Diagnosing the Crisis: How to Explain the Structural Failures of the US Healthcare Model?

Last October, in the early days of my exchange program in Washington, D.C., I found myself at a birthday dinner. As the conversation flowed around the table, one comment caught my attention. An American girl, around my age, casually mentioned she was getting married the following Saturday. She explained that, after graduating, she had lost her university health insurance, and her family hadn’t arranged alternative coverage for her. Her fiancé, on the other hand, was in the military and received free health care, which also extends to close family members, including spouses and children. For her, getting married wasn’t just a ‘sentimental’ choice - it was the simplest way to secure health insurance. 

As international students in the U.S., health also quickly turned into something we had to be cautious about. Though we were technically covered by our overpriced exchange university insurance, we were far from being entirely shielded from all potential costs. I remember being warned on my first day of university to avoid calling an ambulance that was not affiliated with the university, as a ride could cost up to $1,000. Consider this a friendly reminder to think twice before fantasizing about living the ‘American Dream’. 

If, from a European perspective, such capitalization on a universal human right feels almost criminal, I was equally shocked to observe that, despite health being a significant concern for most Americans, the topic was nearly absent from the 2024 presidential contest. While Donald Trump obscurely promised a “concept of a plan”, what struck me most was how the Democrats, who have historically built their popularity on social and health policies, struggled to build a convincing vision of health. Paradoxically, Americans' widespread resentment towards the US health system and medical insurance companies has rarely been this prevalent, as recently highlighted by the murder of Brian Thompson, CEO of UnitedHealthcare. This led me to further question: how can we explain the growing political decline of attention to the US healthcare system despite persistent resentment among U.S. citizens? More specifically, how and why did health shift from being a key Democrat issue to one that barely registers? 

Neoliberalism: What if we Treat Health like a Marketable Commodity? 

Delving deeper into the topic, one way to better understand the issue seems to be rooted in the underlying ‘philosophy’ of health care. One article I came across, “The Neoliberal Turn in American Health Care”, draws parallels between the current U.S. healthcare system and Friedrich Hayek’s neoliberal ideology on health care. In the Constitution of Liberty (1960), Hayek asserts that the ideal of free health care rested on a “fundamental philosophical error”, namely the assumption that health care possesses an “objectively ascertainable character”. According to Hayek, we all have different personal tastes when it comes to social goods, including health care. Such preferences influence the quantity we desire and are willing to pay based on personal circumstances and priorities relative to other material advantages. Depending on factors such as age, or socio-economic background, one might prefer to buy a new phone over treating tooth decay. Put simply, health care should be allocated according to the ‘consumer’ taste, and, consequently, be treated like any other commodity. Interfering with this choice, he argues, infringes on one’s economic freedom. From this view, Hayek disputes the core idea that there could be anything like “free universal health care”. Otherly said, how can we have universal health care if our desires for health differ so widely? 

From Universal Health Care to ‘Consumer-driven’ Chaos: How did we get there? 

Starting in the 1970s, the political economy of American health care has moved towards this neoliberal vision, paving the way for increasing expansion of corporate powers and the rise of private market-driven solutions. Yet, the country has not historically held this ‘private-based’ position. Following World War II, universal health began to settle around the world. The United Kingdom launched its National Health Service (NHS) in 1948, followed by the rest of Europe in the 1950s. Across the Atlantic, the U.S. also appeared to be heading - to a certain extent - towards a similar line. Under his 1944 State of the Union Address, Franklin Roosevelt advocated for the “right to adequate medical care and the opportunity to achieve and enjoy good health”. A vision later revived by his successor, Harry. S Truman, and his plan for a national health insurance program. The push for progressive health policies continued under President Lyndon B. Johnson, who introduced transformative programs toward a universal health system, especially with the well-known “Medicare” and "Medicaid”. 

Regrettably, things shifted radically during the decades of neoliberalism and the so-called “Reagan Revolution”. Suddenly, attention towards social and health policies slowly started to fade away in US politics. Economic shocks coupled with a decline in productivity, gradually set the stage for stagflation. Slowly, the idea of ‘universal health care’ was buried. In the context of the economic turmoil, this project was now seen as a financial burden rather than a solution. President Obama’s struggle to pass the Affordable Care Act in 2010 against fierce Republican opposition is a clear example of neoliberalism’s ‘triumph’ over universal health care reforms. Hence, in the absence of a universal plan, we witnessed an explosion of corporate political action committees (PACs), and, consequently, the rise of “consumer-driven health care”. 

Democrats’ Approach to Health: “Incremental Patches” over Systemic Reforms?

The current issue with the Democrats is the failure to ‘depoliticize’ from this neoliberal system, advocating for “incremental patches instead of systemic changes”. This was particularly evident in Harris’s agenda on health during the 2024 presidential race. Shortly after being the democratic nominee, she backtracked from her initial support for a ‘Medicare for all’ and to get rid of private health insurance. She then promised to “work with states to cancel medical debt for even more Americans”, without however providing any concrete proposals. Overall, Harris’s health agenda seemed largely centered around abortion rights, but more as a reaction to the far right than as a ‘proactive’ agenda, critically lacking a sweeping and bold vision on this pressing issue.

As of today, over 20 million Americans are burdened with medical debt. In an AP-NORC poll, 44% of Americans expressed dissatisfaction with the current medical aid system. While the current chaotic political landscape, the ‘Project 2025’, or even the ‘Make America Healthy Again’ (MAHA) movement may make it hard to envision a positive resolution to the issue, hope for change remains as critical conversations ‘diagnosing’ the U.S. health crisis continue to grow.