The true cost of hope in an upside down world

In a world of instant gratification, politics is an outlier. There's no quick fix. A handful of organised street protests and a few progressive candidate wins are but a drop in the ocean of change

At the risk of repeating myself, I want to begin with the bullet-point list from my last post and repeat the six simple questions I asked. It’s around these that I want to weave a proposition that does not skip over the obvious question of why they are problematic for the Republican argument that America can’t afford the basics on offer in most developed economies.

• Do you believe in universal health care?

• Do you believe in affordable child care?

• Do you believe in paid family leave?

• Do you believe in a living wage?

• Do you believe no child should go to bed hungry?

• Do you believe in free college education?

The central tenet of my argument is that all of the above are denied to every American by default. In short, the system dictates that in the alleged richest country in the world, access to all of the above is not a right, and if you are so bold as to suggest they should be, you are a communist. The implication is that providing what is given in most European and Scandinavian countries disincentivises hard work. This is nonsense, but we’ll get to that downstream.

This longstanding hostage mentality is pervasive in almost every part of American life. It is outrageous for many Western societies to link access to healthcare to a job. Lose your job, lose your healthcare is a completely alien concept to people like me who have access to universal healthcare. Then comes the rationalising moment when I start to think the only justification for it must be that it’s cheaper, but that’s not the case. Take a look at the chart below, which shows the per capita cost of healthcare across a basket of countries.

For those outside the US who might be unfamiliar with the US healthcare system, you might want to read this piece by Matt Bruenig, for the excellent People’s Policy Project, written on May 26th 2026. The reason I think it’s a great reference piece is that it is about policy and how it can be used to improve policy to deliver a fairer system. To a European like me who benefits from universal healthcare, this is a system not fit for purpose unless you have a generous income.

The UK offers universal healthcare free at the point of use. I’m using this as a comparison because, as a British citizen, it’s the healthcare system I have had access to all my life, so I can speak on it with some authority. The NHS is funded from central tax deductions, and healthcare staff are largely employed by the government to provide the service. It is worth noting that consultants and other specialist staff are free to work in the private sector in addition to their NHS duties once they have met their contractual obligations to the NHS.

For context, private healthcare has always been part of the equation when it comes to choice. The premise is that anyone can choose to seek private medical care at their own cost or through private medical insurance. There is, however, no tax rebate because you have chosen not to avail yourself of NHS care. In any event, in most circumstances, if you suffer serious complications in a private hospital, it is likely that you would be transferred into the specialist care of an NHS hospital. Just 12% of the UK population use private healthcare, and 80% of these users are covered by employer-provided corporate healthcare schemes.

As someone who has used the service for many years, including a period when I had private medical insurance, I can say neither is without its problems, and waiting times in NHS Accident and Emergency have definitely risen as demand has stretched the service. The current official target is that at least 95% of patients who attend A&E should be admitted, transferred, or discharged within 4 hours. That target is currently met only about 75% to 78% of the time, but the median wait time is about 3 hours.

The bottom line is that the cost per capita in the UK is around half of that in the US. The critical point is when you need urgent, life-threatening care and a long hospital stay; there is no question of going bankrupt due to the cost of care. It doesn’t matter if you are a rich man or a homeless person; you will receive the same standard of care under the NHS.

I’ve spent a little time explaining this to give you a broad understanding of how the system works. Medical care is dictated by patient need, NOT by the cost of care. The only time care paths are discussed is when, in the opinion of the medical staff, do-not-resuscitate measures are advised where a living will is not in place. As with all services, the quality of care can and does vary from hospital to hospital, and I have personally experienced both the good and the bad, but there are national benchmarks for care provision.

Administrative costs of healthcare in the UK are around 75% lower than those in the US, as shown in the chart below. This stands to reason, given the centralised nature of the service, though there are some regional variations in cost efficiency here too.

Healthcare is a critical area that affects the lives of ALL Americans, and is such a critical expense that it dominates the lives of those who are being persistently priced out of health insurance coverage. I can use the NHS as many times as is required to deal with any medical issue. There will be no out-of-pocket or co-pay costs. It is my right as a citizen to receive appropriate treatment free at the point of need. There is no tax increase based on my usage of the service, and it is available from cradle to grave. Oh, and Britain is not a communist state, no more than it is a Muslim state, despite the piffle which emanates from right-wing cult recruits across the pond.

At the moment, the US pays around $5.3 trillion in healthcare costs every year. It’s estimated that switching to a universal healthcare model would cost between $3 trillion and $4 trillion per year. As you would expect, the cost of implementation is a partisan issue, so getting a common-sense assessment from those for whom maintaining the status quo is a fiscal imperative will always muddy the waters. The NIH estimates that universal healthcare would save between 13% and 20%.

The interesting thing about the argument against universal healthcare in the US is that it has nothing to do with care and outcomes. Just as a reference point, the NHS consistently outperforms the US in life expectancy, maternal mortality, and avoidable/treatable death rates, so I don’t want to get hooked up on the old ‘You get what you pay for argument because it simply does not hold water. A shift to universal healthcare requires a structural economic remodelling of the tax system and would be an extinction event for one of the most profitable corporate scams in America.

In terms of costs, I believe the savings could be greater if the NHS admin teams were consulted to share their experience with centralised procurement and related processes. The reason it will never happen is that, at the moment, YOU are paying the costs shared with your employer, NOT the government. I don’t want to even begin to imagine the lobbying feeding frenzy that would ensue to prevent it from happening. You only have to look back to Obamacare to see what happens when you challenge the system. Add to that, you could not implement it without corporate Democrat support and increasing taxes on the wealthy. Good luck with that.

Image - "The Bosses of the Senate," J. Keppler, Puck magazine, 1889

What should be evident before we have even got past question one on my list is that, in a country where corporations write laws for legislators to rubber-stamp, there would need to be a complete reimagining of the relationship between the legislative branch and corporate America. Before you could even begin, you would need to repeal Citizens United and remove money from politics. Given that the Supreme Court ruled yesterday that there are now no limits on money in political campaigns, the hill to climb just got considerably steeper.

The point I am clumsily trying to make is that the fix required is structural, and within the current Democratic establishment, there is absolutely no appetite to get dark money out of politics. That is why the leadership is so fearful of progressive representatives gaining a platform from which it could happen. The problem America has is that parties on both sides of the aisle have allowed trillions of dollars to shift from the bottom and the middle to the top, and the only way to solve the problems created is to repatriate a proportion of that money.

If you think you have a fight on your hands now with the rich, wait until you try the ‘We want some of our money back” line. By now, you should be getting the message that even Trump’s corruption is small change compared to the challenge of even attempting to level the playing field. I thought it important to focus solely on healthcare in this piece to lay bare the challenge of effecting structural change in a system that has now been modified to serve only the top 10%. The challenge is gargantuan.

Here we are again, with me as the deliverer of bad news. I believe that unless we approach this colossal challenge with eyes wide open, we are just peeing in the wind. The scale of the challenge is immense. Can it be done? Absolutely, it can, but sadly, US politics would have to undergo a never-before-seen transformation, which involves a rewrite of the tax code. Unless Democrats win HUGE, you can’t even begin the work required, and even if they do, given the number of corporate Democrats in the pack, my optimism is NOT elevated.

I can absolutely assure you that my thoughts and commentary come from a place of love. Nobody wants common sense in the US to prevail more than I do, because if you cut off the head of the monster, you will also diminish the threat to the rest of us in Europe, so there is a sense of self-interest involved here too.

I think it remains difficult for Americans to understand that, even with a fair wind at their backs, it will be a generational struggle requiring a once-in-a-generation leader. Just for context, Barack Obama was such a leader, and look at the dogs of war, corporate vested interests unleashed on him to blunt the impact of his agenda. Tragically, the best one can hope for is deliberative, incremental progress, in which voters see enough to keep investing in the change being delivered.

If Democrats were to win in a landslide in November and build on that in 2028, there is hope. What Trump’s backers forget is that this administration has created the conditions for autocratic rule. If I were advising Democratic leadership, I would strongly advise taking the powers Trump has seized to rule from the top down and using them to reimagine the whole ball game. All they need is a good majority in both houses, and the current malign powers acquired by Trump could be used to banish the Republican Party into the political wilderness for a generation.

Believe me when I say this is not lost on Republican leadership right now. They know that a big loss in November will set in motion a deluge of investigations into corruption and theft of public funds, the likes of which have never been seen before in American history. These monsters understand all too well the level of legal jeopardy they will face. It is imperative that Democrats are as ruthless in their approach to weaponising every lever of government to excise the cancer that has infected the heart of government and, to some extent, the judicial system.

Democrats absolutely MUST NOT entertain any semblance of a ‘Truth and Reconciliation Commission’ to try to mend any fences. They MUST be as utterly ruthless as Trump has been to see that justice is served for crimes committed against the American people. They must not be fearful of prosecuting to the full extent of the law any individual complicit in what have been egregious crimes against the American people. They should make Steve Bannon’s words of imprisonment a self-fulfilling prophecy. There must be none of this ‘When they go low, we go high’. Any moral and strategic philosophy for handling adversity MUST be set aside in the relentless pursuit of justice. Republicans have always been great at playing the victim; it’s time to give them good reason to be victims.

to be continued ….

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