Comparison
Universal Health Care In A MAGA World
Comparison
My time in China reflected my identity as an American. I saw themes and similarities everywhere. Some of the biggest similarities were in how everyone was trying to convince me the ways in which China was different from America. My family was a family of immigrants. My mother descended from relatives that identified as British and German and my father was 100% German. To the point of reading his high school yearbook and assuming my father had been legally named “Kraut” and changed his name to “Bob” later in life. My parents, like a lot of other first and second-generation Americans, were something else first, and American second. German American, Italian American, Polish American, Croatian American, African American, Chinese American, the North East Ohio region is filled with museums and national cultural centers from countries long left and long exchanged for the dream of America.
The roots are there if you allow them to be, and in America, our roots tangle with the strands of this new culture and new experiment to create one, big, confusing, beautiful, shared identity. I never went to a friend’s house in America and felt that the older generations were disrespected. I never entered the home of anyone in my family and left hungry or hermetically sealed off from their troubles, dreams and hopes. But if you listen to anyone explain the idea of America in China, than we’ve lost the idea of big family in the States. In their explanation, which is more like a well prepared sermon that you have to listen to, far too often, that very idea is what makes China better, not different, better than America. I would always listen to this and laugh, to myself, about how they clearly didn’t ever enter my grandfather’s home and forget to greet his father first. The idea of big family or filial love is human. Culture can define how we express it, but at the end of the day, family is family no matter where you are.
I took this with me through every aspect of my decade and a half submerged in Chinese culture as an American, often trying not to drown. When the love of my life and I decided to get married, I asked her mother for her daughter’s hand in marriage. She started to cry. Tears of anger and frustration. The wrong kind of tears for that moment. My wife lost her father to a botched open-heart surgery when she was five years old. Asking her mother was a dry run for asking her paternal grandparents. Her grandmother, Li Shidong, and grandfather, Liu Shao Zeng, were salt of the earth people. To the point of her grandmother most likely having more sodium in her DNA than Lot’s wife. They could do no wrong in my eyes and if they had cried those kinds of tears at me asking for their granddaughter’s hand in marriage I might have never recovered. The experience with her mother was expected. My wife and her mom aren’t particularly close, and I was warned that it wouldn’t be a warm story to tell people 18 years later. As a result, when I asked her grandparents I was sensitive to their reaction. Grandma stopped me halfway through and asked, in only a way that she could, “are you sure?”
I had no idea what to say, of course I was sure. I affirmed that yes, I had never been more sure of anything else. She said “well, you need to be, this one can’t cook or clean or do anything around the house, you’ll be on your own and will have to take care of her.” I was the one that teared up when I told her that taking care of her granddaughter would be the joy of my life. She smiled and said, “good, then of course, you’ll be ours from now on.” It’s only fitting that my wunderkind wife would discover her passion for cooking later in life after relocating with me to America, opening a restaurant and already being named a Plate Magazine National Chef to Watch and a Julia Child’s Foundation Fellow.
Immediately following our wedding ceremony in Shandong Province in 2009, her grandparents would move in with us on my insistence. Grandpa wasn’t getting satisfactory health care in their hometown, and I felt responsible to make sure he had the dignity of comfort in his old age. My experience with the Chinese health care system is, let’s just say robust. I have not only stayed in medical detention centers in China for extended periods of time, I’ve also had to hold the hand of a dying man for weeks on end surrounded by the coldest and most bereft of dignity conditions imaginable. There are a lot of assumptions about the health care of everywhere outside of America. Assumptions that our system is inherently broken and assumptions that everywhere else is better in every other way. OR, on the other end of the spectrum, our system is amazing and every attempt to reform it or make it better is akin to Marxism and will make all our lives worse. My perspective is neither, America has an amazing system of health care that is about 93% of the way to being exactly what all Americans need and deserve. Revolutions are for children and the desperate. We are neither, we’re just kind of comfortable to the point of being in a coma most of the time. When we’re shaken out of our comfort induced coma we tend to overreact in both directions.
I started the year of 2019, in a state of deep sadness. In 2014, grandpa had beaten lymphoma, and we were gifted five more years with him. That gift, the gift of extended life after cancer goes into remission, was rescinded when we noticed he had a sore throat that wouldn’t heal and couldn’t eat solid foods comfortably. Lunar new year that year was emphatically joyful with a shadow of finality in the background. It’s impossible to describe the Chinese medical system to people that have never experienced it. Essentially, Chinese people are defined by where they are from. If were born in Peoria, Illinois, you are hardcoded to Peoria for your entire life. You can move to Indianapolis but cannot work unless you apply for a special work registry. Your children must go to school in Peoria. Your health insurance can only be fully utilized in Peoria. If you buy a house or a car in Indianapolis, you must register as an out of town owner or out of town driver. You get the point? Zero freedom of permanent movement. It’s called the Hukou or Household Registration System. The only thing that can disconnect your registration from where you are born and transfer it to a place of higher standing in the hierarchy of China regional registrations is if the place you hope to move to has a special program for people with international master’s degrees (or higher) or domestic doctorates (or higher) and you happen to have one of those things, or if you marry into a family (up until a couple years ago, a family whose son is marrying an out of town woman, not the other way around), or are a party member and have qualified for the honor of being “transferred” to a better place.
My wife was from the same place that Confucius was born, lived, and where he is buried, but Confucius, although the ultimate culprit when it comes to systems like these, was from the middle of nowhere. Her status in the Chinese Hukou system was pretty much the bottom of the barrel, meaning so was her grandfathers. We lived in Beijing. That meant for her grandfather to even find an oncologist we needed to beg, bribe and demand some sort of medical attention. Otherwise, the first glance at his Hukou would’ve sent him back to his hometown, where, I’m not kidding, they still treat diabetes and some forms of cancer with antibiotics.
China also demands cash or equivalent payments and deposits before any treatment can be given. It’s basically the most mercantile health care system in the history of the world. We had team members who worked with us for years at our brewery experience absolutely horrific accidents while trying to simply exist in Beijing and until someone showed up and paid cash for their treatment they would be left bleeding in the hallway. One such incident woke us up in the middle of the night and I’ll never forget that the elevator bay at the ICU had an ATM machine and the pin pad still had blood on it from the last time someone needed to pay cash for their life to be saved.
In juxtaposition, my wife arrived in America during a pandemic, eleven weeks pregnant with our second child. We boarded that plane because the city of Beijing determined that prenatal care was non-essential during the outbreak of Covid 19. We boarded a flight to America in haste and anxiety with our, then 8 year old, son in tow. We arrived in Cleveland, uninsured for the birth and with no prior residency or ties to the region for the last twenty years. We immediately found an OBGYN that still contacts my wife regularly to ask about our daughter and life in general. We found a way to insure an at the time non Green Card holding spouse of a U.S. citizen. We found a way to be calm.
In certain rooms, certain people would tell me that China’s health care system outshines America’s due to amazing socialized health care insurance systems because TikTok or Instagram told them it did. Others would say that China’s health care system is better because the equipment is all brand new and because the doctors are all patriots and America’s is decaying and filled with foreigners because Facebook and Youtube told them so. The reality is that the American system is more empathetic, warm, sympathetic and more ready to serve the sick and huddled masses that most others in the entire world. It’s the way we have to pay for it that is broken.
Tying health care to employment likely won’t change anytime soon. The people who execute our health care in America are unique, amazing and deserving of our support and appreciation, but the people that administer and bill after said health care is provided are not that different than their counterparts in other ecosystems. I’m pretty sure if no one stopped the corporations behind our health care networks, they would prefer we pay in cash up front. Humans are human, and when left to their own ends, people with power will always abuse it unless there is someone to say no. There are certain aspects of our lives that shouldn’t be about turning a profit. Education, infrastructure, defense, and health care should likely be fine with breaking even.
Bernie Sanders and Alexandria Ocasio-Cortez are not wrong in proposing that Medicare should be available to all Americans. In fact, I support the idea, it makes me feel like a good person. Unfortunately, it’s a strategic dead end. Just like hard wiring our children’s education to the property tax system, we’ve hard wired the idea of health care to having a job and being a productive citizen. Probably meant well at the beginning by whoever it was that made the final decision, but it’s rife with political and class conflict that keeps people from seeing the value of a Universal Health Care system.
I’ve felt for a long time that if you walked into any board room or labor union hall or household kitchen in America and asked those in attendance what they would think about expanding Medicare to All… W2’d employees, what the reaction would be? I know a lot of MAGA Republicans who dawned three point hats and balled up dollar bills and threw them at people during protests against Obamacare who, once they turned 65, realized Medicare was amazing. AMAZING. I only ever saw my father shocked by health care policies twice in my life. Once was when I took him to a hospital in Taiwan to have his hearing checked and have hearing aids prescribed. “They won’t let me pay them any money!” Yes, Bob, you are a guest in their country, they would prefer you can hear the bus coming, the alternative can get a bit messy. The second time was when he qualified for Medicare and encountered the same thing. “Everything is covered, it’s amazing.” Yes, Bob, it really is.
If I ran a campaign in 2026, I would have a bunch of MAGA baby boomers in a commercial wearing their MAGA gear and explaining their experiences with Medicare. Then I would explain that all American workers deserve to feel that level of dignity. That’s called a plan. Within ten years you would have Medicare for All, because there wouldn’t be anyone left to say “well, if I work hard and I don’t get it, then why do… those people?!?” Sometimes you need the experience of seeing how bad something can be somewhere else, while you hold the hand of a man you hold in your heart as a hero, in a dirty room, with no toilet, no food, no shower and no place to lock up your most important belongings, to really see the value of what has already been architected in America. Some of us cheer when we watch some jackass with a chain saw talk about ripping our system to pieces because we assume our system is broken. It isn’t. There’s just more money to be made off of our pain, our hope, our desire for upward mobility, and until capital gets to make a maximum profit off of every aspect of our lives, there will always be a jackass with a chainsaw.
Expanding Medicare to all W2 employees would see the overall cost of healthcare in America plummet. The anxiety of the American worker would dissipate just that much more. The quality of care that the elderly recipients of Medicare received would also improve because the pool of those included under the coverage would get younger and healthier on average. Kids would play in the streets. Parents would see doctors more regularly and increase their total lifespan with their kids and grandparents. Mothers and fathers would have more children and you would likely see less ads for ambulance chasing lawyers and pharmaceuticals during your daily life.
We would take a system we should all be proud of and make it a system that truly shines for the betterment of all Americans.