The Healthcare Debate
Warning - this is a highly simplified and probably simplistic view - which sadly is part of the point. It’s also meant to be for the enlightenment of those non-US people still listening to my witterings more than the US folks, who clearly know more about this stuff than I do or ever will. It’s also a little disjointed - I’ve been ading to it in my spare time over a few days.
Freely and openly I will admit that I come from a country which has had what Americans are wont to call “socialized health care” for a number of years (though this phrase is often used to describe a number of quite different systems). What that means, essentially, is that if we need medical attention, we don’t pay for it. That is to say, we don’t automatically get a bill at the end of a doctor’s appointment or a hospital visit. We pay for prescriptions if we can afford to, and of course we pay for healthcare via our taxes - it’s clearly by no means ‘free’. But it is, to use the famous phrase “free at the point of need”.
A few years ago when I got an infection that could have left me blind in (at least) one eye, I called my doctor’s surgery the morning I woke up with my face so swollen I couldn’t really open my right eye, got in to see my GP as an emergency an hour later, was referred by him to the hospital where I was admitted a couple of hours later and spent the next five days being pumped full of intravenous antibiotics. Along the way I had a couple of scans, saw high-powered consultants in two separate disciplines, and received a considerable value of drugs. Total bill at the end of all this; well, there wasn’t one.
I tell that story to my colleagues here in the US, and even though we all have what we suppose to be a ‘good’ health insurance package care of the company, to a man and woman they’re filled with horror at the thought of something similar happening to them, because they all assume, or possibly think they know, that in a similar situation they could end up paying thousands and thousands of dollars either because the plan wouldn’t cover all that care, or the insurance companies would find a way to wriggle out of paying.
The British health system isn’t perfect - if it’s not an emergency you could easily wait a week or more to get an appointment at a GP for example. But at least it doesn’t create a situation where people will avoid even acknowledging they’re ill because they can’t afford treatment. I know someone in the US who was knocked off his bike by a car and got up and walked away even as people were calling 911 because he couldn’t risk being given treatment that he couldn’t afford.
And so, coming eventually to the point, I watch the current ‘debate’ on what people tend to call healthcare reform, but which I think is probably more accurately called health insurance reform, with significant interest. This is all predicated on President Obama’s stated reformist agenda and particularly his drive for a ‘public option’ which is to say an alternative to all those nasty commercial insurance companies run by the state, for all those individuals and businesses that can’t afford big brand coverage for themselves or their employees. It’s not, in any sense a Briton would understand it, “healthcare like ours” - you’d still need to take out coverage, and payment would still be involved, but the public option is important - more than 40 million Americans are currently uninsured, and some unknowable number of others are struggling under the weight of premiums which go up while coverage doesn’t.
Given that in the UK we can opt to supplement our NHS care with private coverage, it’s almost the reverse of our model. And note, critically, that private health insurance does exist in the UK, with its providers apparently able to make solid profits, so that seems to counter any concern that a not-for-profit competitor would damage the business of the corporations.
But there’s a vocal groundswell of opinion against a reform plan that includes a public option. It’s a groundswell that at least superficially actually starts at the ground - in the form of grassroots activism organising against the proposals mostly at what are called ‘town hall’ meetings where elected officials meet with their constituents.
The arguments which have been thrown up (I use the term advisedly) have tended to centre around some consistent scare tactics; that the plan will mean taxpayers paying for abortions, that old people will be euthanised (no, seriously), that taxpayers will be forced to subsidise gender reassignment surgery, the list goes on. I’m going to come back to some of these in a bit.
The other argument against is a slightly odd one. Years and years ago, I think on Metafilter, in a discussion on healthcare I asked “if it means people who need treatments but can’t afford them get treated, why wouldn’t you want ’socialized healthcare’. In seconds I was bombarded with responses from people who said that they didn’t want the government ‘interfering’ in their private lives, which I honestly thought was a bizarre way of looking at it. But it’s cropping up in the current rows too. The looks-like-a-joke-but-is-said-seriously comment I see doing the rounds is “I don’t want the government running my Medicaid!” (for Brits, Medicaid actually already is a government-run healthcare programme). And this isn’t just from people-in-the-street, pundits are coming up with lines like:
If you like the Post Office and the Department of Motor Vehicles and you think they’re run well, just wait till you see Medicare, Medicaid and health care done by the government.
This is simply not the comment of a rational, informed individual. Except it is, apparently - that was said by a former member of Reagan’s Economic Policy Advisory Board. Now, I don’t use Medicaid or Medicare, and I hear both good and bad things about them, so I’m not going to judge. But whether the government is currently doing a good or a bad job in running them, it’s futile to argue against the idea of government getting involved in healthcare when it’s been involved in it in this country for over 40 years.
The astute among you will have noted my use of the word ’superficially’ to describe the source of the opposition. Of course, it’s not really (or at least not just) a grassroots movement at all. A highly organised coalition of professional Republican activists and lobbyists are doing a lot of work on this front, working on a three stage approach:
1) spread the lies about what ‘Obamacare’ is going to do by all channels, including elected officials (yes, actual members of Congress are openly promoting the ‘Obama wants to kill your granny’ lie, among the others. And Sarah Palin (oh yes, she’s still around) supported the nonsense with this gem last week, in which, oh look, she once again used her child as a political prop:
The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s ‘death panel’ so his bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society,’ whether they are worthy of health care. Such a system is downright evil.
It’s interesting to wonder, given the gaping chasm that apparently lies between Palin and an even room-temperature IQ, whether she’s actually part of the plot to undermine the reform or if someone just told her some lies, she believed them without checking, and went off in her usual mavericky way. This ‘death panel’ nonsense, by the way, stems from the provision in ‘Obamacare’ that coverage would be provided for end-of-life counselling sessions to help people formulate living wills IF THEY WANT TO.
2) make sure you get the lies in front of as many people as possible - use the mainstream media and any partisan commentators you can, and spread the message via websites set up by supposedly concerned citizens who are actually well-paid political operatives. Use those sites to promote the town hall meetings of only those representatives who might support reform.
3) give the people you’re hoodwinking and lying to in order to rile them up, not only talking points to raise at the meetings, but guidelines on how to be as disruptive as possible to shut down via volume or physical means not only any attempt by the rep to state their case, but any debate with their fellow voters who may actually support a programme designed to help those 40+million uninsured people.
There’s a fourth stage that’s rapidly coming to the fore too, by the way, which equates Obama specifically with past dictators like Hitler and uses language that actually seems premeditatedly to suggest that violence against him might be in the country’s interests. Might actually in fact be praiseworthy.
Now, I haven’t read every single paragraph and page of the proposed legislation, though I’m fairly sure I’ve read rather more of it than a lot of those screaming at Senators and Congresspeeps, and I can’t claim the intimate familiarity with the issues of people who’ve lived here all their lives. What do I know, after all? I’m from one of those countries with ’socialized healthcare’ - it’s not my debate. (Though as Rachel Maddow points out in one of the clips I’ve linked below, this isn’t actually a debate about healthcare. The people who don’t want there to be a debate are making sure of that.)
But lest anyone not currently in the US (and indeed anyone here who isn’t following this avidly) should misunderstand: all this stuff; the lies, the organised intimidation, the priming of potentially unstable people to commit violence in the interests of billion dollar corporations (and their bought and paid-for politicians) is actually happening in the USA. Today.
Some suggested viewing:
Clip of a Maine protester “tired of having my country taken away from me”
Clip of one of North Carolina’s protesters equating Obama with Hitler
Keith Olberman on ‘Legislators for sale’
Rachel Maddow, a journalist I want to clone and use to populate the world’s media, on:
The real organisers of the ‘grassroots’ activity
The “organized use of initimidation as a political tool in the USA”
The obfuscation of the politics by the vested interests
The increasing tendency of the protests towards violence
This is really quite scary stuff, and it’s getting worse.
August 18th, 2009 at 1:13 pm
One of the funniest comments I’ve heard for a long time was the alleged (cos I can’t find an attribution) “If Stephen Hawking were British, he’d not be alive now:.
Well he is and he is.
August 19th, 2009 at 9:59 pm
Yep - you seem to have just about summed it up. It’s very very difficult to watch this ‘debate’. I think Canada is a combination of the UK and US - we pay into the Medical Services Plan monthly, but not a huge amount (it’s also means tested). As per the UK, it’s not perfect but good lord isn’t the important thing that you can get emergency medical treatment if you need it no matter who you are. One of the most stressful months of my life was having Toby in CA. I couldn’t get insurance because I moved while pregnant, so we just had to cross our fingers than nothing was wrong with me or the baby.
I’m bemused and tempted to just hide from the whole thing and cross my fingers that everyone comes to their senses and stops the US looking like a third world country.
(Hi by the way - hope you’re well!)