related diseases, high cost of medication, an excess of unnecessary tests, lack of competition between healthcare companies, and overmedication.
The average American pays seven times more for medication than the Japanese, and four times more than other developed countries. (36) This difference is absurd when you consider that we are talking about the exact same medication. Many diabetics who live close to the Canadian border cross over to buy insulin because it costs 10 times less. (37) Laboratories argue that their high prices are due to the high cost of research and development (R&D) but the main companies have quarterly earnings twice what they spend on R&D. (38) The government is the main culprit behind the consolidation of these high prices, given that programs like Medicare and Medicaid (state healthcare coverage for adults and children) are responsible for 40% of total spending on prescription medication. (39) Granting universal healthcare coverage to all Americans would cost $2.8 trillion annually, which would put the government in a complex fiscal situation. First, they must tackle the issue of costs through a medium-term plan before expanding the system to all citizens. (40)
Experts recommend greater price transparency, more competition between healthcare providers from different states, reduction of administrative costs, improved preventative care, lowering the malpractice litigation culture, taxing sugary products, healthy diet and exercise campaigns, and reducing the cost of medication. On the other hand, we will later see how this sector is protected by powerful lobbyists who work the technocratic apparatus of states and legislators to ensure bills that would help reduce costs aren’t passed.
The cost of healthcare plays a central role in the issue of inequality in the United States. In the following graphic, we see the percentage of income that Americans spend on taxes. When you include the health insurance payments made by workers to their employers, the tax rate of middle-class Americans is practically twice that of the 400 people with the country’s highest incomes. (41)
TOTAL TAX RATES
The issue of healthcare has a strong cultural component. A significant part of the increase in healthcare spending is associated with chronic diseases, many of which are related to obesity such as type 2 diabetes and high blood pressure. (42) Obesity grew from 30% in 2000 to 42% in 2018, (43) affecting African Americans and Hispanics in a higher proportion.
Many families, especially those with fewer resources, have a high consumption of high-sugar products, soda, fast food, processed food, sodium-rich products, and diets without any fruits or vegetables. On top of that, they do very little exercise and in many cases consume excessive amounts of tobacco and alcohol. Many of these factors explain the large differences in life expectancy between the rich and poor. According to several studies, the richest Americans live between 10 and 15 years longer than the poor. (44) For example, only 7% of Americans who earn over $100,000 a year smoke, as opposed to 14% among people who earn between $35,000 and $100,000, and 21% for those earning under $35,000. (45) A packet of cigarettes costs an average of $6.28. (46) A person who smokes a packet a day from the age of 18 will have spent $110,000 on cigarettes by the time they turn 65. If that money had been saved and invested with an average annual return of 5%, they would have saved an extra $431,000 for retirement. If this same person replaced their soda consumption with tap water, adding another $4 to their daily savings on cigarettes, they would have an extra $691,000 to improve their quality of life in their old age.
Cooking healthier foods and drinking water instead of soda involves not only a financial saving in a family’s monthly budget but also a major saving in medium and long-term healthcare expenses. Buying fresh ingredients and cooking them yourself usually costs less than buying pre-made or canned foods. The habit of cooking as a family, spending time preparing food serves a very important social purpose. The problem is a lot more complex given that obesity, tobacco use, and junk food consumption are closely linked to anxiety and the ecosystem we live in does not make it easier for people who struggle to correct these habits. (47) Our sickly habits translate to sickly bodies.
The pandemic unveiled the health inequalities through the highly skewed mortality rates between high-income and low-income sectors. For instance, in Wisconsin, though African Americans make up 6% of the population, they represented close to 40% of Covid-19 deaths. (48) This is due to African Americans being the group with the highest rates of obesity, (49) diabetes, (50) and high blood pressure. (51) All of these factors exponentially multiply the risk of dying of Covid-19.
THE UNIVERSITY MERITOCRACY
Until the mid-19th century, Argentina was a poor, desolate country, with high rates of illiteracy and constant internal conflicts. But as of 1862 came a series of presidencies that lasted until 1930, which began to focus on the country’s education and development. In 1884 under the presidency of Julio A Roca, a bill was passed into law assuring free, mandatory education for every child in the country. This law, alongside the impulse of university education and good public policies, transformed a poor and chaotic country into one of the richest nations in the world, (52) with one of the lowest rates of illiteracy. (53) The arrival of military governments and populism changed the scenario entirely, turning Argentina into a case study for how a country that was once rich and developed could return to underdevelopment.
As in Argentina, many other countries made primary education free during the second half of the 19th century. In the US, the levels of literacy had been quite high since the 18th century thanks to the Protestants who wanted their congregations to read and study the Bible for themselves. Once the population had learned to read and write, the next step was university education in order to meet the growing demand for professionals required by the 20th-century economy. In many countries around the world, university educations became free and accessible to most of the public in the 20th century. This was the basis for not only economic growth but also social justice and meritocracy.
It made no difference where you were born, if your parents were rich or poor, if your income was low. If you passed the admission exam, you could go to university; and if any expenses were involved, they were reasonable and could be affronted either through state aid, working a job, credit, or family help. University education was the basis for equal opportunities, the tool that allowed those who made an effort to reach the top. In the United States, the universities that had been reinvigorated by the influx of students from different social backgrounds became a central part of the counter-culture movement, which challenged traditional values by supporting causes like the civil rights movement, opposing the Vietnam war, authoritarianism, celebrating sexual freedom, women’s rights, new ways of dressing, and new musical genres like The Beatles and Bob Dylan. It was a place of dreams, inspiration, fear, and discovery. But above all, it was the launching pad for a prosperous professional life, to achieve more than our ancestors, a roadmap to achieving the American Dream.
This ideal of prosperity and meritocracy started to slowly fall apart during the 1990s. University graduates faced a challenging outlook, with fewer available jobs for a growing number of graduates, expensive properties, and a job market demanding constant improvement, forcing people to enter costly postgraduate programs. In Europe and most other countries, university educations are usually free, but in the United States its cost multiplied several times over, with a four-year program in 2018 costing $101,160 in state universities and $203,600 in private institutions. (54)
Why are universities so expensive in the United States? For a host of factors, including limited spots in Ivy League universities in a context of a growing population and a high influx of international students, high salaries for professors who give few hours of weekly lectures, and the high cost of upkeep of their enormous campuses. On the other hand, given than young people acquire debt in order to study and that these loans are guaranteed by the federal government, universities are hardly concerned about costs. This is just another example of a market distortion created by federal government policies. In contrast, European universities are cheaper
