Written by SNaHP member Edward Si
The one key political prerequisite required to bring about healthcare reform in the United States is to reform politics itself and make it more democratic. Polls conducted by the Pew Research Center show that 63% of Americans favor a single payer system while a poll from the Hill shows 69% support. Even if there is a margin of error of around 13% or 19% respectively, this still demonstrates popular support for universal healthcare.
The problem is that the United States is not a direct democracy. The closest thing we have to direct democracy in America is our presidential elections, but those are still not examples of direct democracy because the candidate with fewer votes can still win. In addition, unlike other countries, America does not hold national referendums in which the electorate votes “yes” or “no” on a single issue. Sure, some states have statewide referendums, but the referendum does not exist at the federal level. Perhaps a single payer system could work at the state level, but I believe the state would also need power to negotiate healthcare related costs.
Instead we have a flawed representative democracy that does not necessarily respond to the will of the people. People in congressional districts vote for a representative to Congress, but it is easy to gerrymander these districts to force a certain outcome. The two party system makes it so single-issue voters are forced to choose the party whose other policies they may not support (or likewise voters shun a party because the party has a few values they do not like). To top it all off, some representatives do not represent the interest of the people who voted for them in the first place. Instead they represent the lobbyist hired by the multi-billion dollar industry (healthcare included) who donated to their aligned super PACs. It goes without saying that the majority of people are not multi-billion dollar corporations and cannot match their influence.
It is fair to say that America is not a true democracy and was not intended by the Founding Fathers to be one. However, I believe most of our politicians and citizens will enthusiastically claim that America is indeed a democracy whether or not they understand the fine print.
It is clear that the road to healthcare reform is shared and preceded by political reform as well.
The two go hand in hand. Somewhere along the line it will be necessary to break the stranglehold that corporations have on politics and/or introduce a pass legislation to make our system more responsive to the people. Ultimately those who support healthcare reform should also support greater democratization of our political system.
source: https://www.pewresearch.org/fact-tank/2020/09/29/increasing-share-of-americans-favor-a-single-government-program-to-provide-health-care-coverage/
https://thehill.com/hilltv/what-americas-thinking/494602-poll-69-percent-of-voters-support-medicare-for-all