As much as I sympathize with WHO’s Agnes Soucat when she urges Donald Trump to expand Obamacare and ensure all Americans have access to healthcare, and with Rob Yates when he shouts (not for the first time), on Twitter, that UHC can only be reached through PUBLIC financing, I guess at least in the North (Europe & US), we first of all will have to win the battle of ‘hearts and minds’ in the coming years, trying to find a way to let values like solidarity and empathy again overcome the rising tide of xenophobia, selfishness and fear of the unknown. Only then UHC will be a ‘potent vote winner’ again, in the North. Yes, many citizens care about access to health care, but unfortunately some other issues also turn out to be ‘potent vote winners’ at the ballot box these days, issues most of us in the global health community find a lot less enticing.
The trend is clear, by now. Far right populist parties (see Le Pen’s Front National or Wilders in Holland) do favour more (or at least want to preserve) social security (including UHC), but only for people who are ‘like us”. Apparently that’s a rather catchy political proposition for a number of angry segments in society, and it will take time (and lots of effort) to turn this around. At least in the North, where social security is under pressure in a number of countries (including via privatization), and talk is more about defending what we have rather than expanding, some ‘sequencing’ in the UHC battle thus seems necessary.
Whereas in many other parts of the world UHC might indeed be a vote winner for a number of reasons (such as being a ‘smart investment’, the right to health, … ), in the North I think we first have to focus on trying to win back a significant amount of the people who are currently attracted by (unfortunately, mainly far right) populist policies and politicians. I don’t believe they’re all hard core racists, most of them aren’t. In my opinion, we will only book significant progress in this respect if we manage to convince people that “the system” works (again) for everybody, and that the strongest shoulders do indeed carry the heaviest burden (tax wise), or at the very least do their fair share. As long as that’s not the case, populists will have a field day (and truly “universal” UHC will be nearly impossible).
If you believe, like me, that most people (both on the left & right) do indeed have a strong sense of justice, somehow we have to find a way to make sure that it’s not being trampled upon every day, as near daily ‘leaks’ (Football leaks, Luxleaks, …) and reports make many ordinary citizens (among the poor, the precariat ànd the middle class) very, very cynical. That is fertile ground for populist parties, as we have seen this year.
It’s time to start acting upon this tsunami of leaks & reports displaying the immorality of the current global economic system. Once the 99 % have the feeling that “the system” works again for most people and that affluent people and powerful companies do indeed pay their fair share, then UHC and other key policies and schemes that make this world a fairer place, will suddenly become easier again. While I admit UHC itself can also play a role in boosting this perception, at least in the North I think the battle we face first is one of ‘hearts and minds’ on “the system” in general. A system that is perceived as unfair by ever more people.
By the way, I got an important lesson from my Buddhist monk last Saturday ( well, he said it in general, but somehow it came at the right time for me). Have to say that sitting for five years in a Japanese monastery does indeed lead to more wisdom than frantically following one’s Twitter feed & reading pieces from public intellectuals from all over the world. Anyway, what he said was this: sometimes the world (and the direction it seems to be taking) can look very dark and overwhelming (like after Trump’s shock victory, my meditating mind added J). His advice was to then focus first on the micro-level, as there’s always something you can do there, to make this world a bit better. And it usually makes (more than) sense. Sounded like sound advice in dark times.
Building on that, I do think “the system” will indeed change for the better, when all of us, ordinary citizens, start protesting the excesses of the system in our own sectors and organisations. Whether it’s nurses demonstrating in the streets of Brussels as they need to do ever more with less resources, or a sports journalist who is beginning to ask some hard questions on the (tax) immorality in the sector he makes his living in, or corporatization in academia…
Once enough of us start doing this, there will indeed be an alternative. And most likely, it will include UHC, as well as probably some form of post-capitalism.