A society’s health—and healthcare system—serves as a window into its soul: it sheds light on the balance of class power, on political struggles long settled and still underway, and on who the society privileges and who it lets die.
The year 2017 ended with some somber news in this regard: in December, the Centers for Disease Control reported that life expectancy had declined in 2016 for the second year in a row, an event, as many media outlets noted, that had not occurred since the 1960s. This despite the onward march of science, the discovery of new cures, declining rates of smoking, safer automobiles, and a historic fall in crime. In no small part, the development stemmed from the rise of “deaths of despair” of disadvantaged individuals, to use the words of Princeton scholars Anne Case and Angus Deaton, like drug overdoses, which are continuing their breathless ascent, hitting 63,600 in 2016.
America, it is clear, is sick, but not because of some new virus or bacteria: there is a pathology running through the veins of our political economy, of which falling life expectancy is but one sign.
Consider last year’s regressive turn in the arena of healthcare. “When we win,” Donald Trump promised shortly before taking the 2016 election, “we will be able to immediately repeal and replace Obamacare.” He came within a razor’s edge of doing so, but was ultimately defeated, to some extent, by an impressive wave of grassroots resistance to “Trumpcare.” Yet in December, Republicans were able to claim a modest victory in their war on Obamacare: the repeal of the individual mandate, a development that chipped away at the law but did not end it. Today, their efforts continue with vigor: the administration has moved to ease restrictions on bare-bones short-term healthcare plans, and it has facilitated the introduction of “work requirements” and other nasty modifications designed to squeeze participants out of Medicaid, some of whom are the very individuals at risk for drug overdoses.
Yet if the state of our healthcare serves as a useful reflection of our politics, it should give us hope as well. For even as activists fought to deter Republican efforts to shred the U.S. healthcare safety net, they’ve also been on the offensive, pushing the healthcare discourse remarkably leftward. A single-payer Medicare-for-All bill in the House of Representatives—first introduced in 2003—soared in 2017, winning the support of most of the Democratic caucus. And Bernie Sanders’s new single-payer bill—launched last September—had some sixteen co-sponsors the day it landed.
Few have illusions that such bills will be passed anytime soon. But it is clear from the events of 2017 that a new stage in the movement for real universal healthcare—a central goal of the left for more than a century—has begun, even as health metrics have climbed downward, even as the healthcare safety net is bled. This special section therefore comes at a critical juncture. It provides analysis, historical context, and strategy for today’s movement for healthcare reform.
It is one thing to boldly call for universal healthcare, or even sway public opinion; it is quite another thing to win it. Josh Mound begins the section with a forward-looking analysis of the politics of achieving a single-payer Medicare-for-All program. He argues that the overall popularity of such a reform is not enough: Democrats must frame this policy in a way that speaks to the needs of their base, not the prerogatives of centrist wonks. The stakes are high: if they fail to do so, the whole endeavor could crumble.
Next, Beatrix Hoffman takes on the often neglected issue of healthcare for immigrants, especially salient in the xenophobic Trump era. Hoffman explores the history of activism for immigrant healthcare, struggles often led by immigrants themselves. She suggests that the fight for immigrant rights and for healthcare rights are interwoven struggles, and that each could reinforce the other.
George Karandinos tackles the gravest public-health calamity of our age—the opioid crisis. Drawing on ethnographic work he did in the open-air narcotics markets of inner-city Philadelphia, Karandinos reveals the links between the opioid crisis and the War on Drugs, emphasizing that solutions to both must found in the domain of activism and public health—not the carceral state.
Mary Otto then delves into the disastrous condition of oral health in the United States. The state of our teeth reflects the inequities of our society, and in Otto’s article, we meet disadvantaged individuals who suffer from the grave inadequacies of the American dental system. Achieving oral health equity will require a vision of universal healthcare that treats our teeth as an integral part of our bodies.
Finally, I close the section by wading into the debate on the right road to healthcare reform as we move toward the 2018 and 2020 elections. While support for a single-payer Medicare-for-All system is on the rise, others now point to alternative hybrid reforms—more akin to the Dutch or Swiss systems—as less disruptive models that we might embrace. Drawing on the history of the Canadian system, I argue that single-payer remains the only viable path to universal healthcare worthy of its name.
As we plunge into this new era of the healthcare struggle, we hope that the authors in this section shed light on the lessons of the past, even as they provide guidance for the future. The left will not live forever on the sidelines of political power. When we have an opportunity to remake our healthcare system, we must be sure to seize it.
Adam Gaffney is a physician, healthcare researcher, universal healthcare advocate, and writer. He is the author of To Heal Humankind: The Right to Health in History (Routledge, 2017).