Building and Defending Health Care: Obama vs. Rajoy

I confess that the first time I read in Tony Judt’s “Ill Fares the Land” that Social Democrats should concentrate, above all, on defending the institutions that they have helped create, I found it to be a highly unambitious goal. To give up dreaming of a better world in order to defend the gains we have already made struck me as an impoverished principle, lacking in passion and hope and, therefore, incapable of mobilizing a citizenry in search of political vision. However, after seeing what is happening in our country and in some other eurozone countries and comparing it with the U.S.’s recent experience in the construction of a universal health care system, I am beginning to think that defending what we were able to obtain through many years of political effort and public investment can become a nearly revolutionary principle.

Unlike our constitution — and those of many other European constitutions that recognize economic and social rights — the United States Constitution does not say that citizens have a right to health. This is why the U.S. is in the process of debating the constitutionality of Obama’s healthcare reform. Since the U.S. Constitution does not state anywhere that there is a universal right to health care, the Obama administration has created a form by which all U.S. citizens might have access to it — access that is lacking for nearly 40 million Americans today, people who cannot make a simple visit to the doctor because they do not have insurance. That form is known as the “individual mandate,” which obliges every citizen to have insurance through a private company which would provide them with medical coverage.

Isn’t it strange that in Spain we are discussing how to cut back on health care, while the Obama administration is trying to build a universal health care system that covers some 40 million citizens with the strands provided by a conservative constitutional framework that only recognizes civil and political rights? That is why the U.S. must employ a market solution and require all citizens to enter the private insurance markets in order to guarantee the right to medical care.

Of course there was an impassioned debate in the Supreme Court. There was, to begin with, a feature that I find enviable: all of the sessions were public, so that the arguments of those who supported and opposed the “individual mandate” could be publicly known. This is an exercise in judicial transparency that we might want to consider for our Constitutional Tribunal. In any case, as far as the arguments before the court go, it will certainly be difficult for the nine justices of the Supreme Court — four progressives and five conservatives — to reconcile an obligation to have private insurance as a means of universalizing the right to health (which is not in the constitution) with the importance that Americans place on liberty (which is at the core of the U.S. Constitution).

The political debate has been no less passionate. This has been — one must admit — similar to how it happens in Spain. Every time that a progressive government tries to take a step forward in constructing new rights for the people — in this case a universal right to health — conservative politicians oppose them. Then, when they lose the vote in the legislature they bring the conflict, which is primarily political, before the courts. In Spain, this has become such a constant practice by the conservative Popular Party that in the past — over issues like same-sex marriage, equal rights law and abortion law — it has turned our Constitutional Tribunal into a sort of third chamber where votes can be sought that are not available in the Congress or the Senate. In the U.S. it is the same. The Republicans believe that “Obamacare” is unconstitutional, so they appeal to the Supreme Court, while the Democrats defend the constitutionality of the reform, alluding time and again to the 40 million U.S. citizens without health care — among those, 19 million women who are completely outside of the system.

It must be said — speaking of politics — that this reform is, above all, a policy that helps the middle class. In the United States the very rich can buy health care services in the market and the very poor or elderly have guaranteed health care provided through public programs (Medicare and Medicaid). So, it is the middle class that has the most problems obtaining health care: They do not earn enough to afford medical insurance, which — by the way — is far from cheap (keep in mind that despite the lack universal public access to health care, the U.S. spends almost 18 percent of its gross domestic product on it).

It certainly is ironic that while all of this goes on in the United States, in Spain we are watching in near silence our own health debate — that is, the attempts by the PP-led government to dismantle the fundamental elements of our health care system. It is true that we are living through an unprecedented economic crisis, but the United States is also in crisis. What’s more, “Obamacare” was passed in the toughest moment of the crisis. Health care is not a matter of money, it is a matter of political choices — of knowing which social gains must be preserved in spite of serious economic difficulties.

Unlike the Americans, we do not have to build anything from scratch. Our constitution already recognizes every citizen’s right to have their health protected, and together we have been building a high-quality universal health care system that does not exclude anyone and that especially protects the middle class. It has cost us a lot to reach this point, without a doubt, in both money and effort. But, today, no one in Spain is obliged to count their pennies or check their bank balance before falling ill: We know that if that were to happen, no one would ask for a check before taking an x-ray or removing a tumor. It is this peace of mind — which nobody gave us, but which we have earned with political will and financial investment — that is now in play.

So in the end Tony Judt was right. In these times, where the economic crisis serves as a pretext for just about anything, defending the high-quality public, universal health care that we have today — proclaiming loudly and clearly that we will not allow the crisis to take this from us, and if the Popular Party tries to end it, it will have to deal with us — is a political act which is both brave and very progressive.