Your Independent Journal from the Heartland
In his zeal to wrest Greenland from Denmark, President Trump has resurrected Manifest Destiny. Ages ago we grew our footprint, seizing Texas from Texas, much of the Southwest from Mexico, as well as Oregon and surrounding areas from Britain. Later we took control over Hawaii and Alaska (a.k.a. Seward’s folly). Post World War II, we won Guam, Wake Island, the Marshall and Mariana Islands, etc. At one point we briefly annexed the Philippines. Victory in the Spanish-American War gave us Puerto Rico. In 1917 we bought the Danish West Indies (now the US Virgin Islands) from Denmark. We have an expansionist history.
But let the Greenlanders beware.
Whatever incentives Uncle Sam offer the Greenlanders, they will get not only our largesse, but our health system. On the one hand, life expectancy (77.4 years in the United States, 71.5 in Greenland) looks better; but the data mask vast differences. In one part of Chicago, life expectancy is 90; on the Southside, it is 60. The United States has the highest rate of drug overdose deaths: 31.3 per thousand in 2021, compared to 13.9 in Greenland. Our crime rate dwarfs theirs.
Greenland is not Eden. They suffer from the same diseases as we: obesity, diabetes, and cardiovascular disease. Half the adults smoke.
And we have treatments that are more sophisticated, technology more accurate, surgical expertise more advanced. People flock from all over the globe to Johns Hopkins, the Mayo Clinic, Mass Eye and Ear, et al.
Yet we Americans must jump over an expensive complex insurance hurdle to get that superb treatment — indeed, to get any treatment. Even today, with the Affordable Care Act, with Medicaid expansion, with Medicare, with private insurance, 8% of Americans have no health insurance. In Texas the rate is 18%. In the United States, adults ages 19 to 64 are the most likely to have no insurance.
Overall the rates of the uninsured have dropped, thanks to the expansion of Medicaid and to the Affordable Care Act’s subsidies. But everybody is not eligible for the ACA. Incomes can range from $15,000 to 60,000 (a single person), and $31,000 to $125,000 for a family of four. Premiums can be as low as $10 a month, depending on income. To cite the IRS: “the employee contribution for the lowest cost health benefit option offered by the employer must be no greater than 9.02% (for plan years beginning in 2025) of the full-time employee’s household income.” The ACA itself has four tiers: bronze, silver, gold, and platinum.
The self-insured face a higher hurdle: In 2024, the average monthly premiums for individual coverage was $484; for families, $1,230. That doesn’t count the $4,394 average annual deductible for an individual. Of course, people poor enough (states’ limits vary) can enroll in Medicaid. Over age 65, we all can enroll in Medicare, with premiums pegged to income, and subsidies below a set income. Part B premiums are $174.70 per month for people who make $103,000. But Medicare has considerable co-pays and deductibles, which compel many enrollees to add a “Medigap policy.” You can go online to shop. Then there are the Medicare Advantage plans — much cheaper, but maybe not so comprehensive, with limited formularies, limited networks of physicians and hospitals. If you switch from an Advantage plan to original Medicare, you may encounter“pre-existing condition” limitations.
On to Greenland. Health care is free. That includes general practitioners, public hospitals, prescription medicine, some dental care, preventive care, vaccinations, and transport to the nearest health care facility. All free for citizens and residents. No co-pays. No deductibles. No pre-existing condition limitations. No caps. No “tiered” pricing. No in and out networks.
In rural Greenland, hospitals and clinics cannot give the same services as the Mass General, or even a community hospital in the United States. But If we plant the American flag on Nuuk, Greenland’s capital, Johns Hopkins is not likely to open a satellite there. Greenlanders will go to the same hospitals, see the same physicians as before, yet pay for the care they once got for free.
Joan Retsinas is a sociologist in Providence, R.I., who writes about health care. Email joan.retsinas@gmail.com.
