Austerians’ Next Target: Universal Healthcare

Adam Gaffney at Dissent reports on how austerity is being used to slowly kill the institutions of of universal healthcare, arguably the most important (positive) political innovation to emerge from Europe in the 20th century:

The truly universal health care system, however, was in general a
post–Second World War development and was usually the consequence of the
work of labor and left-wing parties. Most Western European nations took
one of two paths: gradual expansion of coverage until the system could
fairly be called universal or the more abrupt creation of a truly
socialized national health service. In Great Britain, the 1946 passage
of the National Health Service Act brought about the British National
Health Service. Financed through general taxes, it provided health care
as a right, with medical services free at the point of service.

Most other nations, however, took a more incremental path. France,
for instance, built upon its 1928 National Health Insurance system,
passing successive pieces of legislation that covered larger and larger
proportions of the population until, in 2000, the remaining 1 percent of
the nation that was uninsured received coverage. Germany likewise built
upon its nineteenth-century Bismarckian system to create a system of
truly universal coverage. Greece was relatively late to the game. In
1934, it established a Social Security Organization that covered urban
and industrial workers, which was expanded to agricultural workers in
1961. But it was the 1983 legislation of the newly elected Socialist
Party that put into place a National Health Service (NHS), founded on
the principles of universal access. Along similar lines, Spain built
upon a 1942 health insurance law with successive expansions of coverage.
This culminated in the 1980s, when through a number of measures the
Spanish Socialist Party converted the health care system to a tax-based
system with universal access and a largely public provision of care.

No doubt, as they entered the twenty-first century, all of these
systems had their own flaws, their own inefficiencies, even their own
inequities and injustices. But for the first time in human history, the
poorest individuals could avail themselves of some of the most advanced
medical care in the world without worry that their illness would
bankrupt their family, and without the stigma of charity. A true right
to health care had been legislated into existence. Universal health
care, from this perspective, represented a truly massive and historical

[Gaffney then recounts the staggering cuts to healthcare in European periphery countries]. Although universal health care was a relatively recent achievement,
it quickly came to be considered an intrinsic feature of the European
welfare state. It is not, however, immutable. Universal health care
everywhere arose through the process of political struggle, and it can
be similarly unmade. It was generally the creation of parties of the
Left, and was more likely to emerge, and to emerge earlier, in those
countries with a strong tradition of labor unionism. As the balance of
power shifts, it is not only possible, but indeed probable, that those
elements that were fundamentally opposed to universal health care from
its very conception will emerge to challenge it.

The right wing uses the cause of cost-containment and deficit reduction,
combined with allegations of inefficiency, to chip away at the margins
of these programs, to promote privatization and reductions in benefits,
while at the same time avoiding a frontal rhetorical attack. Similarly,
those who would undo universal health care in Europe begin by increasing
the barriers to access (such as increased user fees or the denial of
care to illegal immigrants), by cutting expenditures and reducing
quality, by subtly changing the system away from universalism with
changes in financing or benefit eligibility. Not to recognize that such
measures could amount to the first step in a long process of unwinding
the right to health care would be a dangerous mistake.

2 thoughts on “Austerians’ Next Target: Universal Healthcare

  1. The private health insurance in Germany is under econcomic and political pressure. There are many voices in the political arena who claim that the dual system should be abandoned. The Praxisgebuehr, which had to be payed up to 4 times a year for visiting a doctor, has been abolished.


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