There’s a new book called Another World Is Possible: Lessons for America from Around the Globe, but I think the subtitle under-sells the book. The subtitle should probably be Lessons for Every Country from Around the Globe. The author is Natasha Hakimi Zapata, a journalist and university lecturer based in London.
Answers to big questions may not be so hard to find. Better public schools? Renewable energy? Health care? These problems are being solved all over the world, but most people don’t know much about what’s being done and why it might just work in our own countries.
She begins a book of nine solutions with health care, and describes “the United Kingdom’s groundbreaking universal health care system.” It’s not perfect, but Zapata believes, and offers convincing reasons, why this model could and should work in the U.S. (and elsewhere). As she outlines the history — “prior to the twentieth century, health care in the United Kingdom was provided by a disjoined mix of charity hospitals, the local welfare committees that ran so-called poor law workhouses, and private care.” The system was oriented toward low income communities, leaving those in the middle class with few good options, so they came to rely upon emergency care in emergency care facilities at local hospitals. In the U.S. today, we are trying to solve a similar problem, this time for our lower income residents. Government programs incrementally improved the situation, but did not solve it, but the situation changed with the end of the Second World War, when Britain was in dire straits. “The key principle enshrined in the 1946 Bill was that health was a right, not a community to be bought or sold, or subject to market forces.”
And there’s the pivot. The 1946 Act was an “extraordinary success” because it “incontrovertibly made people’s lives better.” Service began in 1948. In England and Wales, it now employs 68 thousand nurses, 12 thousand doctors, and 22 thousand midwives — and they are a small portion of a workforce of 1.4 million people. (And this does not include Scotland.) It’s funded by general taxation. The range of services is vast, including not only ambulance, maternity care, dental care, prescriptions, mental health, long-term care, and optical care. “Patients rare, if ever, pay out of pocket for anything.”
Yes, there has been enormous political capital poured into the service and its growth, and yes, there are special issues of all sorts — an “immigration health surcharge,” for example.” Overall, the system works, and because it is right and not a privilege, it is very much a part of British life.
The important idea here: it is possible for a large country to operate a national health service. There is a model. More people ought to know how it works, and the power of large numbers of people should make sure the success is widely known so it can become the basis for a new U.S. healthcare system. Certainly, there are reasons why this will never work, but that has been the rallying cry for the (hugely successful) opposition. Zapata provides a useful starting place for discussion, here and in other large area of life.
Estonia is a much smaller country, but it has pursued a very big idea. It’s a simple one: access to the internet is a human right (yes, human rights are a theme in this book). This is a country that was part of the Soviet world, with clunky technology, crumby infrastructure, not a lot of money, and political inflexibility. As the nation began to enjoy the new realities of independence, several organizations worked with government to make free internet connections possible. “In 1992, two of the biggest universities in the country [were] provided with free internet service. Soon enough, fiber optic cables were being laid throughout the country.” The pathways led through government, and a new concept of “e-government” was established as a means to operate the nation by, essentially, distributing power and responsibility to the people. This ignited a very different way of thinking about the relationship between a citizen and the government. “One of the main ideas behind Tiger Leap,” which placed education at the center of Estonia’s future, “was to raise a new generation of computer- and internet-savvy Estonians that could create innovations that could spur socioeconomic growth.” In time, Estonia’s Look@World Foundation helped Estonians of all ages to collaboration “in close cooperation,” and begin to see the importance of 100 percent internet access for all Estonians. And the story continues to unfold, with nearby Finland providing more examples and fueling a competitive spirit, too. Estonia is ahead of international curve on I-voting (via the internet, e-ID systems, and more. Estonia raises serious questions about private control of digital technology in the U.S. — they have certainly demonstrated the value of public-private partnerships, respect for the needs of individuals and the evolving role of government.
The author tells similar stories about Portugal and its drug policy; Norway and its family-friendly laws; Uruguay’s approach to renewable energy, and Aotearoa New Zealand’s approach to universal pensions.
Indeed, another world is not only possible, it has taken shape, but the future is not evenly distributed. In many ways, the U.S. seems to be far behind, a remnant of old thinking about power and the unproductive alliances between government, big money and big companies. There are other ways to think about running countries on behalf of their people, and Zapata’s book is enormously useful in imagining what could and should be.
Digital Insider 