Obama’s Health Plan: Big Debate, Small Reform

Soviet, communist, socialist – The insults are ringing out against Barack Obama’s health plan. Yet, according to Remi Aufrere, this reform is hardly revolutionary. The American president is steering things toward compromise, including controls on health expenses rather than universal health coverage.

In the U.S., though, that’s nothing to balk at. The debates on health coverage reform show how consequential individual freedom of choice can be for public health.

The reform of universal health insurance in the U.S. is a particularly difficult issue. There has never been so much pressure to put the project into practice. Rather, it has only been important on an economic and ethnic level. Recall that nearly 50 million Americans have no health coverage and that this situation penalizes the whole of American society. Bill Clinton can count this issue among his failures.

To understand the current debate, it is necessary to put back a few of our prejudices that hinder us from analyzing the project impartially.

I have two anecdotes to tell:

1. In 2002, during a visit to New York, I had a lively discussion with the head of a communications company of only a dozen employees. My first words were to indicate to him that I was slightly surprised, in a negative sense, to know that so few American workers were covered by health insurance. The head responded that he had proposed that the company go in with its workers on health insurance, a deal worth about US$400 monthly at the time. He proposed that each employee either accept or refuse the proposition to receive a paycheck rounded down a few hundred dollars each month so they could insure themselves. Two out of twelve accepted. He told me that all employees could have thus enjoyed health care, but the majority of them seemed more interested in a higher monthly salary.

2. In July 2009, I was traveling in Arizona. I turned on the TV and stumbled upon an interesting and dynamic debate on Obama’s health plan. Suddenly, I hear a number of spectators clearly testifying that “in France, universal health coverage works!” I won’t hide my short and modest satisfaction to see that our country is not seen entirely as a vestigial soviet society.

It is necessary to understand the American state of mind in order to accept the current polls showing that nearly half of American citizens are opposed to Obama’s plan.

A State of Mind

Recall the essential. In the U.S., the strength of the public is best when it’s reduced to the American minimum.

This signifies that the state must do as much as possible to encourage and stimulate individual initiative and the “company mindset.”

Secondly, the feds and individual state governments must ensure full respect for freedom and the defense of American values that are protected by the Constitution and its famous amendments. This begets a spirit of exacerbated tolerance and a vision of security of the person, goods and values that passes over the bearing of arms (even, since last July, in the public house, as in Arizona) or the debates on the death penalty, abortion and taxation.

The third point to take into account is the citizen’s fight against taxes in the U.S., a corollary to the fight against the state. The maintenance of low taxes, including for the rich, is also shared by the democratic centrist parliamentarians, and the political rifts are much less deep on this point than on other questions. The state apparatus is thought, according to the collective knee-jerk reaction, to act as a brake on progress and action.

This doesn’t necessarily prevent nationalism, accompanied by an army acting so that the tools of defense are protective weapons and an extension of American values.

The Weight of Words

This is why the announcement of a “universal health care” plan has been translated and often denounced as a form of nationalization, which provokes a strong, negative reaction for a large number of Americans.

Yet, President Obama and Hillary Clinton have taken great precautions to avoid this anathema (the nationalization of health care). Clinton has clearly indicated, “this is not government-run. There will be no new bureaucracy. You can keep the doctors you know and trust. You can keep the insurance you have, if you like that.”

It’s not absolutely a social security system “à la française,” despite the objective to cover all American citizens by health insurance.

The Financial Argument

It is estimated that, to insure the 47 million Americans that are not already covered and to improve the protection of the most deprived with the Medicare and Medicaid programs, at least US$1 trillion dollars will need to be spent in the next decade.

Sure, this amount could seem astronomical – and it is – but it is equivalent to the cost of American intervention in Iraq over the past six years. It is thus a question of proportion and political choice. The extraordinary economic, social, political and military failure of the American war in Iraq should be measured up justly.

Today, the idea of a completely public insurance system seems to be put down under the blows of conservative lobbies, the pharmaceutical industry, certain health care professionals, Republicans united in opposition (without an alternative to propose) and centrist Democrats who do not look kindly upon this breed of socialism and the likely increase in obligatory taxes.

President Obama has become fully aware of the difficulties, even while showing his determination. He has meanwhile decided to open discussions with the largest pharmaceutical companies, Merck, Pfizer and Abbott, to negotiate a lowering of the prices of their products without the involvement of the state to force them to fix the price of medicine.

Toward Compromise?

While more and more citizens doubt the potential advantages of the reform, centrist Democrats attempt to come to a compromise with Republicans aiming to impose checks on health expenses rather than immediate coverage for all.

This reminds us that “medicalized control of health expenses,” this time indeed french, often gets mixed up with accounting mastery. Should this solution be retained, at least it would be a reform that will not fail to disappoint the Democrat majority in the House of Representatives and the most progressive leaders in the Democratic Party.

The question of the adhesion of all to either a public or private insurance system will not be debated so long as it is synonymous with worrisome new heights of government control.

It is, though, one of the essential questions, as my first anecdote stands to witness and shows how individual freedom of choice weighs on public health. While the American debate shows the strength of our French system despite all its weaknesses, it will always respect the choice to opt out of obligatory health insurance.

In light of the present financial crisis and the grave malfunctions linked to the fiscalization of the economy and capitalism, it looks like a death wish.