{"id":1669,"date":"2026-01-20T11:00:00","date_gmt":"2026-01-20T11:00:00","guid":{"rendered":"https:\/\/www.artsjournal.com\/scenechange\/?p=1669"},"modified":"2025-11-27T23:27:50","modified_gmt":"2025-11-27T23:27:50","slug":"born-in-the-dsa-the-worst-healthcare-system-in-the-world-needs-an-upgrade","status":"publish","type":"post","link":"https:\/\/www.artsjournal.com\/scenechange\/2026\/01\/20\/born-in-the-dsa-the-worst-healthcare-system-in-the-world-needs-an-upgrade\/","title":{"rendered":"Born in the DSA*: The Worst Healthcare System in the World Needs an Upgrade"},"content":{"rendered":"\n

The DSA has been ranked as having the worst healthcare system in the civilized world, whatever \u201ccivilized\u201d means. But it doesn\u2019t have to be the worst, does it?<\/strong><\/p>\n\n\n\n

\"\"<\/a>
*DSA stands for the Divided States of America (aka \u201cOne Nation, Divisible\u201d). Here we are, exactly one year into a kakistocracy that promises to destroy everything built over the last 250 years. Oh well. Periodically, I\u2019ll be writing more specific takes on issues that are clearly wrong for the DSA, using the arts as context. If there are issues you\u2019d like to take up (or that you\u2019d like me to take up), let me know. As always, sorry, Boss.<\/figcaption><\/figure>\n\n\n\n
\n\n\n\n

Dead yet?<\/strong><\/p>\n\n\n\n

According to the World Health Organization, the Commonwealth Fund, and even the generally conservative CEO World, the DSA ranks well below the mean on average age of death. Here\u2019s a snapshot from the Commonwealth Fund\u2019s assessment<\/a> of that particular piece of information:<\/p>\n\n\n\n

\"\"<\/a><\/figure>\n\n\n\n

<\/p>\n\n\n\n

People here die sooner (by a lot), and pay more (by a lot) for care than any other country in the world. Maternal mortality rates are among the highest in the world, ranked alongside the poorest countries on the planet and three times the rate of Canada and all the countries of Western Europe.<\/p>\n\n\n\n

Last I checked, Canada was a few inches \u2014 sorry, centimetres<\/em> \u2014 from the border, but the differences are staggering.<\/p>\n\n\n\n

Physicians and patients fight with insurance companies more in the DSA than anywhere else, except for Switzerland, where the system is universal, but more in the hands of the private sector than other developed countries.<\/p>\n\n\n\n

But you knew all that already, or something like it.<\/strong> And yet, people in the DSA do not treat this death rattle as a hill to die on, for some reason, which is why I asked at the beginning of this article whether you were already dead and you\u2019re done with hills.<\/p>\n\n\n\n

If so, that would explain a lot of things.<\/p>\n\n\n\n

\"\"<\/a><\/figure>\n\n\n\n

<\/p>\n\n\n\n

When you research the four general categories of healthcare<\/a> in the world, you\u2019ll see that three of them are forms of universal health. The DSA ranks last of the \u201cdeveloped\u201d countries<\/a> of the world because it clings to the most monopolistic, capitalistic, profit-at-the-expense-of-health version, colloquially known as \u201cEvery Man For Himself.\u201d And it\u2019s expensive as hell.<\/p>\n\n\n\n

\"\"<\/a><\/figure>\n\n\n\n

<\/p>\n\n\n\n

In the \u201cOut-of-Pocket Model,\u201d countries are too poor, too new, or too corrupt to have established any healthcare system at all. Predictably, most of these countries are poor and hundreds of millions of people go their whole life (short as it may be) without seeing a doctor. However, the DSA has that same form of healthcare for 15% of its adult population.<\/p>\n\n\n\n

In the \u201cBeveridge Model,\u201d health care is provided and financed by the government through tax payments. These higher tax payments, of course, not only replace current out-of-pocket costs, substantial insurance premiums paid by business (small and large alike), and every other cost associated with seeing a doctor, but actually reduce the cost in the long run. The people, as represented by a non-corrupt government, are in a better negotiating stance to lower costs than the insurance companies, which still call every legitimate claim as a \u201closs.\u201d<\/p>\n\n\n\n

(Note: that terminology alone should provide insight to motives of the insurance industry. Do not believe those happy commercials kids on swings, seventysomethings at farmer\u2019s markets, and soothing voiceovers telling you how safe they\u2019ll make you under their plan. When they don\u2019t pay, it\u2019s a win<\/strong> for them. When they do, it\u2019s a loss<\/strong>. Their words, not mine.)<\/em><\/p>\n\n\n\n

\"\"<\/figure>\n\n\n\n

<\/p>\n\n\n\n

In the \u201cBismarck Model,\u201d everyone is covered through a labyrinthine set of nonprofits called \u201csickness funds.\u201d These funds that pay for healthcare are financed jointly by employers and employees through payroll deduction. These \u201csickness funds\u201d do not show a profit (they\u2019re not supposed to) and are tightly regulated to the extreme, which provides cost control for the users.<\/p>\n\n\n\n

Finally, we have the \u201cNational Health Insurance Model.\u201d The doctors and providers are in the private sector, but their fees are paid with higher taxes (like the Beveridge Model) and the patient never has to worry about payment to any doctor in the country. This is, by far, the most popular model among constituents. It is a \u201csingle-payer\u201d system (in which the federal government is the payer) and has great negotiation power with the pharmaceutical and medical industries. Canada\u2019s system, for example, has negotiated such low prices from pharmaceutical companies that DSA citizens have spurned their own drug stores to buy pills north of the border. National Health Insurance plans also control costs by limiting the medical services they will pay for, or by making patients wait to be treated. In other words, not everything is covered, but what is <\/em>covered is completely paid.<\/p>\n\n\n\n

Because there\u2019s no need for marketing, no financial motive to deny claims and no profit, the \u201cNational Health Insurance Model\u201d tends to be cheaper and much simpler administratively than American-style for-profit insurance.<\/p>\n\n\n\n

The DSA is unlike every other country because it maintains so many separate systems for separate classes of people. Out of pocket, Medicare, Medicaid, Obamacare, Employer-paid health insurance \u2014 all these are present in the DSA. All the other countries have settled on one model for everybody. This is not only much simpler than the DSA system; it\u2019s fairer and cheaper.<\/p>\n\n\n\n

Fairer, cheaper, and more effective, too. <\/strong>Despite spending nearly twice as much per capita on healthcare compared to similarly large and wealthy nations, the DSA has a lower life expectancy than peer nations and the gap has grown for some measures since the COVID-19 pandemic. <\/p>\n\n\n\n

\"\"<\/a><\/figure>\n\n\n\n

<\/p>\n\n\n\n

Yes, there are downsides to universal healthcare. <\/strong>Of course <\/em>there are downsides to systems in which people are encouraged to take care of their health before they have to go to an emergency room. Waits are long. Elective surgeries aren\u2019t covered. And everyone has heard the tall tales spread about somebody else\u2019s Aunt Marge who moved to Saskatoon and had to wait six years to get her broken leg set by a doctor. No really. That happened. I read it on Facebook.<\/p>\n\n\n\n

Having to wait and getting healthcare is better than not having to wait and not being able to afford healthcare until you\u2019re dead, after which you get that whopping $255 check from Social Security for your funeral. But only if your child or spouse applies for it.<\/p>\n\n\n\n

\"\"<\/a>
(Quote is by the author; Photo by D\u039bV\u039e G\u039bRCI\u039b from Pexels)<\/figcaption><\/figure>\n\n\n\n

<\/p>\n\n\n\n

Which brings us back to the original question,<\/strong> especially for artists and other independent contractors: are you dead? For small businesses and nonprofit arts organizations who won\u2019t have to pay through the proverbial nose to get better healthcare for all their people: would you prefer going broke? If not, then where the hell are you?<\/em><\/p>\n\n\n\n

Why do you accept a system that is intended to kill you earlier and in more pain than any other civilized country? Why do you insist on paying more than twice as much as anyone else when you do <\/em>get sick than anyone else?<\/p>\n\n\n\n

Good health is the right of every individual in the world \u2014 except, evidently, the residents of the DSA (what happened to \u201clife, liberty, and the pursuit of happiness?\u201d) and the poorest rural governments. In the DSA, it\u2019s especially awful for anyone with the bad taste of being born non-White. Sorry about that, Black people, but these White elitists promise it will be the last indignity you\u2019ll ever suffer. Ever. Scout\u2019s honor. \/sThe new country of Pacifica<\/a><\/strong> plans to institute universal healthcare. Yes, taxes will be higher. But no one will be one paycheck from bankruptcy or foreclosure due to bad health. No one will be forced to choose between rent and medication. No one will have to pay the exorbitant eight-to-nine figure annual salaries of insurance racketeer executives, let alone its filthy-rich CEOs firing their claims adjusters for granting \u201closses.\u201d No one will have to pay for healthcare marketing. And the nation, as a whole, can negotiate a better price from pharmaceutical companies (as Canada has) than a series of competitive money-grubbing insurance companies. Isn\u2019t that worth fighting for?<\/p>\n\n\n\n

\n\n\n\n
\"Scene<\/a>
If you want your nonprofit arts organization to thrive, just pick up this inexpensive trilogy. If not, I can let you know how to throw “Going Out Of Business” sales. Also, I’ve been doing quite a bit of instruction with college classes in arts administration \u2014 if you’d like me to talk to your students about SCENE CHANGE, just let me know: alan@501c3.guru.<\/figcaption><\/figure>\n\n\n\n
\n\n\n\n
\"\"<\/a>
Thanks for reading all the way to the end. In the name of healthcare, would you consider sending over enough for a cup of coffee to feed my caffeine habit? Just click on the cup. Ooooh, better yet, let’s have a cup together. If you’re in the area or can afford to fly me in, I’d be up for it.<\/figcaption><\/figure>\n","protected":false},"excerpt":{"rendered":"

It’s cheaper and more effective to keep people well than to make people well.<\/p>\n","protected":false},"author":2,"featured_media":1670,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[21,20,100,40,32,28,19,18,17,99],"tags":[85,166,175,10,174,173],"class_list":{"0":"post-1669","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-arts-and-culture","8":"category-board-of-directors","9":"category-book-recommendation","10":"category-change","11":"category-charity","12":"category-diversity-equity-inclusion","13":"category-leadership","14":"category-nonprofit","15":"category-nonprofit-arts-organizations","16":"category-scene-change","17":"tag-community","18":"tag-health","19":"tag-healthcare","20":"tag-impact","21":"tag-national-health","22":"tag-universal-health","23":"entry"},"jetpack_featured_media_url":"https:\/\/i0.wp.com\/www.artsjournal.com\/scenechange\/wp-content\/uploads\/2025\/11\/born-in-the-dsa-4-universal-health.jpg?fit=800%2C581&ssl=1","jetpack-related-posts":[{"id":1746,"url":"https:\/\/www.artsjournal.com\/scenechange\/2026\/03\/17\/born-in-the-dsa-batt-crazy-leadership-does-not-happen-by-accident-and-it-can-only-be-crushed-if-we-do-it-together\/","url_meta":{"origin":1669,"position":0},"title":"Born in the DSA*: Bat$#^t Crazy Leadership Does Not Happen By Accident, and It Can Only Be Crushed If We Do It Together","author":"Alan Harrison","date":"March 17, 2026","format":false,"excerpt":"The popular guy in charge of the DSA is a greedy, paranoid sociopath, a malevolent narcissist, and is probably experiencing dementia. It\u2019s a tactic that works for him, even as it destroys the DSA.","rel":"","context":"In "Arts and Culture"","block_context":{"text":"Arts and Culture","link":"https:\/\/www.artsjournal.com\/scenechange\/category\/arts-and-culture\/"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/www.artsjournal.com\/scenechange\/wp-content\/uploads\/2026\/02\/Born-in-the-DSA-7-Paranoia.jpg?fit=900%2C659&ssl=1&resize=350%2C200","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/www.artsjournal.com\/scenechange\/wp-content\/uploads\/2026\/02\/Born-in-the-DSA-7-Paranoia.jpg?fit=900%2C659&ssl=1&resize=350%2C200 1x, https:\/\/i0.wp.com\/www.artsjournal.com\/scenechange\/wp-content\/uploads\/2026\/02\/Born-in-the-DSA-7-Paranoia.jpg?fit=900%2C659&ssl=1&resize=525%2C300 1.5x, https:\/\/i0.wp.com\/www.artsjournal.com\/scenechange\/wp-content\/uploads\/2026\/02\/Born-in-the-DSA-7-Paranoia.jpg?fit=900%2C659&ssl=1&resize=700%2C400 2x"},"classes":[]},{"id":1628,"url":"https:\/\/www.artsjournal.com\/scenechange\/2025\/12\/16\/born-in-the-dsa-little-donny-dingdong-be-damned-let-everybody-vote\/","url_meta":{"origin":1669,"position":1},"title":"Born in the DSA*: Little Donny Dingdong Be Damned**, Let Everybody Vote","author":"Alan Harrison","date":"December 16, 2025","format":false,"excerpt":"Let\u2019s stop cocking around and just let people vote in peace. * DSA stands for the Divided States of America (aka \u201cOne Nation, Divisible\u201d). Periodically, I\u2019ll be writing more specific takes on issues that are clearly wrong for this country, using the arts as context. If there are issues you\u2019d\u2026","rel":"","context":"In "Arts and Culture"","block_context":{"text":"Arts and Culture","link":"https:\/\/www.artsjournal.com\/scenechange\/category\/arts-and-culture\/"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/www.artsjournal.com\/scenechange\/wp-content\/uploads\/2025\/11\/ev-votes-jpg1.jpg?fit=1075%2C779&ssl=1&resize=350%2C200","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/www.artsjournal.com\/scenechange\/wp-content\/uploads\/2025\/11\/ev-votes-jpg1.jpg?fit=1075%2C779&ssl=1&resize=350%2C200 1x, https:\/\/i0.wp.com\/www.artsjournal.com\/scenechange\/wp-content\/uploads\/2025\/11\/ev-votes-jpg1.jpg?fit=1075%2C779&ssl=1&resize=525%2C300 1.5x, https:\/\/i0.wp.com\/www.artsjournal.com\/scenechange\/wp-content\/uploads\/2025\/11\/ev-votes-jpg1.jpg?fit=1075%2C779&ssl=1&resize=700%2C400 2x, https:\/\/i0.wp.com\/www.artsjournal.com\/scenechange\/wp-content\/uploads\/2025\/11\/ev-votes-jpg1.jpg?fit=1075%2C779&ssl=1&resize=1050%2C600 3x"},"classes":[]},{"id":1768,"url":"https:\/\/www.artsjournal.com\/scenechange\/2026\/04\/16\/born-in-the-dsa-the-american-dream-evolved-into-the-cruelest-most-dangerous-con-ever-played\/","url_meta":{"origin":1669,"position":2},"title":"Born in the DSA*: \u201cThe American Dream\u201d Evolved Into the Cruelest, Most Dangerous Con Ever Played","author":"Alan Harrison","date":"April 16, 2026","format":false,"excerpt":"What a grift. It only exists to make folks feel worthless, angry, and divisive. As such, it\u2019s the perfect tactic to sow national unrest.","rel":"","context":"In "Arts and Culture"","block_context":{"text":"Arts and Culture","link":"https:\/\/www.artsjournal.com\/scenechange\/category\/arts-and-culture\/"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/www.artsjournal.com\/scenechange\/wp-content\/uploads\/2026\/02\/Born-in-the-DSA-the-death-of-the-American-Dream.jpg?fit=1200%2C675&ssl=1&resize=350%2C200","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/www.artsjournal.com\/scenechange\/wp-content\/uploads\/2026\/02\/Born-in-the-DSA-the-death-of-the-American-Dream.jpg?fit=1200%2C675&ssl=1&resize=350%2C200 1x, https:\/\/i0.wp.com\/www.artsjournal.com\/scenechange\/wp-content\/uploads\/2026\/02\/Born-in-the-DSA-the-death-of-the-American-Dream.jpg?fit=1200%2C675&ssl=1&resize=525%2C300 1.5x, https:\/\/i0.wp.com\/www.artsjournal.com\/scenechange\/wp-content\/uploads\/2026\/02\/Born-in-the-DSA-the-death-of-the-American-Dream.jpg?fit=1200%2C675&ssl=1&resize=700%2C400 2x, https:\/\/i0.wp.com\/www.artsjournal.com\/scenechange\/wp-content\/uploads\/2026\/02\/Born-in-the-DSA-the-death-of-the-American-Dream.jpg?fit=1200%2C675&ssl=1&resize=1050%2C600 3x"},"classes":[]},{"id":1701,"url":"https:\/\/www.artsjournal.com\/scenechange\/2026\/02\/19\/born-in-the-dsa-gun-nuts-have-proven-irresponsible-and-treacherous-ban-the-fg-things-already\/","url_meta":{"origin":1669,"position":3},"title":"Born in the DSA*: Gun Nuts Have Proven Irresponsible and Treacherous. Ban the F@#%&*g Things Already.","author":"Alan Harrison","date":"February 19, 2026","format":false,"excerpt":"The image of the current version of this country around the world is that of a gun-happy, murderous, fascist state in which every weapon is available to everyone who wants to shoot up a crowd. 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Did you tell your staff that you\u2019re paying a lower Social Security tax than they are?","rel":"","context":"In "Arts and Culture"","block_context":{"text":"Arts and Culture","link":"https:\/\/www.artsjournal.com\/scenechange\/category\/arts-and-culture\/"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/www.artsjournal.com\/scenechange\/wp-content\/uploads\/2025\/08\/Born-in-the-DSA-with-stars.jpg?fit=900%2C724&ssl=1&resize=350%2C200","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/www.artsjournal.com\/scenechange\/wp-content\/uploads\/2025\/08\/Born-in-the-DSA-with-stars.jpg?fit=900%2C724&ssl=1&resize=350%2C200 1x, https:\/\/i0.wp.com\/www.artsjournal.com\/scenechange\/wp-content\/uploads\/2025\/08\/Born-in-the-DSA-with-stars.jpg?fit=900%2C724&ssl=1&resize=525%2C300 1.5x, https:\/\/i0.wp.com\/www.artsjournal.com\/scenechange\/wp-content\/uploads\/2025\/08\/Born-in-the-DSA-with-stars.jpg?fit=900%2C724&ssl=1&resize=700%2C400 2x"},"classes":[]},{"id":1520,"url":"https:\/\/www.artsjournal.com\/scenechange\/2025\/10\/14\/born-in-the-dsa-its-time-to-outlaw-donor-advised-funds-dafs\/","url_meta":{"origin":1669,"position":5},"title":"Born in the DSA*: It\u2019s Time To Outlaw Donor Advised Funds (DAFs)","author":"Alan Harrison","date":"October 14, 2025","format":false,"excerpt":"Pick up a phone. Go to an office. Tell your community foundations to stop crapping up America with this Ponzi scheme of contributions. And tell them (and your legislators) not to fix DAFs; just eliminate them. The abuse is too much.","rel":"","context":"In "Arts and Culture"","block_context":{"text":"Arts and Culture","link":"https:\/\/www.artsjournal.com\/scenechange\/category\/arts-and-culture\/"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/www.artsjournal.com\/scenechange\/wp-content\/uploads\/2025\/09\/Born-in-the-DSA-2-DAF.jpg?fit=1000%2C730&ssl=1&resize=350%2C200","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/www.artsjournal.com\/scenechange\/wp-content\/uploads\/2025\/09\/Born-in-the-DSA-2-DAF.jpg?fit=1000%2C730&ssl=1&resize=350%2C200 1x, https:\/\/i0.wp.com\/www.artsjournal.com\/scenechange\/wp-content\/uploads\/2025\/09\/Born-in-the-DSA-2-DAF.jpg?fit=1000%2C730&ssl=1&resize=525%2C300 1.5x, https:\/\/i0.wp.com\/www.artsjournal.com\/scenechange\/wp-content\/uploads\/2025\/09\/Born-in-the-DSA-2-DAF.jpg?fit=1000%2C730&ssl=1&resize=700%2C400 2x"},"classes":[]}],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/www.artsjournal.com\/scenechange\/wp-json\/wp\/v2\/posts\/1669","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.artsjournal.com\/scenechange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.artsjournal.com\/scenechange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.artsjournal.com\/scenechange\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.artsjournal.com\/scenechange\/wp-json\/wp\/v2\/comments?post=1669"}],"version-history":[{"count":1,"href":"https:\/\/www.artsjournal.com\/scenechange\/wp-json\/wp\/v2\/posts\/1669\/revisions"}],"predecessor-version":[{"id":1677,"href":"https:\/\/www.artsjournal.com\/scenechange\/wp-json\/wp\/v2\/posts\/1669\/revisions\/1677"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.artsjournal.com\/scenechange\/wp-json\/wp\/v2\/media\/1670"}],"wp:attachment":[{"href":"https:\/\/www.artsjournal.com\/scenechange\/wp-json\/wp\/v2\/media?parent=1669"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.artsjournal.com\/scenechange\/wp-json\/wp\/v2\/categories?post=1669"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.artsjournal.com\/scenechange\/wp-json\/wp\/v2\/tags?post=1669"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}