Where Healthcare and Climate Politics Meet
Our job is to continuously remind skeptics that a GND and M4A stand to greatly expand individual agency and freedom.
Photo by Casey Horner on Unsplash
Climate change is the largest public health threat facing our world. Millions stand to be displaced due to flooding, fires, and an otherwise increasingly erratic climate. Mass starvation looms as soil becomes polluted, dried out, eroded, and sapped of nutrients. Transmission patterns of infectious diseases such as malaria, West Nile virus, and Lyme disease are becoming unpredictable as the territories for carrier insects rapidly change with cycles of droughts, excessive precipitation, and temperature swings. Millions continue to die prematurely due to the thickening carcinogenic and particulate pollutants in our air. Frequent disasters threaten public services and healthcare infrastructure, making the old and the sick in particular more vulnerable. And in addition to the untold suffering of climate change, managing this burden and rebuilding fragile infrastructure is exceedingly expensive, and the bill stands to rise more and more rapidly as subsidies borrowed from our future demand to be paid.
The obvious solution to these threats to public health—to have a shot at avoiding collapse of civilization as we know it—is to address climate change head-on with a comprehensive Green New Deal (GND). In this way, a GND is clearly good healthcare policy. Likewise, good healthcare policy—namely, truly universal care achieved through single-payer or Medicare for All (M4A)—can bolster our movement for an eco-socialist future. These priorities are naturally complementary.
Of course, climate change has no bearing on the central argument for M4A: a country that is reasonably capable of providing healthcare to its inhabitants is morally obliged to do so. Yet as population health becomes more tenuous, the demand for healthcare will exceed the capacity of the current system to provide, precipitating the need for a radical overhaul. Morality aside, M4A will likely be the most economically feasible way to handle the demand. The delivery of American healthcare is staggeringly inefficient: one estimate predicts administrative savings alone would decrease total healthcare costs by 5% under M4A, offsetting costs related to increased utilization of care. Emergency departments will be able to care for everyone without worrying about swallowing costs from the un- or underinsured, and potential single-payer payment mechanisms, including global budgets, capitation, or fee-for-service will correct the problematic trend of hospitals losing money on Medicaid patients. That payments are made from a single source will add significant leveraging power against predatory pharmaceutical corporations, further lowering the total healthcare bill. Altogether, M4A is the best model to achieve universality at good cost as the demand for healthcare becomes more pressing.
Passing M4A sooner rather than later would also serve to correct a disturbing trend in public health crises. Political leaders have a habit of ignoring emergencies until they reach the affluent, willfully looking the other way as vulnerable communities are ravaged: look no further than the AIDS epidemic or the more recent and ongoing opioid epidemic that was recognized as a crisis only after it hit the suburbs. This pattern is playing out once again with climate change, and the cost in human life stands to be enormous.
Pandering to corporations has brought us to the cliff we stand before today, in both the climate and public health. While fuel companies have poisoned our air and water, jeopardizing health on the front end, pharmaceutical and medical tech companies have exploited illness by charging ludicrous sums for lifesaving treatments in the fallout. Irresponsible energy production and climate destruction have already most significantly affected low-income neighborhoods along the coasts and those living in proximity to the worst polluters. In the short term, M4A will serve as one form of long-overdue reparations for the people whose health our government has sacrificed by relying on dirty energy to fuel lazy economic growth. In the long term, it will make good on the basic right to healthcare.
But M4A is not just a band-aid for the wounds laid by systemic environmental injustice—it can play a vital role in the larger vision of the GND. Importantly, the GND should not solely concern itself with protecting the climate at large but bettering day-to-day life for the vast majority of people. The goal of climate protection, after all, is to preserve an earth upon which we are able to thrive. All earthly inhabitants are stakeholders in the condition of the planet, yet with a select and sheltered minority owning the means of production and thus executing the vast majority of decisions affecting the health of the planet, the current economic reality does not reflect our shared human interest in preservation.
A robust GND with a jobs guarantee addresses this discrepancy by extending opportunities for service and connection to environment and community in myriad ways—and by creating an economy that justly rewards such participation. The greater utilization of healthcare would create thousands of low-carbon jobs—particularly in areas currently lacking in services and employment opportunity—that do just that in the form of nursing, technician, long-term care, and healthcare provider positions. Likewise, a GND would complement the transition from for-profit to universal healthcare, guaranteeing well-paying, productive jobs for those currently in the private healthcare industry who could otherwise be left without work. Those interested in retraining for new positions would have that paid for, facilitating career pivots to elsewhere in healthcare, teaching, engineering, construction, conservation, or restoration—all segments of the workforce that will see drastic growth under the GND. Pushing GND and M4A together provides an answer to the objection that axing private healthcare would be too devastating to the workers employed through the industry. Both policies promote active engagement in a cooperative economy and make strides to equitably disperse the power currently held by a small exploitative class.
And while a GND will aid in the healthcare transition, it will simultaneously reduce a major burden on the healthcare system. Nothing is harder on physical health than capitalism. The forced sale of labor at unjust prices not only drains time and energy that could be used for self care, but it also cheapens the sense of self and stunts autonomy. Meanwhile, the expendability of individuals in the capitalist market fuels insecurities over ineffectuality. Productivity is celebrated regardless of the expense, and the toll that has taken is now in plain sight. Upstream determinants of health like low wages and unemployment, insecure housing and homelessness, lack of access to nutritious food, and sprawl-related sedentary lifestyles and isolation manifest in hospitals as obesity, heart disease, diabetes, addiction, depression, anxiety, and panic. As GND policies—universal economic security and the fruits of a fully mobilized workforce in the form of updated infrastructure, pedestrian-centric cities, sustainable agriculture, and restored natural spaces—materialize into public health gains, the healthcare system will be freed to focus on interventions it was actually designed to handle. Downstream interventions will always have a place in protecting the health of the public. But 99% of healthcare occurs outside of the healthcare system, and our efforts to intervene should honestly reflect this capacity.
Housing is one of the most important of those social determinants of health, and so the guaranteed housing of the GND is a key example of how the GND and healthcare—and better lives generally—go hand in hand. Weatherizing and decarbonizing our homes is an absolute necessity in decarbonizing the economy at large, and it only makes the need to build more affordable housing more urgent that a projected 13 million coastal Americans will be displaced by rising sea levels by the end of the century. But poor housing conditions are also associated with increased rates of asthma, infections, injuries, poor nutrition, lead poisoning, and other chronic medical and mental health conditions. Guaranteed housing carries the potential to do as much for public health as guaranteed healthcare. And, more broadly, investments in beautiful rent-controlled public and co-op housing stand to blunt some of the major tools of racial and economic oppression—exclusionary housing communities and suffocating rent.
The climate crisis presents an opportunity to civically engage to a degree unseen since World War II, and the mission is no less lofty: to rediscover a way of living that leaves footprints on our planet rather than scars, to create a home that will be safe and supportive for us and all the life with which we cohabitate, generation after generation. A GND worth its salt transforms this promise into legislation.
The left is rising. Uniting movements like M4A and the GND with similar and often identical goals is crucial moving forward. All of this sounds ambitious, and it is. But as a colleague recently wrote, dialing back the leftist vision does nothing but serve the political agenda of those in power and desperately looking to keep it. And as Daniel Aldana Cohen pointed out recently on Jacobin radio, “skinny” GNDs have been pitched in states like Washington and have failed. Taking an already extremely popular, inclusive, and comprehensive GND that creates good housing and economic opportunity and trying to water it down is not likely to improve the odds of success.
The blind pursuit of capital has created a sick culture and climate that projects onto every aspect of health. Corrective efforts—whether that be in healthcare, housing, jobs, or decarbonizing—will not exist in a vacuum. Given what we already spend on healthcare and rebuilding infrastructure wiped out by climate disaster, an upfront investment in a just transition to eco-socialism as soon as possible is the best bargain to be had. But numbers will not sell this vision.
The job of the political left is to continuously remind skeptics that a GND and M4A stand to greatly expand individual agency and freedom. When the establishment tries to sell “access” to care and vague notions of healing our nation, we will have concrete answers by way of Medicare For All, jobs and housing guarantees, and public luxuries built to connect communities to each other and the earth. Sure, saving the planet calls for concern for CO2 and owl populations, but more so, it calls for concern for our fellow compatriots with whom we are facing this uncertain future, a buzzing democracy, and a vibrant culture. Taking care of the world starts with taking care of each other.
Nicholas Phillips is a medical student at the University of Wisconsin School of Medicine and Public Health.
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