Contact The Editor
Articles By This Author
But former Maryland congressman John Delaney appeared unconvinced, cautioning that "we don't have to go around and be the party of subtraction, and telling half the country, who has private health insurance, that their health insurance is illegal."
Night two featured a testy exchange between former vice president Joe Biden and Sen. Kamala Harris, D-Calif., as Biden challenged Harris on her new health-care plan, which seeks to combine a government-run system with private health insurance. Harris backtracked on her earlier suggestion that she supports virtually ending private insurance - but notably, she still frames this new plan as Medicare-for-all.
"This is the single most important issue facing the public," Biden, who supports building on the Affordable Care Act, told her. "To be very blunt, and to be very straightforward, you can't beat President Trump with double-talk on this plan."
Harris responded that "the cost of doing nothing is far too expensive."
Sen. Kirsten Gillibrand, D-N.Y., drew attention Wednesday to high health-care costs and "for profit" insurance companies, while New York Mayor Bill de Blasio sought to debunk the "mythology" that "all these folks are in love with their insurance in America."
While most Democratic candidates in the crowded field don't support eliminating private insurance, the debates made clear that Medicare-for-all has gained traction within the party.
People overseas have typically been baffled by American disagreements on the basics of providing health care. Many countries have opted for universal health coverage. But these days, publicly funded health care is up for discussion again in Europe. As the continent's population ages, health-care budgets are increasingly strained there, raising urgent questions on the sustainability of health care the way most Europeans have long known it.
Chronic diseases are becoming more common worldwide, partially due to "urbanization, sedentary lifestyles, and rising obesity levels," and are offsetting advances including "improved living standards, better sanitation, and wider access to health care and vaccinations," according to Deloitte's 2018 global health-care outlook. Global health-care spending is estimated to increase by 4.3 percent annually until 2021, with transition economies such as China and Vietnam projected to see particularly rapid increases.
Still, the political effect of that shift will be most noticeable in Europe, where combined costs are high and people have long relied on the type of world-class universal health care some leading Democrats appear to be inspired by. Britain presents the most obvious case study.
Ahead of the 2016 Brexit referendum, one of the most well-known promises of Leave campaigners was to "fund our NHS," Britain's embattled but still beloved publicly funded health system, instead of contributing "350 million GBP a week" to the European Union budget. That number was vastly inflated - and so was the idea that Brexit would save the NHS, which faces severe staffing and funding shortages.
Amid uncertainty over Brexit, thousands of E.U. nurses have left the country in recent years. A no-deal Brexit scenario could result in widespread shortages of crucial drugs, according to the pharmaceutical industry. NHS supporters fear that all of those woes combined may eventually pressure Britain into a far-reaching mistake.
One year before his death in 2018, British theoretical physicist Stephen Hawking, who suffered from motor neuron disease, warned in a Guardian op-ed that the NHS was under enormous pressure from, as a headline on the post put it, "politicians who want to privatize it - when public opinion, and the evidence, point in the opposite direction." Hawking said he feared that the "direction of change is towards a US-style insurance system," which would be "hugely more expensive for the outcomes patients receive" and would mainly benefit big corporations.
Hawking's warnings sounded more timely than ever when President Donald Trump suggested this June that the NHS would be part of post-Brexit trade-deal discussions. After public backlash, Trump backtracked.
But even the remote possibility of the NHS coming up for sale prompted weeks-long discussions. After Trump's comments, British Health Secretary Matt Hancock rushed to clarify: "The NHS isn't on the table in trade talks - and never will be. Not on my watch." New Prime Minister Boris Johnson echoed those comments last week, saying that "under no circumstances" would he agree to such a scenario.
Despite the strong defenses of Europe's health-care systems, pressure to make concessions will only mount - and so will political efforts to exploit the uphill battle. In Germany, the far-right Alternative for Germany party has warned that migrants could put its health-care system at risk of collapse, even though migrants account for a small share of the growing burden on health care in the country.
Similar concerns were echoed in Sweden, where voters named the country's strained health-care system as the second-most-important campaign issue ahead of elections last year, just behind immigration. In Austria, where elections will take place this fall, sustaining the country's health-care system is among voters' top concerns, according to surveys. Meanwhile, in France, President Emmanuel Macron promised substantial changes to his country's still-excellent but overburdened system last year.
There is a good chance that health care will remain a top political issue on both sides of the Atlantic for years to come. While Europe's shrinking working-age population will have to fund health care for a growing population of pensioners, the United States' demographic change is projected to proceed more slowly. Demographics may play into the hands of Democrats supporting a single-payer health-care system, but they could become deeply problematic for their European role models.
Sign up for the daily JWR update. It's free. Just click here.
(COMMENT, BELOW)