Pressure groups and ideology blur public health

The lobbying campaign in the United States got 20 percent of the population to abandon public healthcare and switch to private healthcare: it altered the narrative about health insurance and overturned Truman’s idea of ​​health as a right. human.

A study by the National Bureau of Economic Research (NBER) in the United States shows that pressure groups, such as the American Medical Association (AMA) and the Health Insurance Association of America, have played a crucial role in the promotion of private healthcare in the United States.

These groups have used strategies of lobby indirectly to influence public policies and support the expansion of private health, concludes this study, which also highlights the importance that ideology has played in the promotion of private health insurance.

Without universal healthcare

In the United States there is no public health system that offers universal health coverage, unlike in much of Europe, where most countries have public health systems.

In the United States, however, there is not one health system, but six. First, there is health insurance through the company, which serves 49% of the population as part of their salary compensation. The disadvantage is that without work (due to dismissal) there is no insurance. Furthermore, because this medical care is provided by different private companies, coverage is variable and mandatory co-payments are generally high.

Then there is Medicaid, a federal and state program that provides health coverage to low-income people and of which about 20% of the population is a part. In this program, each State establishes its own guidelines regarding health insurance eligibility and covered services, so its impact on the population is uneven.

budget paradox

There are other public programs such as Medicare, Medicaid, CHIP, and VA, which cover specific groups, such as the elderly, the disabled, low-income children, and military veterans.

Outside of all these programs is almost 10% of the population, some 30 million people, totally helpless in the event of any medical eventuality.

And there is a paradox: as the government takes care of the most expensive patients (the elderly, poor, veterans), it ends up allocating more than 17% of GDP to health spending, which means that it spends more on health than any government in the EU. , except France.

Although if we pay attention to expenditure per inhabitantit turns out that the European or Japanese public health systems are much cheaper and more efficient in terms of medical coverage than the North American system, as we explain in another article.

Despite this evidence, defenders of private healthcare have argued in their campaigns that this format is more efficient and of better quality than the public healthcare system.

AMA under the magnifying glass

The NBER study, conducted by researchers at Harvard University, examined the rise of private health insurance in the United States in the post-World War II era, focusing on the role the AMA has played throughout this time. The AMA brings together more than 190 medical societies and maintains strong ties with the pharmaceutical industry.

The AMA has opposed the creation of national health insurance, arguing that no third party can intervene in the relationship between the patient and the doctor (sic).

The study looked at the AMA-funded campaign against National Health Insurance, which was led by the nation’s premier political public relations firm, Whitaker & Baxter’s (WB) Campaigns, Inc., famous for using tough tactics to defeat candidates. Democrats and progressive causes. Also for helping the AMA defeat the national health care proposal of President Truman (in the White House from 1945 to 1953), which conceived health as a human right. But that idea did not prosper because the doctors opposed it.

Important impact

Analyzing the famous campaign that achieved this victory for the medical establishment, the NBER study found a 20% increase in the population that switched to private insurance in those years, at the same time that social support for public health fell at the same time. proportion.

He also obtained evidence that the campaign altered the narrative about how legislators and social actors described health insurance.

These findings suggest that the rise of private health insurance in the United States was not solely due to wartime wage freezes, collective bargaining, or favorable tax treatment.

Rather, it was also made possible by a malicious campaign funded by economic groups that used ideology (the idea that socialized medicine was part of a plan to make the US communist) to influence behavior and policies. opinions of ordinary citizens, concludes the NBER study.

Spain, exposed

Both Europe and Spain are experiencing a process similar to that experienced by the United States and which led to its painful health situation: Spain has a life expectancy that is 5 years greater than that of an American, although its health expenditure is triple that of ours.

However, European public healthcare is threatened by the strategy of powerful economic groups that, contrary to scientific evidence, seek to reduce and even replace public healthcare.

Using the United States as their flag, they intend to manage with business criteria what is one of the pillars of global stability: universal health care for the population.

Madrid, reference

In Spain, Madrid stands out in this trajectory: it is one of the regions that has cut public health spending the most, that has reduced professional staff the most, that has outsourced health services and centers the most, and that has allocated the most public funds to hiring. with private entities.

And, as in the United States, it is one of the most active Spanish regions in campaigns by private healthcare groups that emphasize the advantages of private healthcare over public healthcare.

Reference

Interest Groups, Ideology, and Indirect Lobbying: The Rise of Private Health Insurance in the United States. Marcella Alsan et al. NBER Working Paper No. w32484, May 21, 2024.