When Malcolm Turnbull visited the United States last month, he was part of a now-viral moment in the debate over American healthcare. Donald Trump was holding court with the Prime Minister, riffing on America’s “failing” healthcare system. Hurtling off script, as he does, the President turned to Turnbull and said: “I shouldn’t say this to … my friend from Australia, because you have better healthcare than we do.”
The praise for Australia’s universal healthcare system – from a president whose legislation would roll back coverage – pricked ears across the country. On MSNBC that night, Bernie Sanders, who was being interviewed in the studio, burst into laughter.
“The President has said it!” the former Democratic presidential candidate – and dogged proponent of universal, government-funded healthcare – shouted. “That’s great! Let’s take a look at the Australian healthcare system.”
It was a neat little TV moment that has been endlessly replayed because it was a bizarre and true comment.
Australia’s universal healthcare system, underpinned by government-funded Medicare, is indeed better than the American system, despite its flaws and deficiencies.
America’s attitude to healthcare is one of the most confounding cultural differences many outsiders confront, up there with abundant assault weapons and cheese in a can. The country is alone among the wealthier OECD countries in still not providing universal healthcare, and suggestions that it should are sometimes treated as a grotesque affront.
Visit a doctor here and the first question is not how are you but what kind of insurance do you have? In two years living in the US I’ve seen people frequently turned away from doctor’s clinics or prescription counters because they didn’t have the right insurance, listened to a woman contemplate a homebirth to avoid hospital fees, and heard numerous stories of eye-watering medical debt (which afflicts even the insured). Despite Obamacare extending coverage significantly, tens of millions still go without any insurance. The system remains complex, volatile and expensive.
It’s not cheap for the government either – healthcare spending in the US was just over 17 per cent of GDP in 2014, according to the World Bank, compared with 9.4 per cent in Australia. Many health outcomes are worse too – Americans have lower life expectancy and live with more illness and injury.
The refusal to embrace single-payer, or taxpayer funded, coverage is hard to understand.
Assistant Professor Timothy Callaghan, from Texas A&M University, succinctly explains it: “[America’s] culture is unusually individualistic, favouring personal over government responsibility; lobbyists are particularly active, spending billions to ensure that private insurers maintain their status in the health system; and our institutions are designed in a manner that limits major social policy changes from happening.”
It’s hard to say whether the President’s remark about Australia was just empty Trumpian flattery, as the White House later claimed it was, or a sign he personally favours Australia’s system. Trump explicitly endorsed a universal model in his 2000 book The America We Deserve, has praised the Canadian and Scottish systems – and even said during the 2015 campaign that he wanted “everyone to be covered” and that “the government’s gonna pay for it”.
But all that is at odds with the plan Trump and many Republicans are pushing now. The hugely unpopular bill, now before the Senate, takes Americans even further from an Australian-style system – reducing Medicaid funding, raising the costs of premiums for older Americans, and making plans prohibitively expensive for the poor, all while giving a tax break to very high income earners.
In its devastating assessment of Trumpcare this week, the non-partisan Congressional Budget Office predicted 22 million fewer people would be insured in a decade under the latest iteration of the bill. Even Trump called it “mean”.
But even if Trump himself won’t lead Americans there, there are signs the public might be warming to a healthcare system more familiar to Australians.
Progressive Democratic senator Elizabeth Warren, considered a possible 2020 candidate, called this week for single payer healthcare as party policy. She framed it as crucial to winning back working class voters and showing the Democrats stood for something.
States are making their own moves too – a proposal for a state-based single-payer system recently passed the California senate. It has since stalled over debates about cost, but it’s a sign of where some Democrats are moving.
Voter attitudes to the government’s role is shifting too. Pew Research polling from January 2017 showed 60 per cent of all Americans now think it’s the government’s responsibility to ensure all Americans have healthcare – nine points higher than the year before. Even among Republican voters that number was rising – most starkly for those on very low incomes, of whom 50 per cent said yes – up from 31 per cent the year before.
Those numbers were not so high in a separate survey when voters were asked specifically if they supported single payer healthcare – 44 per cent of voters said yes. Still, that’s a lot higher than the dismal 17 per cent of Americans who endorse the current Republican bill.
Embracing Australian-style or some other model of universal coverage still seems a long way off. But in a country that elected Donald Trump as president, a lot of things that once seemed politically impossible now seem a little less so.
Josephine Tovey is a Fairfax journalist based in the US.