Within the Caribbean, we often tend to think that our politicians are uniquely ignorant and venal, and that in places like the United States, public life is pursued with a proper respect for facts and reasonable arguments. Yet most of the time this is simply not true. President Obama’s almost quixotically polite efforts to achieve America’s long-overdue health reforms, and the sound and fury they continue to provoke, are a timely reminder of how rare it is that politicians ever overcome the societal divisions they are meant to transcend.
In its determined push for comprehensive health reform in the United States, the Obama administration is attempting to outdo the Clintons – who also acted early in a popular presidency, and with majorities in both houses – on one of the most important and divisive issues in modern American politics. Should it succeed, it would undoubtedly become Obama’s most significant victory to date. The defeat of ‘Hillarycare’ – due largely to White House intransigence and fear mongering by the insurance industry – still rankles the American left sixteen years after the fact. But while it is clear to anyone who has ever lived in America that the existing health care is inadequate, over-priced and immorally exclusive, no two politicians seem able to agree on how best to fix it. Consequently the policy proposals which are currently being considered are wide-ranging and complex, filled with Byzantine compromises and fine print that means little or nothing to the layman. What makes the new contest fascinating to outsiders who stand to gain nothing from the reforms is the way in which the new President is attempting to hold the high ground while his political opponents resort to the old scare tactics.
If Obama prevails the US federal government could put up to a trillion dollars of funding towards reforming the US health system. While this figure still leaves a lot of room for Congressional horse-trading, it is obviously too large to get past Congress without a real fight. Those with a vested interest in the current, profoundly inefficient system are rightfully concerned that an overhaul in health insurance will harm their bottom line. In June, the Los Angeles Times reported that three insurance companies who had just given Congressional testimony on the controversial practice of ‘rescission’ – the retroactive denial of claims, usually on the basis that the policy holder has not fully disclosed their medical history – had, in the previous five years, “canceled the coverage of more than 20,000 people, allowing the companies to avoid paying more than $300 million in medical claims.” Those affected included patients with “breast cancer, lymphoma and more than 1,000 other conditions.” Collectively, the hundreds of other health care companies who profit from evasions like this stand to lose hundreds of billions of dollars if the government introduces proper oversight.
The administration has set about preparing the way for health reform very shrewdly. Learning from the earlier mistakes, it has invited the insurance industry to participate in discussions as to how the system might be reformed. It has made provisions for anyone who is satisfied with their current health insurance to be allowed to keep it, and it has tried at every turn to make reasonable compromises with political opponents. Anticipating bitter partisanship, it has even managed to persuade Congress to adopt ‘reconciliation rules’ which could allow the Senate to pass new health care legislation with a simple majority, instead of a filibuster-proof 60 votes, by mid-October if the Congress fails to act by then. As he did with his earlier financial rescue packages, Obama has repeatedly sought bi-partisan support for his reforms and patiently explained and re-explained the most contentious issues. This willingness to court political adversaries could not be more at odds with the previous administration’s style – Dick Cheney’s forthcoming memoirs reportedly take President George W. Bush to task for being too accommodating to his critics during his second term. Yet none of these concessions seems to have made any difference.
The President’s opponents have fought back asymmetrically, with their usual vitriol. Instead of arguing with the facts, they have encouraged rumours that the new plan will encourage euthanasia, and recast it as another attempt for the ‘far left’ administration to extend government bureaucracy into the sacrosanct domain of the free market. The new proposals are “downright evil,” said former Alaska governor Sarah Palin, whose notorious ineptitude as John McCain’s running mate during the last election campaign has done nothing to harm her popularity with the Republican base. Wilfully misconstruing proposals to create panels that would assess the efficiency of various treatments, Palin posted a Facebook message which read: “The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s ‘death panel’ so his bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society,’ whether they are worthy of health care.”
That soundbite, despite its provenance, has pushed the whole debate into a much more familiar direction. Instead of debating policy, the American media has largely returned to the easier task of reporting wild exaggerations and then, occasionally, refuting them. What ought to have been a careful, detailed discussion of reforms that will affect the lives of tens of millions of uninsured Americans, and arguably make the American economy significantly more competitive, has begun to degenerate into simplistic assertions about “socialist medicine” and conspiracy theories about the imaginary harms that government regulation will bring.
Obama may yet out-manoeuvre his opponents and broker another of his habitual compromises. He is not without support – Bill Clinton has recently entered the fray and encouraged the Netroots community to get behind the President’s proposals – but he will inevitably be forced to yield significant ground to some of the most intemperate and unreasonable voices in American political life in order to do so. His willingness to keep paying this price in order to deliver the main elements of the platform he ran on is a measure of the difficulties that he now faces.
The economy still shows no signs of recovering soon – July set another record for home foreclosures – and the situation in Iraq and Afghanistan is poised very uncertainly. If health care reform fails to pass, and there is a backlash in next year’s mid-term elections Obama could well find himself reliving the worst of the Clinton years, with the additional burdens of a stagnant economy and two intractable wars. Failure, in other words, is not an option.
