Obama’s health reforms stir the hornets nest

US President Barack Obama has developed a program for health reform, which aims to deliver affordable, accessible and quality health care for all Americans. His plans have provoked a vicious backlash from an alliance of Republicans, evangelical Christian pastors, insurance companies and right-wing media commentators.

The United States has had an outbreak of fevered political activity in recent months: riotous public hall meetings, accusations of fascist government policy and airwaves swamped by political advertising.

The issue that has provoked this radicalism isn’t American intervention in a war or a coup. The polarising issue has been health reform.

Barack Obama campaigned strongly on health reform, including a publicly-funded insurance option, during his bid for the Presidency and has come up with a program for change that would be seen as modest in other Western countries.

In one swoop, his plan would address the problems of cost, access and quality. Obama aims to extend health coverage to 45 million Americans currently without any health coverage. His last budget allowed for an extra $634 billion over 10 years to finance this extension. He also wants to create a government-run insurance plan, which he says ‘will keep insurance companies honest’.

An irrational backlash

A potent alliance of Republicans, evangelical Christian pastors, insurance companies and right-wing media commentators have fuelled a vicious backlash to the Obama plan.

Rush Limbaugh, an Alan Jones-like talkback radio host, said Obama’s proposal for universal healthcare reminded him of the Nazis. Another talkback giant Glenn Beck originally thought the plan smacked of socialism but then he changed his mind. It was now leading the US towards fascism, he said.

Influential conservative media outlets and bloggers have peddled the lie that Obama’s plan includes the creation of ‘death panels’: governmental bodies that would cut off care for the critically ill as a cost-cutting measure. These inflammatory views have been given credence by Republican politicians such as Sarah Palin, who have, bizarrely, portrayed health reform as pro-abortion and pro-euthanasia.

Town hall meetings organised to debate the reforms have been swamped and disrupted by Republican party activists comparing the Obama administration with the Third Reich and wearing t-shirts saying ‘Hitler made great speeches too’. Meanwhile, private insurance companies have been spending enormous sums on TV advertising, attacking any publicly-financed health insurance option.

A moment of opportunity

For almost a century, Democratic presidents have tried and failed to provide universal health care to Americans. The last attempt – by Bill Clinton – was buried under a similar onslaught of organised resistance by the health insurance industry and other beneficiaries of the status quo.

What is different this time, despite the frenzied resistance, is the broader coalition of support for reform, including some unlikely allies. One of the most significant changes between Clinton’s attempt at reform and Obama’s is that employers and business groups are now among the strongest supporters of reform. The American Medical Association has also historically been opposed to reform but it is supporting Obama’s plan.

The United States’ predominantly employment-based health coverage has become a major business burden in the midst of a full-blown economic crisis with health costs continuing to spiral out of control. US health care is the most expensive in the world and the cost of health care continues to soar. In 2008, 16% of GDP was spent on health care (compared to 9% in Australia). Yet an estimated 46 million people are still without coverage.

American nurses stand up to be counted

American nurses have been prominent in the pro-reform lobby. Rose Ann DeMoro, Executive Director of the California Nurses’ Association, outlined the nurses’ position on PBS television.

‘Every registered nurse in this country advocates for her patient at the bedside,’ she said. ‘She’s the last line of defence for the patients. She fights for the patients against hospital corporations, often putting her own job in jeopardy. And you can’t fight for your patient without changing the social structure in which that care is delivered. So, registered nurses, organised by us, have become a pretty dramatic force in this country to change the healthcare system.

‘If you look at health care in America, there is no health care system. There’s a health care industry. The major objective is profit making. Which means not providing the patient all of the care they need, discharging patients early, patients without insurance being treated differently than wealthy people, frankly. And that is the healthcare system in America. Those who can afford it get to live and those who can’t suffer needlessly.’

The United States’ motley health system

  • Most Americans (59.3%) receive their health insurance coverage through an employer.
  • Less than 9% of the population purchases individual health care insurance.
  • Government programs directly cover 27.8% of the population (83 million).
  • In 2007, 45.7 million people in the US (15.3% of the population) were without health insurance.

The privatised US health system is spiralling out of control

  • US health expenditure grew 6.1% to $2.2 trillion in 2007, or $7,421 per person, and accounted for 16.2% of Gross Domestic Product.
  • The health share of GDP is projected to reach 20.3% by 2018 – a poor performer among the developed countries.

More is spent on health care in the United States on a per capita basis than in any other nation in the world yet:

  • among OECD nations, the United States ranked third last for the health care of women (after Mexico and Hungary) and fifth last for men;
  • The World Health Organisation ranked the US health care system 37th in overall performance and 72nd by overall level of health (among 191 member nations included in the study);
  • a 2008 report by the Commonwealth fund ranked the United States last in the quality of health care among the 19 compared countries;
  • the US has a higher infant mortality rate than all other developed countries.