Saturday, 1 August 2009

Mike's Letter from America No 15

The Worst of Health

Yesterday, I went to have some blood samples taken. The first thing I was asked when I got to the clinic was ‘could I see your insurance card?’ This is always the first thing an American resident is asked when going for the first time to a doctor, dentist, or even a hospital – except in the direst of emergencies, no insurance = no treatment.

The irony of this is that, if you believe the Republicans and their allies in the media, in Britain or other countries that have a public health system ‘government bureaucrats come between you and your doctor’. Yet in 39 years under the care of the NHS, I never had to see a bureaucrat, government or otherwise. When I lived in Oxford, the NHS medical centre was literally across the road - the only thing ‘between me and my doctor’ was a street. In the US, however, the private bureaucracy of the insurance companies always stands between a patient and his or her physician.

Another example of my experience of the US healthcare system: soon after arrival in America, I went to the pharmacy for a prescribed nasal spray. When told it would cost me $40 (about £26), I asked whether they had remembered to deduct the portion paid by the insurance. They told me that yes, they had, and that the full price for the medicine was more like $400! Now, I know for a fact that this medicine sold for a market rate of about £8 in the UK, where it is obtainable over the counter. With a prescription, of course, it costs even less (and is free in Scotland or Wales).

As shown by Michael Moore’s movie Sicko, the US healthcare system regularly fails those who need it most. Over 47 million Americans (nearly 20% of the population) have no health insurance and, as Moore demonstrated, even those who are covered constantly find that their insurers fail to pay up. Whole armies of bureaucrats are employed by the insurance companies to investigate their clients to find loopholes that will allow them not to pay for their treatment. In 1993, when health care reform was proposed by the Clinton administration, the insurers paid out 95c for every $1 they collected in premiums; now, the figure is only 80c. Meanwhile, their profits have increased by over 400%.

Fortunately, Obama has a plan. To listen to the Republicans and the pundits on Fox News, you’d think he was going to bring in a fully-funded public health-care system, paid for by expropriating the bourgeoisie while strangling some particularly adorable puppies. In fact, Obama’s plans are incredibly moderate, consisting mainly of a public insurance scheme to compete with the private insurers, and making it compulsory for employers to offer health coverage to their workers. His administration has been very careful to reassure the health insurance industry that their profits will be left intact. A few weeks ago, Health Secretary Kathleen Sebelius was on the radio telling listeners that the government-sponsored public insurance scheme would not undercut the private insurers – to which my reaction as ‘why the hell not?’

The other plank of the healthcare scam is the pharmaceutical companies. My $400 nasal spray incident was made possible by the fact that the in insurers are essentially in cahoots with the drugs companies to maximize their profits. Pharmaceutical companies can charge what they like, knowing insurers will (grudgingly) pay up; insurers can charge what they like, knowing that the public have no other choice but to pay their premiums. Yet the Obama plan leaves the big pharmaceutical companies untouched. Recently, Harry and Louise, the adorable white middle-class couple who famously appeared in ads opposing Clinton’s health reform proposals (paid for, of course, by the health insurance industry), have been on our screens again. This time, however, they are supporting Obama’s plan. And who is paying for the ads? The lobby representing the drugs companies. You may think any healthcare reform that is backed by big pharma is not a reform worthy of the name – and you’d be right.

Still, Obama’s plan is a tiny step in the right direction. It ought to be very popular – polls show that 72% of Americans want some kind of public health insurance. Yet the barrage of lies and scare tactics against ‘socialized medicine’ seem to be having an effect, with some polls showing Obama losing popularity over the healthcare issue. The ‘Blue Dogs’ (right-wing Democrats who would not be out of place in David Cameron’s Tory Party) are getting cold feet, and Democrat senators are trying to cobble together a deal with the Republicans to remove even the tiny, weak public insurance scheme proposed by the president.

Ironically, public health care already exists in the USA. Medicare/Medicaid, which covers the poorest and the elderly, has been in place since the 1960s, and is incredibly popular. More to the point, members of Congress benefit from a health insurance scheme of the sort that they would deny the rest of us. The military also have publically-funded health insurance, and John Stewart on the Daily Show managed to get neo-con Bill Krystol to admit that (a) it is better than private health care and (b) that the rest of us don’t deserve the same.

If health care reform is scuppered again, as it was under Clinton, it will show where true power lies in US society. The Democrats have the presidency, both houses of Congress (including a supposedly unassailable 60-40 majority in the Senate), and the backing of 72% of the population. But the private health industry has the $500 million it paid last year on lobbying and campaign contributions to politicians. It will take a mass campaign from outside the halls of Congress to counter that, and make sure Democratic congressmen vote with their electors, not with the lobbyists.