a good-enough person. I think we live better lives when we help each other. When we think about what we want, what policies and laws we want to vote for, we have to put ourselves in others’ shoes and consider what would be good enough for all of us.
Nicole Hassoun is Professor of Philosophy at Binghamton University, State University of New York.
Al says
If the socialized medical systems work so well why do the leaders of these countries ome here for surgery? There are a lot of sick people that get that way because of personal choices. Smoking is still prevalent amongst younger women in spite of years of messaging about cancer. How do you handle that? What about drugs used for getting high? What do you say about dangerous activities and extreme stunts for streaming? I don’t care if you do these things just don’t expect me to bail you out when you fail.
Yesterday I saw a report that 1 in 20 Canadians are opting for controlled suicide, this is state sponsored and encouraged. Vets with ptsd are being pushed to this solution also. Years ago I was married to a girl from Britain, she had an aunt that was a nurse and this lady preformed operations because there was a doctor shortage. Be careful what you ask for you may not want it once you get it.
Samuel L. Bronkowitz says
I remember reading a post from a nurse that worked with kids, some of which have well understood and treatable seizure disorders. UHC would deny effective medication, requiring that a child be treated with a lower tier completely ineffective one for 6-8 weeks until it was proven to not work. So these kids would just seize dozens of times a day for weeks, needlessly, because some paste eater or AI system deemed it necessary to ignore actual medical advice from a doctor that knew what the disorder and what treatment worked.
Maybe that’s a “frustration” and I’m sure their parents “feel” that the system is broken. I will say this, though – look very carefully at how luigi mangione is being portrayed in the media, and compare that to how other high profile shooters have been. Had he simply shot some black people or kids they wouldn’t have put out the kind of manhunt that they did for him.
Pogo says
@The first 2 comments
… from Trollville say as much about the cause of the current state of US healthcare as Hassoun, herself, does; in that they ignore the evidence Hassoun presented, state boilerplate propaganda, baldfaced lies, and provide a free trip around the block that has literally nothing to do with the destination in the title of this page.
Right in front of them:
https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/
Make of it what you will. Me? Don’t eat the yellow snow — the real thing, truth, is freely available.
richard lee santomassino says
I have heard your “speech” before. Social medicine is bad, “I heard a story from a friend of my mother’s postman” etc.
I spent 30 years in healthcare and continue as a 8 year volunteer for SHINE (we help w/ Medicare, Medicaid). For many years I traveled for my job to Toronto. I spoke to many Canadians about their healthcare. I have counseled hundreds of clients as a volunteer. This is my (firsthand) expert opinion: Our healthcare system is one of the worst in the world. When you factor in the amount we pay for this healthcare, we are probably dead last. We should have installed Medicare in the 1960’s as a single payer government insurance. We dropped the ball as a country.
So don’t tell me about something you read on Facebook about “Canadians opting for suicide due to the healthcare system”. I seriously doubt you have any experiences that qualify you as an expert. I hope Dr. Oz fixes Medicare so we can be #1 in the world in healthcare. Maybe you’ll vote for him for president one day.
Jim says
What leaders from the Organization for Economic Cooperation and Development countries are coming to the USA for surgery? Just curious. If you’re speaking of leaders from outside this group, it’s not germain to this discussion. That said, this discussion is not about how people get sick – it’s how they are treated once they are sick or need medical care. And what veterans are being pushed to controlled suicide? In this country? I’d like to know your sources. And finally, when you say a nurse performed surgery in Britain, what kind of surgery? There are some minor procedures that a nurse could perform if properly trained. So what operations are you talking about? Brain surgery, heart surgery, organ transplants? Please provide some detail.
Getting back to the subject of the article, it is clear to me that the stigma of “socialized medicine” is so pervasive in this country that we’ll likely never give it the serious consideration it deserves. Right now, the insurance and medical executives are making fortunes off the combination of either charging exorbitant fees for medications and medical procedures or by denying medical coverage (or delaying it) to people who desperately need it. And, per this article, we’re spending twice as much per patient for less coverage. Just pure common sense should tell us all that our system is not working. At some point, “average” people in this country need to wake up and realize that the system is not set up to do what’s right, it’s set up to drive profits to a small group of people at all our expense.
The definition of insanity is doing the same thing over and over and expecting a different outcome. How’s that working out?
Scott says
The health system in this country can be pretty messed up at times without a doubt,but this was an execution.MAHA!
Atwp says
Samuel I agree with the last statement 100%. No Black lives are as important than white lives. That is what this country teach us everyday. That isn’t true All lives are important.
Samuel L. Bronkowitz says
One of the best things about the United States is that you have the freedom to be absolutely dumb as fuck and post things like this. 1/20 Canadians opting for suicide? Oh for sure, right, I totally believe that.
Sherry says
Thank You Richard and of course, Jim! Thank you, Richard, for bringing us your first-hand experience on the subject, and your expert opinion. Thank you, Jim, for asking the important relative questions.
Unfortunately, there are those who routinely post misinformed conjecture/Fox BS and conspiracy theories on this site as if they were credentialled facts. al is one of those “Usual Suspects”.
D says
I just want the same health insurance that is provided to our elected government “servants”.