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.

photo credit: tsevis

Obama’s first State of the Union address was pretty accomplished. And I don’t say that to damn him with faint praise. I could go on about how it was an uplifting speech – and it was. I could go on about how steadfast Obama seemed in the face of economic crisis. And he did. And I could definitely go on about how deftly he mixed the substantive with the personal- the story about the guy who gave his bonus out to his employees was a nice touch, and if you didn’t get a lump in your throat at the mention of that young girl’s remarkable letter then you probably have a model number stamped somewhere on you. But, more than anything, it accomplished what Obama set out to do: that is, lay the groundwork for what is set to be the biggest program of reforms since the Great Society – or maybe even the New Deal. Not only did he put the finishing touches on his case for the recently passed economic stimulus, but he tackled all the big legislative issues ahead of him: the budget; the bank, housing market and auto bailouts; climate change; healthcare reform; education. In doing so he not only framed the debate to come, but deftly rebuffed the objections of the cynics before they’ve even had time to get going.  So yeah, I could go on about how it was was uplifting and stirring. And it really was. But what this speech showed more than anything else is that Obama isn’t going to let anything get in the way of the huge, unprecedented reforms that are coming to America this year – he’s going to control the debate and not repeat the mistakes of the stimulus battle.

Here, then, are what I think were the top 10 key quotes from Obama’s State of the Union. These weren’t necessarily the most memorable or stirring of lines – for that, we have the endless analysis of cable tv – but the lines that I felt were most important, at least in terms of the battles to come. (You can read the transcript of the speech here)

So let there be no doubt: Health care reform cannot wait, it must not wait, and it will not wait another year.

Brilliant. This was definitely the most newsworthy line of the night. There was some concern that with everything on Obama’s plate economy-wise, he wasn’t going to get round to healthcare reform this year. Which would have meant that, given the 2010 midterms and then Obama’s re-election, healthcare would have been delayed till his second term – when his political capital may not be as voluminous as it is now. But with this simple line, Obama announced to America that he’s deadly serious about reform and he’s not going to let it fall by the wayside. The ball is now very much rolling on what will hopefully be the most significant, life-changing domestic bill ever to pass through Congress. 2009 is the year of healthcare… that he made very clear.

History reminds us that, at every moment of economic upheaval and transformation, this nation has responded with bold action and big ideas…

In the midst of civil war, we laid railroad tracks from one coast to another that spurred commerce and industry.

This was very significant. A key concern articulated by many liberals recently – most prominently, perhaps, by Paul Krugman – is that Obama may not be taking advantage of this golden opportunity to let the government pull of the kind of reforms that in normal, non-emergency times would seem impossible to get away with. With these lines, however, Obama showed that he gets it – he understands that this is a once-in-a-century chance to pull of a monumental liberal agenda the likes of which, in theory, will make the Great Society look positively conservative.

And for that same reason, we must also address the crushing cost of health care.

This is a cost that now causes a bankruptcy in America every 30 seconds. By the end of the year, it could cause 1.5 million Americans to lose their homes. In the last eight years, premiums have grown four times faster than wages. And in each of these years, 1 million more Americans have lost their health insurance.

Obama’s emphasis of the excessive cost of the current healthcare system over, say, his desire for universal coverage was very significant in terms of framing the debate to come. It’s a very clear indication of his strategy for healthcare reform: to all the opponents – and there will be many opponents – who will criticise its cost, Obama will respond with the definitive answer: that we literally can’t afford to not pass whatever plan he comes up with.

And there is, of course, another responsibility we have to our children, and that’s the responsibility to ensure that we do not pass on to them a debt they cannot pay. That is critical.

Talk about ambitious: not only did Obama propose a massive agenda of reform but he also promised to halve the deficit by the end of his first term. Critics will no doubt say he’s trying to have his cake and eat it. But they’re wrong – as Obama then went on to say, it’s actually possible to do both at the same time thanks to the savings that will be made by allowing the Bush tax cuts to expire and pulling troops out of Iraq.

We’ll eliminate the no-bid contracts that have wasted billions in Iraq and — and reform our defense budget so that we’re not paying for Cold War-era weapons systems we don’t use.

This was nice. Such actions will help in Obama’s reduction of the budget deficit, but on a more basic level it’s just nice to see an American president who doesn’t treat war as a chance to fund old school weaponry and let defense contractors run riot.

Now, let me be clear. Let me be absolutely clear, because I know you’ll end up hearing some of the same claims that rolling back these tax breaks means a massive tax increase on the American people. If your family earns less than $250,000 a year, a quarter-million dollars a year, you will not see your taxes increased a single dime. I repeat: not one single dime.

Get ready to hear this a lot. Republicans will try to paint this as a tax on the middle class, but if the administration keeps up this refrain 24/7 then saying goodbye to Bush’s tax cuts should prove one of the less difficult tasks ahead.

And that is why I can stand here tonight and say without exception or equivocation that the United States of America does not torture. We can make that commitment here tonight.

We’ve already heard him say this over and over again, but to hear it loud and clear in the State of the Union was just… so refreshing. However I take this not so much as a declaration but as a challenge to keep him to his word. Check again in eight years, then we’ll see if he’s really earned some praise.

Now, to preserve our long-term fiscal health, we must also address the growing cost in Medicare and Social Security. Comprehensive health care reform is the best way to strengthen Medicare for years to come, and we must also begin a conversation on how to do the same for Social Security, while creating tax-free universal savings accounts for all Americans.

This was both good and bad. On the one hand it was nice to see the old “entitlement crisis” myth converted into an argument for comprehensive healthcare reform – in other words Obama is saying to Republicans that if you’re really  worried entitlements like medicare, then make sure you’re on the right side of the upcoming healthcare battle. It’s nice to see the old entitlement canard twisted on its head like that. On the other hand, WTF (and the W stands for why) did he feel compelled to throw in the appeasement line about social security?

This time — this time, CEOs won’t be able to use taxpayer money to pad their paychecks, or buy fancy drapes, or disappear on a private jet. Those days are over. Still, this plan will require significant resources from the federal government and, yes, probably more than we’ve already set aside. But while the cost of action will be great, I can assure you that the cost of inaction will be far greater, for it could result in an economy that sputters along for not months or years, but perhaps a decade.

The news deftly hidden in these lines is that Obama is admitting that he will have to return to congress for some more bailout money. But, as is made clear from the the line that precedes this admission and the line that follows it, he has a clear strategy for doing this: on the one hand emphasise that they’re getting tough on the fat cats while at the same time outlining – in no uncertain terms – that no matter how much people don’t like it, if the banks aren’t helped out in some way than America will be looking at a loooong recession. The reference to “perhaps a decade” was a none too subtle way of saying: look guys, we don’t want to end up like Japan, do we?

So I ask this Congress to send me legislation that places a market-based cap on carbon pollution and drives the production of more renewable energy in America. That’s what we need.

Environmentalists take heart. There was no mention of when this would happen – unlike healthcare reform, he didn’t commit to this year – but you would have to imagine they’ll be trying to get this done sooner rather than later. I should add though that cap-and-trade is a much inferior solution to direct carbon regulation, and may not even work, but I guess this still counts as significant progress – a President promising to help the environment in his address as opposed to openly promising to damage it.

In summary, 2009 is going to be – as Steve Doocy of Fox news might say – huuuge!