Stephen Ginn on US health care reform

I was out for dinner with a New Yorker friend of mine recently. She’s British, but she’d brought along an American friend and I happened to mention to him how much I was digging President Obama. Things deteriorated from there. “Obama is a socialist!” the heads of the rest of the table turned, as the conversation up until that point had been about interior furnishings.

“I don’t think that you appreciate what a socialist is,” I replied. “You should try living in France; America doesn’t have a party of the left. All you’ve got is centre and right”. The conversation then moved onto health care, which was proposed as an example of where liberal economic theory fails to deliver. Our American friend was undeterred by this argument.

“It’s possible to get free healthcare in the United States” he opined. “People come into a hospital sick and get treatment, and once they’re in, the hospital can’t throw them out”

I’ve been thinking about this curry-fuelled conversation over the past few days whilst reading about Obama’s troubles in pushing healthcare reform, something he considers to be the most important aim of his presidency. To the European bystander, US healthcare would seem to be in desperate need of attention. Despite the United States being the world’s richest country, millions of its people do not have health care cover and anyone who’s seen Michael Moore’s film Sicko will know that even those with cover can find themselves severely financially compromised by the payments they are forced to make. The system costs more per head than anywhere else in the world, but yet is only rated 37th in comparison to other countries. The effects have been felt beyond that simply of the individual; the struggling General Motors cites the health care costs of its staff as a significant contribution toward its instability.

Why then are some American right so vociferous in their opposition of reform? Meetings of members of Congress who are trying to promote Obama’s plans are frequently being disrupted and Congressman David Scott had a swastika painted outside his office. It seems that health care reform is being equated with increased state intervention in the lives of citizens something that is, in the minds of some, directly comparable to fascism. Former Vice-Presidential candidate Sarah Palin – whom, for what it’s worth, I entirely loathe – is not shy of this imagery. She wrote on her blog, in a gross characterisation of the Obama proposals:

“…the America I know and love is not one in which my parents or my baby with Down’s 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 healthcare. Such a system is downright evil.”

Here and elsewhere the NHS has been getting caught in the crossfire. Palin is presumably referring to NICE’s attempts to decide whether expensive drugs provide value for money. Republican senator Chuck Grassley has also confidently said that, under the NHS, Senator Edward Kennedy would be left to die untreated for his brain tumour.

If I was the NHS I’d sue for libel.

Misinformation must be blamed for the violent reaction to the possiblity of health care reform, but if I was an American I would be more concerned about the wider issues. If the society that the Americans have built is simply not coherent enough for people to wish to contribute toward the health of their fellow humans then it is in urgent need of reevaluation. Those without healthcare should not simply be the disparaged “them” of my dinner companion’s discourse. For universal healthcare to work “us” is the most important word.

I should point out that I do not consider myself to be “anti-American”. An interesting read on the subject is The Eagle’s shadow: Why America fascinates and infuriates the world by Mark Hertsgaard. Also BBC North American correspondent Justin Webb wrote this interesting piece for Radio 4’s From our own correspondent recently.

Independent: Is US healthcare so bad that it needs a lesson from Britain? – Q&A
Guardian: US Healthcare
Guardian: Debate over US healthcare reform takes an ugly turn
Guardian: ‘Evil and Orwellian’ – America’s right turns its fire on NHS
Guardian: This NHS row is paralysing progress – if you only read one of these links make is this one

Stephen Ginn is a psychiatrist in training working in London. He writes the blog Frontier Psychiatrist.