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The recent healthcare reform bill passed in the United States can be seen as marking two seemingly contradictory things: firstly, the biggest leap forward in U.S. domestic policy since the Johnson Administration and secondly, the most obvious indication of business as usual politics since the Clinton Administration. The bill lays out coverage for 95% of Americans (few people are asking about the other 5%) and, amongst other things, ends the practise of refusing treatment based on ‘pre-existing conditions,’ which has been the biggest kick in the face to Americans who have the misfortune to fall ill. The bill achieves a lot, but what is perhaps more striking is what it omits.
Flash back to 2009. No matter which candidate was to emerge victorious, healthcare would inevitably be the main domestic agenda. With Obama in office, the general feeling at the time was that a so-called ‘public option,’ in which the government provides a separate healthcare plan which competes with the private health insurance industries, would emerge. Bear in mind this is exactly the kind of thing the American public has wanted for decades. A 2009 amalgamation of polling data on healthcare reform showed that between 60-80% of the U.S. public support a public option for healthcare, and this is roughly the same throughout the past 30-40 years.
Understandably, the private industries were scared. The U.S. government already provides coverage to members of its own congress, U.S. soldiers and elderly citizens through programs such as Medicare and its coverage is generally thought to be superior to care provided by the private industry. The companies were effectively afraid of being run into a ground by a superior product, and America is nothing if not willing to provide support for its most ineffective, but ‘too big to fail’ businesses.
The media were also very quick to misrepresent the debate. Katty Kay, a BBC Washington correspondent, opined on her blog that the U.S. public would, by their very cultural make-up, reject a government-run healthcare system similar to the NHS or the French healthcare models. ‘There is something quintessentially un-American about nationalization because the American character is simply too entrepreneurial to tolerate it’ she opined, conveniently ignoring the fact that this is exactly what American public opinion (presumably a good indicator of ‘American character’) has been in favour of for well over 30 years.
And so a bill was passed which effectively gave in to the idea that private insurance could continue providing sub-par treatment to U.S. citizens, but 95% of them will now be signed up to it. With the idea that private coverage would become essentially ubiquitous, the insurance industries were apparently more than willing to make a few small, but significant concessions to the benefit of the people they are covering.
Yet when put into perspective, it seems a wonder that these kinds of things were tolerated for so long. Some of the more extreme and ridiculous aspects of the U.S. media attempted to drum up paranoid right-wing opposition to any kind of healthcare reform by insisting that because the Nazis had nationalised healthcare, the U.S. nationalising healthcare would be one step away from replacing the stars and stripes with a Swastika making love to a Soviet hammer and sickle.
It’s true that the Nazis did have a national health care plan, but that’s only the case because Germany’s national healthcare plan dates back to 1883 and by 1933 healthcare was as much a part of German life as the roads and bridges. Yes, even Hitler had to initially rely on voter support and “We will make you pay through the nose for your healthcare” isn’t an attractive policy proposal. It becomes pretty obvious in nations that have similar systems to our NHS that healthcare is a right, not a privilege and it seems that the American public generally agrees with this assessment, partially because they’re not as stupid as snobby Europeans like to pretend they are, but also because they are in the belly of the beast when it comes to private-run healthcare plans and have day-to-day experience of how atrocious they are.
So whilst there are a whole load of positive things to say about Obama’s healthcare bill, like any good story the clues are in the subtext. What is revealed on closer look is the outright contempt that the American political leadership generally exhibits to the opinions of its own population and that, when asked to choose between business or popular will, nine times out of ten they will opt for business, as usual.