Austerity is Bad for Your Health Care

Fully established largely in the middle of the 20th century, Europe's universal health care systems are an immense achievement of progressive governance. To this day, these systems remain popular in their respective countries, garnering support and confidence from public majorities. Indeed, when the United States expanded its health care system under the Patient Protection and Affordable Care Act (aka "Obamacare"), reactions from Europeans ranged from congratulations to bemusement and scorn for the process having taken so long. But only three years later, European health care systems have been transformed from secure national institutions to beleaguered systems facing cutbacks and restructuring.

In the spring 2013 issue of Dissent, Adam Gaffney presents the gradual drift of European health care systems from the principle of universalism:

health expenditures dwindle, hospital budgets shrink, health care needs rise, and human suffering worsens. Suicide is on the rise; basic hospital supplies are missing; potentially life-saving surgeries are delayed; the rate of new HIV infections increases; drug shortages are ubiquitous; the prevalence of mental illness spikes. And these are just the obvious results.

The effects of austerity on health care are both immediate and long reaching. Deep cuts in public health spending clearly exacerbate the suffering caused by the prolonged economic depression. At the same time, the cuts contribute to a more pernicious, slow-moving, and decidedly political process.

Because these systems are being subjected to a slow "death by 1000 cuts," it is a process going largely unnoticed by those not directly affected. 

What's happening brings to mind Naomi Klein's book The Shock Doctrine, which argues that crises and disasters over the past few decades has been seized upon by advocates of privatization as opportunities to realize their agenda. The current crisis is no different; across the Eurozone, countries working to service their debt are jettisoning publicly-owned enterprises and property and cutting government services. Rob Johnson of the Roosevelt Institute argues that a "self-fulfilling spiral" has been created which is undoing the social contract in a number of European states. What even Margaret Thatcher at the height of her power could not do the National Health Service in the UK is being done gradually by stealth on the continent.

Meanwhile, these cuts to health care systems not only weaken their universality but also have dramatically negative impacts on public health. In a book to be released later this month, The Body Economic: Why Austerity Kills, Sanjay Basu and David Stuckler reveal some truly horrifying statistics. In Greece, which just underwent a new round of austerity on Monday, the rate of new HIV infections has doubled since 2011 and a malaria outbreak has occurred for the first time in decades. Greece's hospitals, which already suffer from shortages of medicines, equipment and basic supplies, will suffer further as the country is pressured to reduce its public health expenditures from 10% to 6% of GDP (compare this with 8.6% of GDP in the U.S. in 2011). Suicides have risen in Greece and Italy as desperation increases and social services cut back. In many of the Eurozone countries undergoing austerity, ordinary people face "shortages of essential medicines, lost healthcare access, and an avoidable epidemic of alcohol abuse," according to Stuckler.

For those who think that the U.S. has been spared austerity and has rather been enlarging its healthcare system under President Obama, the facts will disappoint. Last year, 84 million Americans were either without insurance or with out-of-pocket costs so high as to render them effectively underinsured; among other effects, this made them far "less likely to receive recommended preventive care." Even as legislation expands the scope of health care at the federal level, state budgets cut $4.35 billion dollars in mental health treatment and services from 2009 to 2012. Reductions in Medicare spending due to the sequester and President Obama's proposed means testing for Medicare recipients are only the beginning; they could portend other potential reductions in the U.S.'s already limited public health care system in the future.

Even though policies of austerity are finally on the defensive, the hollowing out of universal health care systems will have a lasting impact that will be hard to fully reverse. These changes are especially pernicious in that they immediately impact health and mortality. If the relatively efficient and modern health care systems in Europe are weakened further, the immediate impact will be a human tragedy. The new limited scope of the system, however, would be a semi-permanent social tragedy, given what universal health care accomplished in these countries.