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Nobody talks about the fear

I wouldn't have founded my first startup without socialized medicine. Although my background was squarely middle class, I didn't come from wealth, and I didn't have a safety net to fall back on. If I'd had to pay hundreds of pounds a month for healthcare on top of my basic living expenses, or if I'd known that an accident could have led to lifelong financial catastrophy, there's no way I would have quit my salaried position to start a company.

Of course, I didn't have that risk, because I lived in a country with a safety net. It was also a country where I could get the computer science degree that has enabled my career for free, meaning I've only ever had the barest whisper of student debt. And where going to the doctor was something I could do any time something was wrong with me, without having to care about how much it would cost.

I didn't understand how privileged I was to not be afraid of those things until I moved to the United States.

What boggles my mind is that this is often used as a legitimate argument for not having a safety net. The need for health insurance in particular means that millions of people remain in the relative safety of their jobs, rather than stepping out and doing something on their own, or looking for something new. Because most workers either don't have significant savings or can't risk them, they're effectively trapped into working for wealthy employers, who have leverage over them as a result.

Employer-provided health insurance creates a chilling effect on entrepreneurship. It also reduces incentives for employers - particularly of the low-income employees who are the most trapped and are in the most need - to compete for workers by offering higher wages, better working conditions, and more meaningful work. It's bad for everybody except for the wealthy employers themselves.

As Aaron E Carroll wrote in the New York Times:

One effect of this system is job lock. People become dependent on their employment for their health insurance, and they are loath to leave their jobs, even when doing so might make their lives better. They are afraid that market exchange coverage might not be as good as what they have (and they’re most likely right). They’re afraid if they retire, Medicare won’t be as good (they’re right, too). They’re afraid that if the Affordable Care Act is repealed, they might not be able to find affordable insurance at all.

I felt the difference. It was visceral, and it's hard to completely articulate: no matter which choice I made, I knew I would never slip through the cracks. Even if I fell into poverty, it would not be a death sentence. In the US, that's only the domain of the very privileged. Everyone has to make a monthly payment - whether provided by them or their employer - that could mean the difference between their life and death. It's bonded labor that keeps workers from rising above their stations. And it's an omnipresent fear that underpins almost every aspect of American life. You've have to compete; work hard; always be productive. Because you know what will happen if you don't.

American society has fear running through it. It informs every decision. It's internalized as a fact of life and a part of the natural order of things. And it manifests everywhere. It's what's bringing American life expectancy down year on year. And it has effects on mental health and happiness that we've only begun to scratch the surface of.

The people who talk about these things in terms of abstract economic arguments have missed that everyone should also get to be human. Everyone deserves a decent life, no matter who they are. Nobody should fall through the cracks of society because of chance or a bad decision. And everyone should have the right to live without fear.

People talk about a social safety net out here like it's some mythical beast that couldn't possibly truly exist. It exists. And speaking as someone who had free healthcare, had free education, who lived under the protection of a compassionate, democratic system, let me tell you: these things are great, and I couldn't have existed without them.