After eight years of swallowing massive, co-pay-coated promises of "universal health care," it's a relief that a substantive debate is opening up around single-payer health care during this election cycle. However, too many conversations on this issue are being halted by calls of "impracticality." Real health care for all would be nice, we are told, but there's just no room for it in the budget.
What's rarely mentioned in these "no room" conversations is that the current version of the budget - the place where our taxes go and metamorphose into services and activities that are supposed to support us - is extremely bad for our health.
Much of our tax money, on both the federal and state levels, is funneled toward activities that are literally killing people. Instead of dismissing "health care for all" as an appealing-but-unachievable dream, we need to talk about how we can shift our overall funding priorities from a framework of death and destruction to one of life and healing.
In mid-February, the Obama administration released its 2017 budget proposal, in which almost $623 billion is allocated to the Pentagon and related spending. The Pentagon alone snags $583 billion, receiving a $2 billion raise over last year, according to a National Priorities Project analysis.
Less than 2 percent of Pentagon funds would go toward "fighting ISIS." (The idea that ISIS can be effectively "fought" is, of course, a highly problematic prospect - but even if you think it can, that's not where your taxes are flowing.)
Plus, the 2017 budget proposal includes a $59 billion Pentagon slush fund, which allows the military to break congressionally set caps on its spending over the course of the year.
These aren't new developments: The Pentagon has long eaten up the majority of our federal discretionary budget - and those funds don't even include treatment for the veterans whose lives have been harmed by this system.
Of course, all this Pentagon money isn't simply sitting idly in government coffers. According to a 2015 Physicians for Social Responsibility report, the "global war on terror" has left 1.3 million dead in Iraq, Pakistan and Afghanistan alone - and that's a conservative estimate.
Our national budget is spent on killing and wounding massive numbers of people of color around the world and at home.
Beyond Pentagon funding, the administration's 2017 budget calls for $19 billion for nuclear weapons and related expenses. In fact, President Obama recently proposed launching a vast nuclear "modernization" process, which would expand the US's arsenal, spending $1 trillion over 30 years. According to an analysis by Stephen Kinzer at The Boston Globe, the proposal would include the development and purchase of "1,000 new missiles with adjustable nuclear capacity, 100 new long-range bombers, and a new fleet of nuclear-armed submarines." Kinzer cites former Secretary of Defense William Perry, who warns that if the expansion plan goes through, international disputes would be "more likely to erupt in nuclear conflict than during the Cold War."
This prioritization of state-sponsored death and destruction over health and renewal is by no means limited to the US Defense Department.
Each year, in total (including local, state and federal expenditures), the United States spends about $80 billion on incarceration and over $100 billion on policing. And the Obama administration's 2017 budget actually requests a substantial increase - of about 6 percent - for federal law enforcement, which includes the FBI and Drug Enforcement Administration. Despite recent public enthusiasm for decarceration, the 2017 budget proposal maintains the same funding levels as last year for federal prison and detention.
Like the dollars that are shuttled to the Pentagon, the money deposited in prison and police budgets is not just "wasted." It is not simply money that could be "better spent" on things like health care and food and housing. This country locks 2.3 million people - overwhelmingly Black, Brown, poor, trans and disabled people - inside cages; chains millions more with electronic monitors and harsh probation sentences; and subjects millions upon millions more to brutal surveillance and violent policing, including the violence of the immigration system.
The institutions of prison and policing were born out of slavery and colonialism, and they still function in the service of maintaining white supremacy. The money that's allocated to prop them up is fueling the opposite of health and life: It's fueling oppression, sickness and slaughter.
Our national budget is spent on killing and wounding massive numbers of people of color around the world and at home, at the expense of supporting people's efforts to live and thrive.
We need to ask ourselves: What would our list of budget priorities look like if we started from scratch? What would "health care" mean to us if we freed ourselves to advocate for a drastic re-evaluation of what is important?
In part, real "health care" would necessitate dismantling the violent institutions that remain safely lodged inside our budget - not only because they are taking up massive amounts of resources, but because they are, in themselves, threatening our health.
Within a society that prioritizes health, there is no room for empire. There is no room for state violence, at "home" or "abroad."
War is a health threat, for soldiers and veterans - many of whom are poor and working-class people of color, for whom few other opportunities are currently available - and for those the United States regularly targets, murders and displaces. Real "health care for all" would involve a commitment to end war and imperialism - and to provide an abundance of other opportunities for young people besides being taught and forced to kill. This would mean an intensive, sweeping culture shift, along with a policy shift - and would require deep, ongoing work over generations. Imperialism won't disappear in a day. But a push for a genuinely healthy society would include a sustained struggle against empire.
Prison, policing and deportation are health threats. Real "health care for all" would mean abolishing the prison industrial complex - including the carceral immigration system and the rapidly growing electronic-monitoring regime that is shackling people inside their homes.
The mounting attacks on our reproductive freedoms are health threats. Real health care for all would include policies in the service of reproductive justice, from ensuring safe access to abortion for all, to providing full prenatal and postnatal services, to substantially expanding free child care, to funding a wide range of services for survivors of domestic and interpersonal violence. It would mean ending the destructive foster care system that particularly targets Black and Indigenous mothers and children, tearing families apart and punishing them for their poverty.
Another blatant health threat is the ongoing plundering and poisoning of our environment. The federal government currently spends $20 billion on fossil fuel subsidies per year. To its credit, the Obama administration's budget for this year aims to slash those subsidies - though those reductions may not happen; in the past, Congress has been reluctant to make any cuts. A full commitment to health would mean setting a much more rapid timeline for moving beyond fossil fuels, and coming to grips with the environmental degradation that has our futures (and for many, our presents) in a stranglehold.
Houselessness and hunger are health threats. Medicine doesn't operate in a vacuum; your prescription can only go so far if you don't have a roof over your head and something in your refrigerator. Prioritizing real health care would mean a commitment to housing and quality food for all people.
Of course, none of this is meant to minimize the importance of medical care itself.
Our prioritization of healing over destruction must also mean comprehensive, cost-free, accessible medical and mental health services, including a wide variety of treatments that go beyond pharmaceuticals, doctor visits and hospital stays. We'd also need to take seriously what is meant by "preventive" care, beyond regular "checkups" and vaccinations. An expansive vision of health care would acknowledge the importance of free time, sleep, relaxation and even joy in keeping ourselves "healthy." Paid leave time - not only to have a baby, or to confront a life-threatening illness, but also to engage in less formally sanctioned healing projects, or simply take a break - might fit within this vision. Widespread access to the arts might also be recognized as a component of "health care": Human beings have always used music, dance, art and theater to nourish and heal our bodies, minds and souls, even though these strategies are not currently covered under most insurance plans.
Moreover, although budget shifts - funding healing and defunding harm - would mark an important prioritization of health over destruction, real "health care for all" would also mean thinking beyond budgetary allocations. It would mean, in a larger sense, understanding and challenging the overlapping forces of capitalism and white supremacy - the forces that fuel incarceration, assassination, plunder, abandonment and exploitation.
Within a society that prioritizes health, there is no room for empire. There is no room for state violence, at "home" or "abroad" (whatever those terms mean; we probably have to rethink those too). There is no room to feed the machinery of murder.
Let's not limit ourselves to a health care debate about taxes and tame trade-offs. Let's use this debate to expand our notions of health and healing. Let's make room for real universal care.