So many presidents have been frustrated in their attempts to introduce universal healthcare that when Barack Obama declared it would be the signature legislative achievement of his first year in office, it was tempting to accuse him of hubris. But after a tough week of negotiations in the Senate and the House Of Representatives, the most significant change in social policy for decades is finally within reach.
Two versions of the bill have been drawn up. Both contain a public option, run by the government, as one of the choices available. Neither has any Republican support. A third version drawn up by the Senate Finance Committee, due this week, is more likely to make concessions to conservatives.
Flanked by nurses for a photo op on the White House lawn, Obama gave the two draft bills a typically cautious welcome. “This progress should make us hopeful – but it shouldn’t make us complacent,” he said. He wants the act to be passed before Congress breaks up for August and knows there is more wrangling to come. On Friday, a group of moderate Senators, from both parties, wrote an open letter urging patience and warning that “there is much heavy lifting ahead”.
The phrase “socialized medicine” was coined by the American Medical Association in 1945, to derail Harry Truman’s welfare programme. It is no longer the bogeyman it used to be. In a recent New York Times/CBS poll 85% of respondents said that the USA’s healthcare system needs to be fundamentally changed or completely rebuilt. 72% backed a public insurance plan.
When the Clintons tried to introduce universal healthcare in 1993, the Health Insurance Association of America ran adverts featuring a white, suburban couple called Harry and Louise, worrying that government bureaucrats would deny them treatment. This time around, commercials feature a bright yellow bulldozer rumbling towards the camera, as an apocalyptic voiceover warns that “a government-run plan could crush all other choices.”
So far this year, insurers, hospitals and drug companies have spent $1.4 million a day on lobbyists. A Washington Post investigation found that 350 former government employees or members of Congress have been hired to influence the debate. This is nothing new, of course. The medical lobby has been adept at framing the discussion, despite damning statistical evidence that the profit motive has corroded America’s health system. According to the latest available data, the USA spends an average of $6,402 per person on healthcare each year. That’s around twice as much as Britain, France, Germany or Japan, yet by the most basic criteria, such as life expectancy or infant mortality, it gets the worst results of any developed nation.
This doesn’t stop Fox News relating National Health Service horror stories or tracking down disgruntled Canadians, upset at the level of care they receive for their tax dollars. A Wall Street Editorial predicted that “the real victims of government health care will be American patients.” To conservatives, the public plan is merely a precursor to a complete takeover of the system.
Rick Scott, a leading figure the last time healthcare legislation was blocked by Congress, has re-emerged to fight the bill, arguing that “we’ll be stuck with a government-run health plan that rations care, forces us onto unacceptable waiting lists and denies us lifesaving drugs we desperately need.” In 2001, his chain of hospitals was forced to pay back almost $1 billion for systematically overcharging the government’s Medicare welfare programme, which covers elderly and disabled people.
Rising healthcare costs pose a severe threat to Medicare and Medicaid, available to people living below the poverty line. Private insurance premiums have doubled in a decade, rising four times as fast as wages. The crippling medical bills run up by its unionised workforce were one of the key reasons General Motors went into bankruptcy. But on his radio show, Republican Rush Limbaugh is still telling listeners “there is no crisis… the crisis in healthcare here has been manufactured.”
Obama is expending a great deal of energy selling the proposal, at town hall meetings and through his campaign group Organising For America, which is running television commercials aimed at wavering Democrats. A poll commissioned by the think tank Third Way shows there is work to be done. When asked “who do you think will benefit most from reform?” 60% of the survey chose “other people, but not me.”
The final bill will contain subsidies to enable poor families to buy insurance. It will expand Medicaid, invest in primary care and regulate insurers, to end the practice of denying coverage to people with pre-existing conditions. It won’t be cheap. The House Of Representatives version has enraged conservatives, because the estimated cost is $1 trillion and a punitive surtax would be introduced on the richest 1% of Americans to pay for it.
It is far from a done deal. Max Baucus, who chairs the Senate Finance Committee, is a declared opponent of single-payer health systems, not to mention the beneficiary of $3 million in campaign contributions from the medical industry in the last six years. He has suggested that a bi-partisan solution can be reached, possibly by replacing the public option with regional healthcare co-ops, or including a ‘trigger’ for the government plan that is only activated if the industry fails to achieve agreed savings in a few years time.
Liberals argue that without a public option, reform will be toothless. On Thursday, the AMA President, James Rohack, released a statement in support of the House bill, saying “the status quo is unacceptable.” Doctors have historically been reluctant to support universal healthcare, partly because the government pays less than private insurance, so it is a major coup to have them on side.
Negotiations will begin again tomorrow, as centrist Democrats concerned about the price tag seek to settle on a compromise version that can get the 60 votes it needs to beat a Republican filibuster. Congress has killed universal healthcare before. Obama must hope that this time will be different.