How The Phrase “Universal Healthcare” Became Meaningless

By talking about universal healthcare without supporting an actual universal healthcare system, centrist Democrats turn an important demand into an empty marketing slogan.

The first line of the Democratic Party’s healthcare platform reads, “Democrats have fought to achieve universal healthcare for a century.” Obviously, that’s not true. Neither is the Party’s claim a few sentences later that Democrats “fundamentally believe healthcare is a right for all.” Medicare for All is the one policy in Congress that guarantees healthcare for all, free at the point of service, no cost barriers—yet it has virtually no chance of passing this Democratic Congress or of being signed by Joe Biden. Less than half of senate Democrats support Medicare for All, and Biden outright opposes it. Universal healthcare, of the kind offered by many other countries, is on the table, yet far from fighting for it, most Democrats oppose it. We know that the for-profit healthcare system cannot get everyone the care they need, but instead of trying to dismantle it and replace it with a functional system, the Democratic Party’s commitment is to the rhetoric of universal healthcare rather than the reality. 

The phrases “universal healthcare” and “healthcare is a right” are often used interchangeably in Democratic politics with the phrases “universal healthcare coverage” and “affordable healthcare is a right.” But universal health insurance is not universal care—just because someone has insurance coverage, doesn’t mean they have the money for premiums, co-pays, deductibles, co-insurance, and unexpected bills. It doesn’t just matter whether someone is “covered,” it matters what kind of coverage they have—their real-world experience of care. And a real “right” should not have any kind of cost barrier at all—the right to public education, for instance, would be undermined by a proposal to charge means-tested fees to elementary school students. Rights are the things you get for free, without qualification. 

The Democratic marketing plan on healthcare stresses the moral imperative of getting everyone the care they need. Democratic policy, on the other hand, is not about health justice or universal care. It’s about tinkering around the edges of a sloppy patchwork system that deters people from getting care, sticks people with big bills, rains money on insurance companies, and takes care of wealthy Big Pharma, insurance, and private hospital donors. Voters are expected not to notice the difference between the stated goals and the actual proposals. 

It’s not hard to find examples of the empty moral marketing on healthcare within the Democratic Party. One striking moment came in President Biden’s second debate with Donald Trump. Biden said, “I think healthcare is not a privilege, it’s a right. Everyone should have the right to have affordable healthcare.” First, Biden says healthcare is a right, embracing universal healthcare as a brand. But the next sentence undercuts the initial assertion. Biden now says the “right” is to “affordable” care, not simply a right to the care we all need. What does affordable actually mean? If your treatment requires you to take a second mortgage, and involves endless bureaucratic negotiation with your insurance company, but technically you can “afford” it, have we solved the healthcare problem? This kind of slipperiness is common in centrist Democratic rhetoric. A fundamental right will be endorsed, and then qualified with a word like “affordable” or “accessible.” 

Another objective of the obfuscations is to make it exceedingly difficult for voters to choose a candidate who does truly advocate for healthcare for all. In Democratic primaries, every candidate will say they have their own plan for universal healthcare (of course, it’s the right thing to do!). Medicare for All is presented by its opponents, pundits, and journalists as just one option to achieve universal care, along with the hodgepodge of “strengthening” the Affordable Care Act (ACA), a public option, expanding Medicaid, more subsidies to private insurers, etc. It was much harder to distinguish between candidates during the 2020 Democratic primary on healthcare because all of them claimed to be seeking different routes to the same end. Biden said that he and Bernie Sanders shared the goal of “universal healthcare access” and simply “disagree on the detail of how we do it. But we don’t disagree on the principle.” They did disagree, though, because only one had the policy platform to back up the branding. Voters, however, are destined to have a difficult time telling the difference so long as every candidate’s words are nearly identical, and the crucial distinctions are found in subtle caveats and qualifiers. 

Biden’s non-universal healthcare platform was indeed too good to be true. The biggest piece of healthcare policy under the Biden administration so far has been the massive transfer of public money to private insurers in the America Rescue Plan (ARP) in March. In an interview shortly after the bill passed, Mehdi Hasan asked White House Senior Advisor Cedric Richmond why the ARP spent billions on short-term subsidies to private insurance companies—for things like six months of COBRA coverage for people who lost their jobs—instead of investing in universal healthcare. Richmond misunderstood Hasan’s more left-leaning perspective, got defensive, and said “I won’t put a price on lives…I’m not going to put a price tag on a woman finding out that she has early stages of breast cancer.” Richmond accidentally made the exact case for single-payer. Hasan clarified, saying he wishes Democrats would spend more money on healthcare, specifically a public program like Medicare for All rather than giveaways to insurers. Flustered, Richmond responded, “Well, remember, this is a response to a pandemic. If we didn’t have COVID-19, you wouldn’t see us doing that COBRA appropriation. So, we’re probably saying close to the same thing.” Not “putting a price on lives” is apparently for a limited time only. After that, it’s back to indifference. 

Exchanges like this illustrate the gap between marketing and motives—the moral marketing language of rights and care contrasted with the policies that boost the status quo private health system that kills tens of thousands of people a year, and causes many more to suffer trying to ration medicine, forgoing care, and drowning under medical bills. Richmond makes the case for universal healthcare rhetorically, but is forced to completely back down when challenged on policy. 

Now President Biden is doubling down on this private insurance subsidy centered healthcare policy. In the proposed American Families Plan, the centerpiece healthcare policy is subsidizing private insurers to make insurance premiums cheaper for folks buying insurance on the ACA exchange. Yet, in the lengthy press release on one of Biden’s big legislative packages, the White House says the familiar phrase, “Healthcare should be a right, not a privilege.” A “right” that you’ll need to pay your premium, co-pays, deductibles, co-insurance, and surprise bills to receive. 

This all fits in with the cementing of “hypernormalization” in our politics. Hypernormalization, a term coined by anthropologist Alexei Yurchak, is the surreal, uniform acceptance of a false version of reality and the myths that fuel that false reality. “Healthcare for all,” “healthcare is a human right,” “my plan for universal healthcare”—politicians say it but everyone knows it’s a facade. Mainstream Democratic politicians know they have no intention of enacting a universal healthcare policy. The media knows it, too, yet repeats the same conflations as Democratic leaders. And Democratic primary voters must know it, because they have seen that electing Democrats does not get them the healthcare policies that Democratic voters demand. But many accept the false reality that Democrats are the party that wants to get everyone healthcare, perhaps because the alternative is just too bleak to accept. 

Even some co-sponsors of Medicare for All make sure to signal that their true goal may not actually be single payer. It’s commonly accepted on the left that there are some co-sponsors of Medicare for All that are little more than paper sponsors—Democrats who never advocate for single-payer, aren’t forced to discuss it on the record, and likely only put their names on the legislation to avoid being outflanked on the left in a primary. After all, a staggering 87% of Democratic voters want Medicare for All. If Democratic politicians were reflecting the will of their constituents, Medicare for All would be U.S. law right now. 

Yet Democrats in Congress can’t even come together to back expanding and improving existing Medicare. One hundred and fifty-six Democratic House Reps and 17 Democratic Senators signed letters to Biden urging him to lower the Medicare eligibility age to at least 60 and expand Medicare to cover dental, vision, and hearing care through the American Families Plan. The Biden administration hasn’t signaled any interest in these two incremental measures, nor has it allowed discussion of a public option to see the light of day, despite Biden campaigning on all three policies last year. The 99 Democrats in Congress who didn’t sign these letters must see a small public expansion of healthcare coverage as too extreme for their donors, too much of a threat to the current system, or are staying silent to not upset anyone in the White House. 

These Democrats may have the same perspective on Medicare as House Speaker Nancy Pelosi, who said in an interview in late 2019, “I’m not a big fan of Medicare for All. I welcome the debate, I think that we should have healthcare for all. I think the Affordable Care Act benefit is better than the Medicare benefit.” This is the Democratic healthcare myth. It clearly isn’t better, but saying that it is allows Democrats like Pelosi to pretend that they are in fact delivering on the promise of universal care. In fact, we should be extremely troubled by what Pelosi says here, because by suggesting that subsidized private insurance is “better than the Medicare benefit” she opens up the alarming possibility that further privatizing existing Medicare might not be a bad thing. 

In a recent piece for the New Republic, Alex Pareene explores how the Democratic Party could, and probably needs to, start investing in different advertising, messaging, and media strategies to match the GOP’s effective use of propaganda to win elections. In closing, he points to one reason why Democrats may not do it: “their benefactors might prefer to underwrite propaganda that broadly supports liberal capitalism rather than specifically progressivism.” This gets to the core of the problem. Democrats do use propaganda, but largely only to protect capital and to quite literally “virtue signal,” i.e. to suggest that the Party believes in the morally virtuous goal of universal healthcare regardless of whether it actually does. Health insurance companies and Big Pharma don’t care if Democrats say “healthcare is a right” for electoral, political, or moral gains—as long as those Democrats don’t back that up with advocating for single payer.

So, where does this leave us? As an electorate, we’re asked to practice harm reduction by supporting the political party that will maintain the deadly status quo in our private healthcare system. As a people, we’re forced to endure the physical suffering, mental anguish, health crises, and financial hardship endemic to that system. As a country, we’re left with very few high profile advocates for universal social programs and the protection of the most basic human rights. It is important to interrogate not only the policy failures of the Democratic Party and the language used to obscure the party’s intentions, but also the morality argument central to this propaganda. Until the motives of the Democratic Party change around healthcare policy, or some massive political or social shift forces a change, the public is doomed to the private healthcare system while top Democrats echo the now meaningless phrase “universal healthcare” over and over and over again. Whenever we hear this, we must demand to know: what do you mean by “universal healthcare”? The answer too frequently turns out to be “something other than universal healthcare.” We cannot settle for that.  

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