Tuesday, December 01, 2009

Obama, Health and the Left

Tribune 25th November 2009
Ian Williams

New York, with its vestigial social democratic culture, is less committed than most cities to private affluence at the expense of public squalor, but it’s still hard to find a public toilet in Manhattan. Left and right have a hand in this. A few years ago, New York was about to sign up a company to provide the type of automated toilet common in other cities. Threatened legal action demanding that these toilets meet standards for disability access flushed the deal away. The result is that everyone, wheelchaired or walking has to cross their legs.

The landmark health care debate in Congress shows similar behaviour from both sides. The Catholic hierarchy, whose flock includes millions of the uninsured, decided that it would be better that they die disease, than get insurance offering abortion services. Catholic Democrats on Capitol Hill joined the Republicans to hold the bill to ransom unless abortion was excluded. It is typical of such posturing that the Republican Party’s own staff insurance was promptly revealed to include just such services.

On the left, Dennis Kucinich, the most left wing, but poorest in cash and charisma, of Democratic primary contenders, voted against the narrowly passed bill in the House of Representatives because it did not include a public option. The lobbyists have indeed laboured mightily to exclude the one option that would make sense.

Since being an American conservative entails believing at least three impossible things before breakfast, we should not really be surprised that many of the states that fervently oppose “socialised medicine,” actually have socialised alcohol: the state government actually has a monopoly on liquor distribution. Even more relevant are the actuality-conflicted protestors who demand “Keep the government’s hands off my Medicare,” the latter being the Canadian-style single payer health insurance programme for millions of American pensioners and disabled of all ages.

Not do such “fiscal conservatives” often mention the defence budget. But it is almost a constitutional convention in Washington that no one ever cavils at money for killing foreigners or letting native defence contractors make a killing out of the Pentagon budget, even if the sums dwarf health spending.

With similar dissonance from reality, the so-called “Blue Dog” Democrats who profess worry about the budget deficit, are most worried about the public option, whose cheapness could undercut the massive profits of the health insurance and drug companies. But if a few other Democrats had joined Kucinich’s politically correct gesture it would have wrecked the only chance since the New Deal to bring any sense at all into American Healthcare.

The bill is indeed deeply flawed. A single payer system like the National Health is insurance in the best sense: it spreads the risk and costs across the entire public, but the public option would at least allow the uninsured to buy the equivalent of what pensioners in the US have from the government. Instead, the current string and sealing wax effort mandates the purchase of insurance from money-gouging and inefficient private companies, who set their premiums on strictly commercial grounds. In 45 states they refuse to cover you for “pre-existing” conditions, and in any case, if you are old and more at risk, you pay more. Under the current bill if you do not put money in their pockets, the government will fine you.

There is a trade-off. In return for thirty or forty million compulsory new customers, the salivating insurance moguls promised that they would drop some of their current inhumane practices, like deciding that because you did not mention your adolescent acne on your application form, they will not pay to treat the cancer you have just discovered.

But despite all these pertinent points, Kucinich was wrong to oppose the Bill. Establishing the principle is far more important. The House Bill goes to a conference with the Senate to merge with their version, where some of the more egregious idiocies can be reconciled out. Admittedly there is a chance that some new ones could actually be added in, but, whatever the wording of the final law, for the first time it brings the USA somewhere close to middle of the twentieth century in making it the government’s business to ensure access to medical care for its citizens.

Without taking the piss – too much – we get back to the Manhattan toilets. Surely it’s a better tactic to build the toilets and get the plumbing in, and then to campaign for disability access.

In fact, precisely because Kucinich is correct about the inherent inefficiencies and injustices of the bill, there is scope now for improvements and inefficiencies. When the drug companies and the insurers show their true colours – putting the government more and more in the red -legislators can and should put the squeeze on them. They can introduce a public option, ensure that it can use its bargaining power with private providers to reduce costs and widen access. It’s the American way: get a toe in the door and then push hard.

What could keep me awake at night is nightmares about planeloads of New Labour acolytes, for example, the type who love primaries because they worked a few weeks on the Obama campaign, trying to get the NHS to emulate the deeply dysfunctional deal now being slapped together in Washington. It might be better than the present system, but if someone raises the Titanic, that’s no reason to book a cruise in it.

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