Although you might not believe it from reading the
Israeli and American-Jewish press, the issue dominating American
politics today is not how many caravans Israeli settlers can shunt
around West Bank hilltops. Rather it is President Barack Obama's
proposal for a major reform of the health-care system.
The issue is immensely important - after all, if
this isn't a matter of life and death for the average citizen, then
what is? - and incredibly complex. However, the debate surrounding it
is proving to be a very sad and telling reflection on American society,
politics and media.
Most of the arguments put forward, by people on both sides, are
simplistic or dogmatic. But to most non-Americans, the arguments and
claims of the opponents of the reform are almost incomprehensible. They
reflect a massive gulf between the way the American political and
social Right views the issue of public health and the way the rest of
the developed world views it.
Probably the most fascinating aspect of how the debate is
playing out in the public arena, is the way in which intelligent
Americans, obliged to come to grips with the basic facts about their
county's health system, gradually have their eyes opened to its huge
flaws and are reluctantly forced to stop mouthing the mantra that "the
US has the best health-care system in the world."
What are these basic facts? First, at the macro
level, it is clear that the US spends nearly double the share of its
GDP on health-care than do other large developed countries (UK, France,
, etc.). Yet its "critical data," especially
life-expectancy rates, are among the lowest of the developed countries.
As you drill down into the data, you get to understand why this is so
and discover more amazing facts.
A huge proportion of the population - at least 25 percent to
30% - has no health-care insurance. That's also pretty macro, but try
this: An estimated 20,000 people die every year because they have no
medical services accessible to them. These facts are the flip side of
the claim that the US has the best health-care in the world. Both are
true. For those who can afford the best, it is more readily available
than anywhere else; but for those who can't afford anything, there is
The truly incredible thing, though, is how many
people who consider themselves intelligent, empathetic and moral, find
nothing wrong with this situation. The world's richest country, in
terms of total resources, wastes mind-boggling quantities of money on
frivolous procedures and on dealing expensively with medical problems
that could and should have been addressed far more cheaply by
preventive measures, such as the treatment of diabetes in the hordes of
Yet the idea that the government has a basic obligation to use
the national wealth to provide basic medical services to the poor and
needy is regarded as anathema. Indeed, many otherwise rational people
become apoplectic over the very concept of government involvement in
the provision of medical services and start screaming about "socialized
Whether such people actually believe that America of 2009 has
no truck with "socialized medicine" or other "socialized" services is
not clear - to me, at least. Granted, some right-wing extremists want
to abolish Medicare and Medicaid entirely, and there are those (on the
extreme Left) who claim that former president George W. Bush shared
this dream. But it's hard to believe that all those who oppose the
current proposals on the specious grounds of "socialized medicine" are
in this camp. On the other hand, what are they thinking? Indeed, are
they thinking? Or do they become totally irrational on this topic?
In a way, it's a throwback to the McCarthyite 1950s and even to
the "Red scares" of the 1920s. But the old slogan "Better dead than
red" was supposed to be a political war cry, to do with liberty and so
forth. In its current incarnation, it would seem to mean: "Better that
they (the poor, elderly, etc.) die, than that we use part of our
massive wealth to provide them with health services commensurate with
our country's capabilities."
The tragedy is that the entire effort may prove to be in vain.
It looks increasingly as though Obama's proposal will not be adopted,
or, if it is, it will be massively "doctored" along the way. But that's
not the main point. It may well be that the goal of universal
health-care is now unreachable in the US, at least for the next
generation. Not - or not merely - because of political intransigence,
but because the resources needed for it are no longer available.
Had the Clinton proposal, or something like it, been passed 15
years ago, the country would have better health, now and in the future.
Instead, it has "underwater" home owners and bust banks. It's gone red
right enough: red ink.