There are a lot of barriers to the adoption of a single-payer health care system, but one that doesn’t get much attention is our tendency to view health care as something we need to earn. To see what I mean, take a look at articles like this one about growing enrollment in Medicaid. People interviewed for the story express guilt at accepting government “handouts”. That’s the problem with the peculiar historical development of public health care programs in this country. When Medicare and Medicaid were passed four decades ago, they were explicitly framed as programs for the aged, poor, and disabled. That made political sense at the time, but it also had the unintended consequence of setting the terms for future health care debates. Any reliance on government health care programs meant that you were part of the underclass; that you had failed as a self-sufficient provider for yourself and your family.
Most other Western countries never fell into this trap. When it came to health care access, they enfranchised everyone from the start. I’d like to think that this economic crisis, combined with the breakdown of modern conservatism, might push us to a point where we no longer associate government health care with personal failure or inadequacy. But old prejudices die hard.
