Observing it from afar, there are many aspects of the debate over healthcare reform in the United States that, on the face of it, defy comprehension.
Why on earth would anyone vociferously oppose a law that makes it harder for the sick to be denied treatment? How, in heaven’s name, can the ‘freedom’ to die of a curable disease be elevated above the right to receive medical attention?
Mind you, the legislation passed by the US House of Representatives and signed into law by President Barack Obama last week does not guarantee that right. Yet who can seriously doubt that, for all its shortcomings, the Patient Protection and Affordable Care Act is a step in the right direction?
Sure, it entailed any number of compromises with vested interests, particularly the health insurance and pharmaceutical lobbies. The public option was dropped, and towards the end of the tussle, the mental blocks of anti-abortion Democrats had to be accommodated. If the reforms encapsulated in the legislation are ever fully implemented, the US will still lag behind most developed countries in this sphere.
But then, as Obama conceded, “This legislation will not fix everything that ails our healthcare system.” He added, however, that “it moves us decisively in the right direction. This is what change looks like”.
One could quibble about the adverb ‘decisively’. Reversals cannot be ruled out. But it’s hard to argue with the contention that it’s a step in the right direction, although the size of that step is open to conjecture. “The legislation … doesn’t promise sufficient reform,” Ezra Klein commented in The WashingtonPost this week, “but it does lay down many of the necessary preconditions for it. It is an incremental bill with a comprehensive vision tucked inside, [and] the work of realising that vision starts now.”
Private health insurers’ reservations about measures that potentially affect their bottom line are not hard to understand. After all, they are in the business not because they are particularly concerned about the state of anyone’s health, but because, if you’ll excuse the irony, they want to make a killing. By no stretch of the imagination are they the only institutions that put profits before people: that’s the logic of capitalism, and the Obama administration is hardly any more inclined than any of its predecessors to question it.
It does, however, entertain concerns about some of its more immoral implications. After all, it makes sense for the insurers to deny coverage to those with ‘pre-existing conditions’, whose medical bills could outstrip the premiums they pay. Even if the bills don’t go that far, they diminish the profits. It’s much more lucrative to sign up members who’ll seldom need to consult a doctor, let alone go in for life-saving surgery. And if a patient can’t afford the grossly overpriced medicines they need to recuperate — or, for that matter, to stay out of hospital — who is going to subsidise them?
Once implemented, the new act will make it harder to discriminate on such grounds. Small wonder, then, that the insurance and pharmaceutical industries devoted billions of dollars to lobbying against the reforms. They were partially successful, because even if all the changes entailed by the new law can successfully be implemented, the US will remain backward in this crucial sphere compared with its developed counterparts, not to mention impoverished neighbours such as Cuba.
No doubt the state-sponsored health systems across Western Europe, Canada and Australia leave a lot to be desired: they are ramshackle, under-resourced and over-bureaucratised in many cases, often as a consequence of misplaced priorities. Yet in most of these countries, citizens are not denied treatment just because their bank accounts aren’t big enough — although the requisite attention sometimes entails a long wait. It’s inadequacies notwithstanding, this approach is surely preferable to a situation where a negative reaction to ‘show me the money’ all too frequently means that you go home to suffer. Or die.
Americans were considerably worse off before, 45 years ago, the Lyndon Johnson administration — whose justly reviled atrocities abroad, particularly in the context of its escalation of the aggression against Vietnam, tend to overwhelm the memory of its significant domestic initiatives — instituted Medicare. As surgeon and medical academic Atul Gawande points outs in TheNewYorker this week, “In public memory, what ensued was the smooth establishment of a popular programme, but in fact Medicare faced a year of nearly crippling rearguard attacks”, not least from the American Medical Association (AMA), plus the disinclination of hospitals in the southern states to desegregate.
That was part of a wider backlash against civil rights legislation that, a century after Abraham Lincoln’s emancipation proclamation, effectively gave African-Americans the right to vote and to be considered equal citizens. Obama’s elevation to the presidency has helped to make it clear that the backlash continues. On Capitol Hill last week, the racist and homophobic epithets flung at some Democratic legislators were reminiscent of the abuse endured by African-Americans who turned up at desegregated schools and universities in the early 1960s.
They bore in their hearts the audacity of hope. And they were ultimately vindicated. But, as the tea-partiers have adequately demonstrated, the US still isn’t by any means a post-racial society. The 24 per cent of Republicans who, according to a recent poll, consider Obama to be the antichrist, and the 38 per cent who believe he is “doing many of the things that Hitler did” — not to mention the 45 per cent who believe, notwithstanding the absence of any credible evidence, that he wasn’t born in the US and therefore isn’t eligible to be president — adequately demonstrate an anathematical degree of intellectual backwardness.
It is not hard to sympathise with those who opposed Obama’s healthcare bill on the grounds of its inadequacy. Those who see it as a communist conspiracy are, arguably, more to be pitied than reviled — although, were mental healthcare to be made mandatory, most of them would find themselves institutionalised.
Mohammed Abbasi 