Wednesday, 24 March 2010

Health Care Reform

So, the US Congress has passed President Obama’s health reform legislation and around 32 million US Americans will finally get some kind of health insurance. Seen from a Western European perspective, the USA has finally joined the group of nations which officially sees health care as a basic human right.

I admit to finding the US debate strange. Manipulated by various vested interests and some frightening ideologues, many US Americans of a conservative bent genuinely seem to see the reform as an attack on the foundations of their society, ramming through dictatorial socialism in the land of the free and the home of the brave. A confirmation of their fear of what the election of a black president with Hussein as a middle name and a surname which contains only one letter’s difference to the first name of the fanatic mastermind behind 9/11 would bring. One evangelical preacher has been making headlines by starting a list to pray for the deaths of all those representatives who voted for the health bill. This kind of fanatic, hate-filled opposition is frightening. The ironic thing is that it was the regions with the highest proportion of people with no health insurance whose representatives voted most strongly against the bill. (Those interested in the statistics can view them here:

It all suggests to me that a lot of the opposition to Obama’s health care proposals is of basic ideological nature, rather than actually about health coverage. It’s about complex issues of perception rather than the concrete issues on the table. There are deep roots in old American memes of mistrust in government and a frontier mentality of self-reliance. These join with conservative evangelical themes which have a deep distrust of secular liberal pluralism and a feeling of being threatened by a dangerous, unknown, possibly hostile world outside the glow of the camp-fires around which those of like-mind, those you trust and love, huddle. A world of outlaws, of people who look and think differently to you; a world where you can be cheated and robbed – either by those poorer and more desperate than you, or by those who are cleverer, more smooth-talking and educated than you, who will take your money and leave you with snake-oil. Against the poor and the desperate you can protect yourself with a gun, but what will protect you from self-secure, godless, liberal lawyers, who want to take your money and (having pocketed a good portion of it) give the rest to those too lazy and indigent to look after themselves? And, there in the back of your mind, there’s still that niggling worry, the fear that you too could loose your job, get sick; but if there’s one thing you’ve learned, it’s that in such situations, the only ones you can really rely on anyway are family and, sometimes, trusted friends, and, of course, God. In him you trust, the rest pay cash and you do too, when you need something and you have it.

There’s a kind of residual Calvinistic tinge to all of this; a feeling that, somehow, sickness is a judgement of God, a result of your own failings and that general health insurance will be “wasted” on those who have stuffed themselves to obesity and diabetes or fornicated themselves into sexually transmitted diseases or situations in which they consider terminating pregnancies. The factual grounds for obesity in poor, cheaper diets and lack of exercise, the genetic component in diabetes, that the treatment of stds (with the exception of the special HIV issue) is generally cheap and easy and that it’s a miniscule amount of the health budget in developed countries anyway disappear in the heat of emotional discussion. But, as I said, most of the discussion is about perceptions rather than facts.

Not that there aren’t enough facts to be discussed. Health care is expensive and will become more so, especially in the developed countries, with ageing populations and ever better, more complex treatments which mean that people are coping with and living much longer with chronic illness. Are there limits to what society can carry collectively in the area of health and, if so, what are they? How much do we want to spend on the basic right to health care, how do we allocate and manage the resources? Are there deeper questions which need to be asked about the moral vectors in society with regard to the major area of confluence between health care and the dynamic to maximise multi-national business profits by banking and insurance corporations and the pharmaceutical and medical-supplies industries?

These are questions hotly debated in Europe and Japan and there is enough stuff for bitter conflict. There are many issues which can only be tackled internationally. But progress on these issues is dependent on two basic premises: firstly, that basic, universal health care is a human right and, secondly, that illness cannot be fundamentally seen as self-inflicted or deserved. Hopefully now that the USA has legislated for general basic health care, they can now join the rest of the world in the discussions about the more important and difficult areas; how to go about providing it.


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