No, Never

Interesting post at TPM on health care from Maggie Mahar:

In countries where most people are “middle class,” groups living on different rungs of the income ladder still identify with each other. Some earn more; some earn less—but they are not living in different worlds.

By contrast, in the U.S, Reinhardt pointed out, the divisions are much sharper. “We have our fabulously wealthy ‘corporate aristocracy’—people who are not part of the U.S. They don’t participate in American life anymore; they have five homes all over the world.”

Then we have a class of families most would call “rich.” They aren’t billionaires, and they don’t have hundreds of millions of dollars socked away, but they may well live in a home worth several million dollars. They own second homes, drive the most expensive cars and send their children to private schools.

Move down another rung or two and you find an entirely different world of upper-middle class and lower-middle class Americans. This group covers a wide swathe of society ranging from those who are “comfortable,” live in a nice house, own two cars, and go on vacations—to those who worry about making the mortgage or rent, ever sending their children to college, and paying off credit-card debt. The poorest are the “working poor.” The households on these two rungs don’t see much of each other. They live in different neighborhoods; their children attend different schools and they shop in different stores.

Finally, on the lowest rung of a five-rung income ladder, Reinhardt observes, “America has its very poor—these are the people who were in New Orleans when Katrina hit, and who receive no services.”

Following his lecture, I asked Reinhardt whether he thought that, if we made a real commitment to healthcare reform, the U.S. could build a system that provided a high standard of care for most Americans.

Reinhardt didn’t hesitate: “No, never.”

Why not? I asked.

“Because there is no social solidarity in the U.S.”

Reinhardt is predicting that we cannot—and will not—pull together to create and finance a high-quality healthcare system for all Americans because we don’t identify with each other. Instead, we live in our separate pods, defined, to a large degree, by how much we earn, and what we can afford to buy.

So often, we’re told that the U.S. cannot do what other developed nations have done because “the U.S. is different”–not “exceptional,” just different in a way that is not to our credit.

I’m not willing to accept that diagnosis.

I'm not exactly sure where I sit on this. I tend to agree with the diagnosis, but not the prognosis. I think the reason we don't demand universal health coverage in this country is because we see the very poor as an undeserving underclass that is not "one of us" and brings us down. But I also don't think this has to be a permanent condition in this country.