Entangled Alliances

photo credit: the_repairman

What connects U.S. Senator Ted Kennedy, renowned physicist Stephen Hawking and your Grandma? The answer, if you’re a right-wing American, is that all three would be left to die if the NHS – Britain’s world famous universal health service – had its way.  Yes, that’s right, welcome to the madness that is the current debate in the US over health-care reform: a bizarre dumping ground for crazy that has now – thanks to self-serving Republican politicians and the loonier fringes of the right – set its cross-hairs on Britain’s health care.

Thus Kennedy, who is battling a brain tumour, was cited by Republican Senator Chuck Grassley last week as someone who would be denied treatment for his tumour if he had the rotten luck to find himself in England. Grassley is one of the leading Republican players in negotiating a health-care bill. Needless to say, his claim is a lie.  Then there’s the claims that the NHS has “death panels” that refuse costly treatment for old people, thus sentencing them to a premature death. Another lie.

And Stephen Hawking? According to a now legendary editorial by the Investor’s Business Daily, people such as Hawking  “wouldn’t have a chance in the U.K, where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless.” Unfortunately for the editors of this fine publication Hawking is, obviously, British and has lived in Britain, under the Nazi-like grip of the NHS, his whole life.  Oops. “I wouldn’t be alive were it not for the NHS” was his rather definitive response.

Naturally, these kind of accusations tend to focus the debate on the relative merits of the NHS . Defenders of British health-care can point to the incredible, mind-boggling cheapness of the system compared to America: according to OECD figures, in 2007 Britain spent a staggering $4000 dollars less on health-care per person than the U.S. And yes, there is rationing in the British model (a logical inevitability in a universal, free system) but the common sense, cost-effective decisions of NICE – the body that gives advice on the effectiveness of treatments – are much preferable to America’s idea of rationing which is, you know, leaving 45 million people without any form of health care. And considering how incredibly cheap it is, Britain’s health-care is not that far behind America in terms of patient outcomes and even ahead of it in many areas.  Moreover, despite its lower levels of health spending, Britain still manages to be second only to the US in terms of pharmaceutical innovation, which rather puts a sword to the lie that government health-care stagnates medical progress.

But all this is in danger of overlooking what is surely the most startling element of America’s health-care debate, which is that so much is being made of the merits of the NHS despite the complete absence of anything at all like it in any of the health-care reform proposals. This is a really crucial point, so I’ll say it again: Nothing remotely like the NHS is being considered, in even the smallest measure, in any of the health-care bills currently on the table.  The current debate, then, is like attempting to reform the rules of cricket and getting mired in a row over the merits of baseball. It’s just not relevant.

To understand quite how far off-kilter right-wing American critics are when they drag the NHS into the debate, we need to go back to (health-care) basics. The British system is an example of socialised medicine, where the government doesn’t just pay for your health-care but also owns everything involved with it – the doctors, the hospitals, the equipment. Nothing like this is in on the table in America. Nothing remotely like this is on the table. Indeed, the most liberal alternative present in the debate is a “single payer” system, in which a single body – i.e. the government – pays for everyone’s health-care. Just pays for it. Doesn’t own it. America already has a single-payer model for all those over 65; if you get to that ripe old age without your morbid obesity seeing you off, then the U.S. government covers your health-care from there on in. It’s called Medicare and is an immensely popular and by all accounts politically untouchable programme. Yet bizarrely even a single-payer system, which is the closest America is ever likely to come to the NHS,  is so far off the table it never got into the room in the first place, considered too radical to ever get the votes in Congress.

So what do the current plans envisage? They all share the same  general features, which is to say that the dominant system of health-care payment in America – private insurance – is getting a bit of a regulatory smack-down to ensure that American insurers no longer do  the disgusting things that everyone loves them for, such as refusing to cover people if they’re too sick or revoking your insurance once you get too sick . Other than that, if you’re covered through your employer – which the vast majority of insured Americans are – then you’ll see no change. None. If you have individual insurance or no insurance at all, then you’ll be able to choose between private insurers in a consumer friendly  “health-care exchange” , with generous government subsidies for those who can’t afford insurance. Note, in all of this, the emphasis on private insurers  – the vast majority of the bills’ provisions are centred on the private, not the public, sector.

The only real expansion of government contained in any of the bills is the presence of a controversial “public option” – government insurance that is meant to compete with the private insurers and thus keep their costs down. Liberals have set their store on the public option, partly because it’s seen as a stealth mechanism to introduce single payer – the idea being that faced with the government’s power to offer lower cost quality insurance, the private insurers will be put out of business  and suddenly America becomes Canada (but still not Britain). However, the public option will only  be available in the health exchange – which those insured by their employer (the vast majority) won’t have access to -  and according to the Congressional Budget Office, by 2019 only 27 million will have the choice of going for the public option, and only 13.5 million are likely to actually go for it . Out of a population of 300 million . Hardly a government takeover, is it?

So, to cut a long (and very wonkish) story short,  a mainly private sector overhaul of the health service – with the only sign of government intervention being a public insurance option open to a small minority  of Americans – is being treated as similar to a system where the government owns everything. The last time a public debate was so skewed from reality was, uh, well the last time Democrats tried to reform health-care, really.

This is all well and good I hear you cry, but apart from proving that the American right just makes stuff up, what’s the point to all this? Simply put, the point is this. It’s very clear that conservatives are, for the most part, forming their opposition to health-care reform based not on the actual content of the bills on the table but on a fictional narrative built to be scary, effective and loosely designed around a single messages: THE GOVERNMENT IS COMING FOR YOUR HEALTHCARE… RUN!!!!

Some Democrats have decided that the best response to this is to make big, up front concessions- like getting rid of the public option – in a bizarre attempt to placate the people who are basing their criticisms not on the bill at hand but on some mythical socialist tract. But this is stupid. Clearly, the real lesson Democrats should take from is that since  Republican opposition is based on a mythical bill, there’s no point in watering down the current bills in order to curry their favour. In other words,  Democrats are in a perfect position to hold their hands up and say: “these guys can’t be compromised with. They’re off in their own world, so we’re just going to go ahead and bring a final bill to a vote”. At which point healthcare-reform will surely be on the verge of becoming reality, since with a healthy majority in the House and a filibuster-proof 60 Democrats in the Senate, it would take a Senator from Obama’s own party to jeopardise the bill. Which, given that this would make them a pariah in Democratic circles, simply isn’t going to happen.

Is passing health-care reform really that easy? Well, no. Nothing is ever that simple in Washington. Democrats may still find some way to screw it up.  Given that an average family’s annual insurance premiums have almost trebled since 1996 to $17,000 and are set to rise to an unimaginably catastrophic $45,000 by 2040, this would be a very sad state of affairs. At which point Republicans may want to reflect that, thanks to their predictions of English-style health-care dooming the US, it turned out that the American economy was humbled instead by the status quo, private sector version.

Oh, the irony.