Today is the big vote on US Health Care, a moment that has been described as “historic” by President Barack Obama. The Democrats are now confident they have the necessary support to introduce health reforms. Congressman John Larson, chairman of the House Democratic caucus, claimed the party had the 216 votes needed to pass the bill. The debate has raged for more than a year and it has frequently looked as if the bill might collapse. It has taken extensive lobbying by the Democratic leadership and an impassioned plea to Democratic members of Congress by Obama, to allay the fears of some in the party who were reluctant to support the bill, either because of the costs involved, estimated at $940bn (£626bn), or because they objected to possible public funding of abortions.
Health reform had been the centrepiece of Obama’s domestic policy on the campaign trail. The debate has been hugely divisive and embittered right across America, as I witnessed myself after writing a letter about the subject to the Florida Times-Union newspaper in September. All 178 Republicans have promised to vote against the reform in the House, where the Democrats have an overwhelming majority. Passage by the House should ensure the bill will become law. It must return to the Senate this week but the Democrats only require a majority of 51, and have 59 votes in the 100-member chamber.
The bill aims to expand health care to a further 32 million Americans, giving the country 95% health coverage. It would require most Americans to carry insurance, with subsidies for those who can’t afford it, expand the government-run Medicaid programme for the poor, and create new marketplaces where small businesses and self-employed people can pool together to buy cheaper health care. However an amendment to allow a public or single-payer option was not included despite being passed in an earlier debate.
Most newscasters and commentators have focused on the opposition to the bill in terms of the views of the Republican Party or anti-establishment Tea Party movement that share fears of the hand of “Big Government” making unwelcome intrusions into the private lives of individuals and leaving a massive debt which must be paid off by future generations by tax increases. A conversation with a cashier at a local supermarket in Jacksonville Beach two days ago echoed this view. While chatting at the check-out she revealed she was unhappy with the health vote that was about to take place because it would make the US system more like the UK or Canada, and she told me ” I don’t want my grandmother being refused treatment because it cost too much”. I expressed my view that having experienced both American health care and the NHS, the British system was better. She disagreed. However I would have been more accurate to say that the Obama reforms would not create a system which matched the NHS.
Indeed there is a whole side of the argument that seems to have been ignored or at least been given little coverage. There are critics of the reforms that believe the proposed bill does not go far enough. Organisations like the Physicians for a National Health Program, Health Care Now!, and the Green Party of America , all favour a single payer or public option that would be more in line with the British NHS. While making health care available to many more Americans, Obama’s reforms have been drafted with considerable help from the insurance industry, will not make health care universal, and will not introduce a “not-for-profit” system. Nor will the reforms remove the obligation to employers to provide health care, an additional cost that could affect competitiveness with firms from countries that have universal health systems.
The status quo is unacceptable. Millions of uninsured and under insured Americans is a disgraceful state of affairs. Obama’s reforms attempt to address that situation and is maybe the best that can be expected given the nature of America’s political system and the millions spent by lobbyists on adverts attempting to preserve the current health system. However as “historic” as the vote may prove to be, it feels like a missed opportunity, and does not deliver what is really needed to improve the health care of ordinary working class Americans. I cannot help but feel disappointed. Change we can believe in? Not yet.
[Based on a report by The Observer]
