The issue is immensely important - after all, ifthis isn't a matter of life and death for the average citizen, thenwhat is? - and incredibly complex. However, the debate surrounding itis 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, aresimplistic or dogmatic. But to most non-Americans, the arguments andclaims of the opponents of the reform are almost incomprehensible. Theyreflect a massive gulf between the way the American political andsocial Right views the issue of public health and the way the rest ofthe developed world views it.
Probably the most fascinating aspect of how the debate isplaying out in the public arena, is the way in which intelligentAmericans, obliged to come to grips with the basic facts about theircounty's health system, gradually have their eyes opened to its hugeflaws and are reluctantly forced to stop mouthing the mantra that "theUS has the best health-care system in the world."
What are these basic facts? First, at the macrolevel, it is clear that the US spends nearly double the share of itsGDP on health-care than do other large developed countries (UK, France,Germany, Canada, Japan, etc.). Yet its "critical data," especiallylife-expectancy rates, are among the lowest of the developed countries.As you drill down into the data, you get to understand why this is soand discover more amazing facts.
A huge proportion of the population - at least 25 percent to30% - has no health-care insurance. That's also pretty macro, but trythis: An estimated 20,000 people die every year because they have nomedical services accessible to them. These facts are the flip side ofthe claim that the US has the best health-care in the world. Both aretrue. For those who can afford the best, it is more readily availablethan anywhere else; but for those who can't afford anything, there isnothing.
The truly incredible thing, though, is how manypeople who consider themselves intelligent, empathetic and moral, findnothing wrong with this situation. The world's richest country, interms of total resources, wastes mind-boggling quantities of money onfrivolous procedures and on dealing expensively with medical problemsthat could and should have been addressed far more cheaply bypreventive measures, such as the treatment of diabetes in the hordes ofobese Americans. Yet the idea that the government has a basic obligation to usethe national wealth to provide basic medical services to the poor andneedy is regarded as anathema. Indeed, many otherwise rational peoplebecome apoplectic over the very concept of government involvement inthe provision of medical services and start screaming about "socializedmedicine." Whether such people actually believe that America of 2009 hasno truck with "socialized medicine" or other "socialized" services isnot clear - to me, at least. Granted, some right-wing extremists wantto abolish Medicare and Medicaid entirely, and there are those (on theextreme Left) who claim that former president George W. Bush sharedthis dream. But it's hard to believe that all those who oppose thecurrent proposals on the specious grounds of "socialized medicine" arein this camp. On the other hand, what are they thinking? Indeed, arethey thinking? Or do they become totally irrational on this topic? In a way, it's a throwback to the McCarthyite 1950s and even tothe "Red scares" of the 1920s. But the old slogan "Better dead thanred" was supposed to be a political war cry, to do with liberty and soforth. In its current incarnation, it would seem to mean: "Better thatthey (the poor, elderly, etc.) die, than that we use part of ourmassive wealth to provide them with health services commensurate withour 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'snot the main point. It may well be that the goal of universalhealth-care is now unreachable in the US, at least for the nextgeneration. 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 15years ago, the country would have better health, now and in the future.Instead, it has "underwater" home owners and bust banks. It's gone redright enough: red ink. landaup@netvision.net.il
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