How Are You, Mr. Obama?

It’s not easy when you’re in the United States to get the Americans interested in Canada.

The majority of Americans that I have met in my life picture our country as a large bank of flat snow, a sort of Weston bread slice with no butter and jam on it. A country with no history and no story, which is just similar enough to theirs not to be appealing to them.

As far as I know, there’s just one subject that is able to light up their faces: our universal health insurance program (and ladies, let’s not forget the parental leave and the $7 day care centers).

Gosh, how chatty we are!

Take out your carte-soleil [a card that gives Canadians from Québec free access to medical care] in a living-room in Chicago’s South side or North Beach in San Francisco, the Upper West Side in New York or East L.A. and you’ll get the chance to become the center of attention for a little while!

“Wow! So you show this and you have NOTHING to pay? Nothing, really?”

Let’s take an example. One night in mid-January, I’m staying at a black family’s home in the Englewood ghetto, in the South of Chicago, to talk about Obama. The shed is quite poor but well closed, as Victor Hugo would have said [Hugo was a French poet/writer (1802-1885). His work is considered rather romantic and revolutionary]. On the wall, the crooked pictures with broken frames show pride. On the battered armchairs, some pieces of leatherette try to hide the wear that has been caused by all the people that have entered this room, year after year, to discuss reform, injustices, and change.

We’re starting to speak about the convenient needs of the black community, especially anything that is medical care related. I’m asking the people if they want to take a look at my carte-soleil and I’m taking it out of my bag.

They’re staring wide-eyed at it, and their cries are admirative.

“Wait a minute. This is unique!” Wanda, the host, says. As she couldn’t believe her eyes, she went to get a camera and film me while I was explaining how it works in Canada when you go to the doctor’s, with your card and no money…

The following day, I’m sitting at the bar of a downtown cool restaurant, and I’m taking out my card to show it to the two ladies sitting next to me: a nurse and a lawyer. And here I go again – more success. “Amazing!”

Ron, the senior editor of Bronzeville’s community newspaper, the Chicago Harlem, expressed the most revealing commentary as he was examining my little piece of plastic.

“I didn’t even know that could be possible,” he said.

One of Barack Obama’s major promises during his electoral campaign was to introduce some measure that would guarantee everybody access to medical care. At present, the United States can’t cure everybody.

Some programs do cover the costs for elderly people, recipients of state aid or government employees. Nonetheless, many Americans are covered by private insurance they get from their work since these companies are, on a fiscal level, encouraged to offer health insurance. Losing one’s job often means losing health insurance.

This doesn’t mean that the U.S. allocates only a small amount of money for health care. In 2006, according to the figures that were published by the Organization for Economic Co-operation and Development, the U.S. allocated 15.6 percent of its gross domestic product for health care. At the same time, Canada allocated 10 percent of its GDP for health care, one percent higher than the average of the countries being included in the OECD. Half of the money spent on healthcare in the U.S. was paid for by the government.

Why is the bill so expensive in a country where millions of people have limited access to health care, a country where the media regularly report horror stories about someone whose life was in danger because they couldn’t afford to visit a doctor?

Yes, indeed, the American medical system is very expensive.

Obama has been in the White House for almost two weeks and hasn’t said the slightest word about health care reform yet. This annoys some commentators. “Health Care now!” said Paul Krugman, the recipient of the Nobel Prize in economics, in a column for the New York Times. Last week, the surgeon and journalist Atul Gawande, former adviser for Bill Clinton, recommended in the New Yorker that the reform could take place.

According to Krugman, the present situation of crisis – a mix of job losses and very high prices in the health care field – could be the beginning of an improvement, just like the Great Depression helped Franklin Roosevelt set up the New Deal.

Not everyone is that optimistic.

“Polls show that there is among the American population a true desire for a change,” Antonia Maioni, a political scientist at McGill University and an expert in such questions, told me on Friday. The Depression didn’t make it possible for a health insurance measure to get approved though. The Clintons also failed, even if, when the election took place, there was a strong political impetus for this. Maioni also admits that the conditions for healthcare reform are present. But is that really enough?

The political game that controls such a reform is very complex. The participants in place are numerous and mighty. There are the insurance companies, doctors, hospitals, the States, the Congress, the federal administration, patients, consumers, lawyers, pharmaceuticals and HMOs, these hybrid companies that both have the function of insurance and health services. There is this instant reaction from many Americans to governmental interference and those awful stories telling about patients who have to postpone their cancer treatments because they have lost their jobs.

And there are Ron, Wanda and their neighbors who find us Canadians very lucky to have our little brown plastic cards.