The Health Care Plan, Obama’s Achilles Heel

President Barack Obama will defend his health care plan again, in front of Congress on September 9. It would be tempting to attribute his problems to the eminently ideological character of the American debate, of which we have seen some truly over-the-top examples this summer.

Sarah Palin, former Republican governor of Alaska and ex-vice-presidential candidate evoked the nightmare of public “death panels” which would decide the fate of people’s relatives and take the right to medical treatment away from the handicapped. Kicking up Palin’s rhetoric up a few notches, Investor’s Business Daily denounced the National Health Service (NHS, the British public health system), saying that it would have refused to treat physicist Stephen Hawking. This claim was debunked by the professor, who is still very much alive despite the NHS dictatorship, and very happy with his medical treatment. In France, we are not very much in the habit of seeing our British friends’ economic system equated with North Korea’s, or to the English getting lessons on the virtues of healthy, regulated competition versus state-run bureaucracy!

As for the American demonstrator who shouted, “Keep the government’s hands off my Medicare!” he probably did not know that Medicare is a program for seniors run by…the government. But the American left cries treason the minute Mr. Obama shows the slightest inkling of backing down from a public insurance option and sees a future with regulated competition among private insurance companies. Obama runs the risk of forgetting that the provider matters less than the quality, and the cost, of the services provided.

The French health care system has been overwhelmingly praised several times in comparative studies by the International Organization for Economic Co-operation and Development (IOECD). Certainly, it has its weaknesses, and probably owes some of its strengths – like the low death rate from heart disease – to wine growers as much as it does to doctors. But it is a good example of how the question of universal coverage can be separated from the question of allocating services between public and private companies. Couldn’t this economic pragmatism be a lesson to the Americans?

Unfortunately, the problems the Obama plan is running into do not just come from the ideological fervor of the debate. The American administration claims that its plan can increase the number of insured, reduce the costs of the system and not raise taxes, a magic trick that provokes skepticism from the respected, non-partisan Congressional Budget Office. The story of the death panels may originate partly in paranoia, but there will definitely be a difference in political perception between decisions to treat or not to treat made by the government, and decisions currently being made by insurers.

The Achilles heel of the plan comes out of a calculation that is cynical but difficult to avoid. Thanks to the changes made with the inception of Medicare starting in 1965, seniors are already covered and do not have much of a stake in universal health coverage. This is a textbook case of the danger of partial reforms. In short, the average American voter, as a taxpayer or as one of the insured, is not convinced that Obama’s plan will be of any benefit to him. To persuade him to end the scandalous absence of health insurance, like every other developed country, will require all of Obama’s talents as a preacher and as a magician.