It’s been a long year since President Obama and the Democrats began the process to reform our health care system and provide relief to the million of Americans, mostly working families, who didn’t have access to affordable health insurance. Last night, victory was finally achieved.
The process was brutal. Passing legislation is rarely an easy process. It’s usually messy, and with an initiative this big and controversial, it was bound to be a difficult process. But it was made even worse by the strategic decision by the GOP to do everything possible to kill the bill. Obama tried to strike a bipartisan deal, and the GOP happily strung him along while they whipped up opposition from the angry right and the Tea Party crazies. The process became the story, hurting the popularity of Obama and the Democrats.
Despite all these challenges, the Democrats were poised to pass health care when Scott Brown won a stunning win in Massachusetts. Most assumed that Obama would fold and that his presidency was permanently wounded. Pundits on the right and the left had a field day questioning Obama’s effectiveness and his toughness.
Yet Obama doubled down, and he had a tough ally in Nancy Pelosi. The right loves to hate her, and now they have another reason, as she pushed this through the House when most assumed she’d never pull it off.
There were many ups and downs in the process, but I think that Obama’s visit to the Republican House retreat will be remembered as one of the turning points. The GOP was feeling cocky after Brown’s victory, and they were believing their own talking points. Obama eviscerated one Republican congressman after another on live national television. It was like a professor schooling a bunch of obnoxious high school kids.
I think the White House realized that it was time to fight and take on the GOP. Obama was back on his game, and the overconfident GOP wasn’t up to the fight.
This is a huge victory for Obama, the Democrats and the country. Health care is the signature issue of this presidency, and failure here was not an option.
Well, congratulations to the President and the Democrats in Congress. They snatched an OT from the jaws of defeat. But healthcare in the United States isn’t reformed, not by a long shot. Take a look at the charts and graphs that accompany this story (http://news.bbc.co.uk/2/hi/americas/8580192.stm), and you will see were the U.S. healthcare systems must get to before we, Americans, can say that we have successfully reformed our system of healthcare.
We spend too much on healthcare and get too little for it. Graph 1 from the BBC story, supra, shows that the U.S. spends about 2.2 trillion dollars on healthcare. That comes to 16% of the U.S. GDP; $7,290.00 per capita; Compare that with our allies and competing economies: France at 11% of its GDP, $3,601 per capita; the UK at 8.4% of its GDP, $2,992 per capita; and Singapore at 3.4% of its GDP and $1,229 per capita.
Expenditures from the private sector are: Singapore at 67.4%; U.S. at 52.8%; France at 20.8%; and the UK at 12.9%. Don’t be fooled by the large percentage of private sector spending for healthcare in Singapore. Unlike the U.S.’s largely unregulated for-profit private health insurance companies, Singapore’s private health insurance companies are highly regulated, and their profit are so restricted by regulation that they are little more than quasi-governmental pass-through bureaucracies.
And what do we, as Americans, get for our lavish spending on healthcare through private, for-profit insurance companies. Well there are many measures of a population’s health, but on any of the consensus measurements, the U.S. is at or near the bottom. Here are two measurements, life expectancy and infant mortality. First, infant mortality per 1,000 live births: U.S. at 6.7; U.K. at 4.8; France at 3.8; and Singapore at 2.1. For life expectancy: France at 81 years; Singapore at 79.7 years; UK at 79.1 years; and the U.S. at 78.1 years. Other indices of health tell the same story: For the most expensive system of healthcare in the world, the U.S. gets the worst results.
The President’s original principles for reforming healthcare would have carried us much closer to getting us a system of healthcare on a par with our peer developed nations, particularly his proposal for a robust and genuine public option. And, as the President said himself, in his early days as candidate for public office, the single-payer type system is the best and what he would propose, if we were starting from scratch. Well, it is not the need to start from scratch that precludes single payer, for every healthcare systems, which I am aware of (Canada, UK, France, and Germany with pass-through private insurers), started as a private, for-profit system. What made the President think that a public option was the best that he could get was the politics.
Well, the politics left us with what the U.S. House did last night. It is far cry from single-payer or even from what the President originally proposed. The private, for-profit health insurance lobby and other interested industries defeated the President’s much better initial proposals, and left of with the instant half measure, which, though it is an improvement, is still inadequate to put us on a par with our peer developed nations. To get the rest of the way to necessary reform of our system of healthcare, the President and the Democrats will have to continue the push for the necessary reform of healthcare as soon as the moment permits and wisdom recommends.
Oh, yes, I forgot to mention in my comment, supra, that with the initial and inadequate first step towards necessary reform, the burden of healthcare still falls heavily on American businesses, so that they are not competitive with their competitors in countries that have either entirely remove healthcare from business’s balance sheet or at least dramatically reduced the costs of such insurance by going with quasi-single payer systems, which collect insurance premiums through what are essentially not-for-profit, highly regulated private insurance companies. One great disappointments of what it appears that Congress will produce is that healthcare still uniquely burdens American business with a burden that is at least 2X to even France.
Can we, as Americans, be proud of that? Is that the best that we can do? If so, I guess we must conclude that our developed peers are either smarter than we are or have better character or both.
Orlando – those are all valid criticisms.
The fact remains, however, that we don’t have the political will to go that far at this time. I think the bill is a good start. Now that the concept of universal coverage has been introduced and the nation becomes accustomed to it, then we can continue the debate on how to best deliver it.
For years we’ve been stuck on this first step. We had to break through, and that’s why I think this is such a big victory.
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