As US awaits "Obamacare" court ruling, some US-EU comparisons

This week the US Supreme Court will issue a landmark ruling on the constitutionality of “Obamacare”. It is still a mystery what the conservative-dominated court will decide.

There is speculation that the court may rule that just parts of the legislation are unconstitutional. The main provision everyone is watching is the requirement for all people to get health insurance or face fines. Republicans are arguing that it is illegal to force people to buy health insurance. But Democrats say that throwing out even just this one piece of the legislation will make the whole thing fall apart.

The healthcare reform changed the law to make it illegal for insurance companies to deny someone coverage because they are sick. Experience has shown that such a requirement has to be coupled with a requirement for everyone to have health insurance – otherwise healthy people would wait until they get sick to buy coverage. Eliminating the requirement to purchase insurance could send the whole system into the so-called “insurance death spiral” – where sick people suddenly flood the insurance market and send costs soaring.

The US healthcare bill - what's in it?

Today Barack Obama signs the US healthcare reform bill into law. It's been a long, ugly and draining process, but in the end Obama and the Democratic congress have succeeded in doing what no US president before has been able to - reform the broken American healthcare system.

I thought I'd write a brief entry on what this bill actually entails because I've found a lot of Europeans (and Americans, for that matter) are confused about what it contains. Many of my friends on the left seem to be under the impression that the bill has been watered down so much that it is almost meaningless and will do no good for anybody. People on the right still seem to believe that this is a government takeover of the healthcare system that mandates rationing of care. Neither is true.

Lobbyists 1, Obama 0

I’m here in the US for a white Christmas, it’s been lovely so far. The big news here, other than the terrorism attempt on a trans-Atlantic jet last night, was the historic passage of the healthcare reform bill in the US senate on Christmas Eve. But if some of you across the pond think this represents a fulfilment of the ‘hope and change’ promises in Barack Obama’s campaign, think again. The compromise legislation about to be enacted is being seen by liberals as a disappointing failure, and an indicator that the change the American president promised is not likely to materialise.

By definition, what was passed in the senate Thursday is not universal health care. It will bring the coverage level up to about 94%, meaning the US will remain the only developed nation without universal coverage. True, it will bring an additional 30 million people into the coverage umbrella. But it does so simply by legally requiring them to purchase insurance, without lowering the astronomical cost of insurance. It would force 30 million people to buy into the existing broken healthcare system. Rather than real reform, it’s a bit of a fudge.

Don't be so Shocked, Europe - US Healthfight similiar to EU Debate

You could call it a rude awakening. Over the past few weeks Europeans have reacted with shock and incredulity as they’ve watched the “debate” over US healthcare reform unfold across the pond. How could it be, they’ve asked me in tones of sheer exasperation, that even in the face of a healthcare crisis Americans could be so credulous as to believe the outlandish lies being spread about Obama’s healthcare reform effort. Death panels? Enemy lists? Nazi euthanasia? How, they’ve asked, could anyone be so stupid?

I haven’t had a good answer to give them, except that this is the cold hard reality of the place American politics has found itself in today. As I’ve written about before, many Europeans were lulled into a premature sense of relief when Barack Obama was elected in November. But while the head may have changed, the body remains the same – this is the same American public that elected George W. Bush twice. The combination of powerful vested interests in Washington, a strong right-wing media that dominates civic discourse, and a population that is, let’s face it, rather uninformed, mean that Barack Obama has his work cut out for him if he wants to effect real change. Getting elected was just the first step.

The mobs that have turned up to congressional town halls to shout down any discussion of healthcare reform, waving placards of Obama with a Hitler moustache and screaming about his “Nazi policies”, aren’t actually concerned about healthcare. This is about something much bigger, a general right-wing paranoia and militarism that tends to arise every time a progressive Democratic president is elected. It happened in the 1960’s culminating in a wave of political assassinations, it happened in the 1990’s culminating in the terrorist bombing in Oklahoma city by right-wing fanatic Timothy McVeigh, and it’s happening again now. Progressive Democratic presidents scare the bejesus out of the right-wing fringe inspiring hysteria and violence (although why this didn’t happen with Carter I don’t know, any ideas?).

What’s different this time around is that powerful Washington forces have decided to tap into this right-wing rage and use it to their own political advantage. Fox News has seen an opportunity to define themselves in the Obama era by stoking the flames of hysteria and paranoia, increasing their viewership handily over the past several months. The healthcare and energy lobbies have been able to tap into this paranoid rage by convincing people that attempts to reform their industries are actually part of a grand fascist scheme to enforce a dictatorship.

The most absurd example of this came yesterday when protesters congregated in Texas to rail against Obama’s “Nazi” climate change bill, which would finally sign the US up to international agreements to fight climate change. At first glance it might seem bizarre that ordinary citizens are turning up to yell and scream about a piece of legislation that doesn’t have much to do with them but rather affects the oil and gas industries, right? Well if you look at the bottom of their placards many read that they are concerned “Energy Citizens”, and if you look into the origin of this group you can see it’s actually sponsored by the oil and gas industry, whose trade organisation was recently revealed in a leaked memo to be suggesting that oil company employees be mobilized for these “grass roots protests” in order to “put a human face” on the resistance to the bill.

The same has been true of the healthcare protest and the “tea-bagging” protests, both organised by powerful Washington lobby groups working with the aid of Fox news, which gets people revved up telling them the healthcare reform bill will kill their grandma.

Is this in the bill? No. Is it rational to say Obama is a racist Nazi because he’s trying to reform the nation’s healthcare system? No. But these myths persist, with the majority of Americans now saying they’re concerned about Obama’s healthcare reform effort. It now looks like the administration is going to take the public option off the table or break up the legislation, which would effectively mean the myth-spreading tactics have worked. Meaningful healthcare reform could be dead.

Don’t Get too Smug, Europe

But before Europeans shake their heads and roll their eyes at the seemingly hopeless ignorance of the American public, might I remind them that they are not immune to these impulses either. In trying to explain to Europeans the raw emotion surrounding this debate, I’ve been struggling to think of an issue here that brings out the same level of irrationality. It wasn’t long before my mind settled on the EU. When it comes to ridiculous irrational myths, European knowledge of the EU - particularly in the UK - could give these American healthcare protesters a run for their money.

Take the debate over the Lisbon reform treaty. The accusations levelled against it in the UK and Irish media have been absurd almost to the point of self-parody. According to the British media the treaty is a “massive power grab” that will turn the EU into a “totalitarian super-state”. Sound familiar? In reality, the treaty simply makes tweaks to the EU’s governing structure, changes that have been made necessary by the recent EU enlargement. The main purpose of the treaty is to make the EU more efficient and cost-effective, not to give it more power. Its goal, much like the healthcare reform bill, is to help people – not to hurt them. But that doesn't stop the totalitariansism comparisons. Just take a look at this over-the-top video from YouTube.



Euromyths are rampant in the UK. Some examples of completely baseless euromyths spread by the British media: English fish and chips shops would be forced to use Latin names for the fish (The Sun, 5 September 2001), double-decker buses would be banned (The Times, 9 April 1998), British rhubarb must be straight and barmaids would have to cover up their cleavage. (Update April 2010: Here's a recent patently absurd - and easily disprovable - example from the Daily Mail about the EU supposedly changing the name of the British Channel to the "Anglo-French Pond". That story was picked up by numerous other media outlets including the BBC's 'Have I got News for You'.) All of these are widely believed in Britain yet are completely untrue. Many euromyths can be traced directly to deliberate attempts by lobbysists to influence policy in Brussels. And they’re frequently presented in the same kind of screaming-headline, hysterical tone that is now being employed in the US healthcare debate.

And of course, a recurring complaint about both the Healthcare reform bill and the Lisbon reform treaty is that they're too long and complicated for ordinary people to understand. And because they're so long, they must be trying to pull something over on everyone. Because naturally, incredibly complex pieces of legislation should be easily understandable by your local trash collector.

In the UK, the right-leaning media makes completely baseless and false accusations about the EU and about the Lisbon Treaty, saying it will do things that are not at all in the document such as ban abortion across the EU, mandate an EU army, establish an EU constitution or subjugate member state courts. The public comes to accept these myths as fact. Then when it comes time for a vote, as occurred with the Irish referendum on the Lisbon Treaty last June, the public bases their vote on the misinformation they’ve received about the EU and the treaty. Democracy at its finest.

Can you imagine if healthcare reform were being put to a referendum in the US? It would never have any hope of passing. In fact the only way that this legislation may actually come to pass now is if the US congress does the right thing and bypasses the will of the people, making the responsible informed decision that a vast swathe of the American public cannot make themselves because they are so misinformed. This is how representative democracy is supposed to work – citizens elect representatives and entrust them with the responsibility of becoming versed in issues that ordinary citizens are not equipped to make decisions on themselves. This is why it is irresponsible to put a complex legal document like the Lisbon Treaty or healthcare reform to a public referendum. It is the worst perversion of Democracy – mob rule.

People tend to be pretty gullible, and powerful interests will always be able to manipulate them. Now that the internet has brought us what sociologists have termed the "post-fact society", this misinformation is very easy to spread - be it in America or Europe.

No Appetite for Revolution

Now to be fair, the level of hyperbole used in mainstream media around the Lisbon Treaty hasn’t reached the alarming heights of the US healthcare debate. And the Lisbon Treaty hasn’t inspired gun-totting mobs to show up at politician’s doorsteps last time I checked. Comparisons to Nazis are rarely used in continental Europe, as the memory of what the Nazis really were is still too raw to throw around the comparisons as lightly as Americans and, to a lesser extent, Brits do. But the difficulties encountered in both efforts for reform show how difficult it can be to change societal systems at the dawn of the new millennium, as we prepare to enter the 7th decade of peacetime in the Western world. 

The fact is all of these big social programs, on either side of the Atlantic, were instituted in the years following World War II at a time when the public was still traumatised enough to have the appetite for real massive change. People are living in an era of unprecedented peace in the Western world, and even if there are major problems with system X, it’s working just fine for now thank you very much. Whether it be the EU project or healthcare reform, people in 2009 are just not mentally prepared for big change. Having lived their entire lives in peace, they just don’t have the appetite for risk. And powerful interests have grown up around the existing institutions that will resist change in order to safeguard their own interests.

Yet in both situations, the seeming comfort of the status quo is an illusion. Neither current situation is tenable in the long-term. In the US, while one out of every five Americans under 65 is uninsured, the majority do have insurance and, since they don’t know any better because they’ve never seen a European healthcare system, they think their coverage is the best in the world (Americans usually by default assume their anything is the best in the world). But the system of employer-funded healthcare is untenable. The US now spends around 15% of its GDP on healthcare, second only to East Timor among United Nations member states. Left unchanged, that number could rise to something like 30% in just a few decades. The current system is literally strangling small business. But all most Americans with insurance see is that they go to the doctor, he treats them, they get better. There is no crisis, they assume.

The same can be said of Europeans and their thoughts about the place in the world of their individual member state. The fact is that in a post Cold War world, with the rising power of India and China and the fact that the US no longer has a strategic long-term interest in safeguarding European defence, no individual European member state can hope to be a significant player on the world stage in the 21st century on its own. Yet your average British person hasn’t come to grips with this fact. As far as they can see, they appear to have a big influence on the world culturally (they often mistake American cultural imperialism and the widespread use of English as somehow attributable to themselves), they are nuclear armed, they have a seat on the UN security council and they are in the G8. But the fact is in 50 years they are unlikely to have any of these things (except perhaps an ageing fleet of dangerous and dilapidated Trident submarines) if they were to go it on their own. It’s a situation where the prospect of the UK separating from the EU could easily appear to be fine to the average British person, but where people with a real knowledge of world events and future projections know that is not a viable option.

In the meantime the media, big business and right-leaning politicians are all too willing to exploit the average person’s ignorance and lack of foresight in order to serve their own interests, convincing them that reform efforts that are meant to help the average person are actually an effort to impose a dictatorial superstate. It’s the situation we find ourselves in at the dawn of the 21st century on either side of the Atlantic.

We are, it would seem, a risk-averse species by nature. And a gullible one to boot.

Germany, and Reason, Ignored in US Healthcare Hysteria

I’m sometimes accused by commenters on this blog of wishing to make Europe into the US, and while it is true that I often yearn for European politics to be a bit more self-assertive, ambitious or efficient, make no mistake - I would never wish for European politics to devolve into the kind of mob hysteria US political discourse has sadly become.

The current debate going on in America over Obama’s attempt to overhaul the broken US healthcare system has been particularly hard to watch in this regard, and makes me feel pretty fortunte that I live in Europe. The way this healthcare debate is unfolding in the US is not only shockingly unreasonable, it’s getting downright scary. And unfortunately, what’s been occurring around the heathcare debate isn’t an isolated incident - it’s reflective of the dangerous road the American right wing is heading down.

The worst part is that the illogical hysteria surrounding the debate is drowning out any kind of reasonable argument. The scare stories being floated in the US media about single-payer systems in the UK and France would be missing the point even if they were true – what’s being proposed by Obama isn’t a single-payer system but rather a multi-payer combination of public and private plans, much like exists in Germany. But astonishingly, Germany hasn’t been mentioned at all in the US debate, even though it currently has a system very similar to the one being proposed, while the British and French systems don’t even resemble the Obama plan.

A ‘Plot to Kill Old People’

The health insurance lobby in the US has launched a full-on campaign to sink Obama’s efforts at health care reform. The plan that is working its way through congress is to add a public option to the list of private insurance options available to the American public. Currently the US has a completely private system for those under 65, the only non-universal healthcare system in the developed world, in which nearly one in five Americans under 65 don’t have any healthcare at all.

Not having healthcare can bankrupt a person if they get sick or have an accident, and it happens often. In fact, medical debt is the principle cause of bankruptcy in the United States.

Healthcare in the US has developed in an uncoordinated fashion over the past half century after the US government was unable to come to an agreement over a national health plan (Medicare, in which the government insures all people over 65 through a single-payer system, was a compromise enacted in 1965).

People under 65 have traditionally been insured through their employer. This means if you lose your job, you lose your health insurance (so if you get hit by a bus two months after losing your job, you’re facing a $30,000 hospital bill and no income!). But as healthcare costs have risen many small businesses have been unable to offer their employees health insurance any longer, leading to a dramatic rise in the number of uninsured. Even people who are insured face ever-rising deductable costs every time they visit a doctor, and their insurance companies can deny them coverage at any time by claiming that they had a “pre-existing condition” before they enrolled in the plan.

So to put it mildly, the system is a mess. Yet what Obama and congress are proposing isn’t a complete overhaul - it’s more of a reform. The private insurance companies would continue to exist, and everyone who’s already insured could keep their existing plan if they so wish. But a new player would be introduced into the market, a government-funded public insurance plan that people can opt into. Additionally, everyone would be required to have insurance, and regulation of the insurance industry would be tightened to prevent insurance companies from denying people coverage because of pre-existing conditions or charging exorbitant deductable charges.

However the insurance industry fears that having the US government as a competitor will eventually drive them out of business. So they’ve mobilised their media outreach, finding people in countries with single-payer universal healthcare systems like the UK, France and Canada, and trotting them out to do interviews with US media outlets about their horrible experiences. These strange, wild-eyed European defectors tell stories of being denied treatment and having to go to the US in order to have desperately needed operations to save their lives.

Or, they tell tale of public hospitals with dead people lying on the floor all over the place. I wish I was making this up. To hear the stories that have been spread in the US media, the NHS in England is effectively a government euthanasia program that kills people once they reach old age Republicsn Congressman Louis Gohmert has said under the reform seniors "be put on lists and force them to die early.”

This group that’s spreading word that the healthcare reform bill will kill old people have even been given a nickname, the “deathers” – a reference to the mob of people claiming that Obama wasn’t really born in the US – the “birthers”.

Of course, all of these tales have been proven to be absolute lies by reputable organisations, yet these people keep appearing on US cable news.

Harnessing the Mob

Now the healthcare lobby and the Republicans have gone a step further, actually organising mobs of angry 'birthers', 'deathers', 'teabaggers' and other assorted crazies to show up at open town hall meetings that Democrats typically host during the August recess. These mobs have been instructed to scream down the representatives as they try to speak. It’s absolutely insane, and getting quite scary. Take a look at this clip from the Rachel Maddow show.


Right-wing lobby groups are organising these mobs, telling them where the town halls are, and instructing them to block all discussions. They refuse to allow anyone to speak. If actual townspeople at these town halls try to ask a question, the mob shouts them down with chants of "just say no". Congressman Boehner, the Republican House minority leader, has praised these mobs and encouraged them to continue.

The Republican party is now aggressively harnessing the energy of the “teabaggers” –a group of mostly lower middle class Americans who are angry at Barack Obama’s election and were organized into protests by GOP groups earlier this year under the mistaken belief that Barack Obama’s budget was making their taxes go up (Obama is actually lowering their taxes or keeping them the same). It’s also harnessing the energy of the “birther” movement, a group of angry white Americans so incensed that Barack Obama was elected that they have developed a conspiracy theory that he wasn’t actually born in the US and is therefore ineligible to be president.

Republican congressmen and talk show hosts have given credence to the conspiracy by saying Obama has never released his Hawaii birth certificate – even though he has and it’s been on his website since the campaign.

So it’s a two-pronged attack by the right: organising mobs of crazy people to disrupt town halls where Democrats are attempting to explain heath care reform to their constituents, and getting fake healthcare scare stories into the media

Better European Comparisons

But beyond the fact that these random Canadians, Brits and Frenchmen being trotted out are just flat-out lying and are actually being put out there by the health insurance industry, the reality that everyone in America seems to be missing is that even if these stories were true, they are completely irrelevent to the current US healthcare debate. Canada, France and the UK all have single-payer systems – where you walk into the doctor’s office and never see a bill. That system is not on the table in the current debate in the US. What is being proposed is a combined public/private universal health insurance program much like exists in other European countries, most notably Germany.

Germany’s system would be the more obvious comparison, yet it has not been mentioned at all by the US media, which continues to focus on single-payer systems that have no relevance to the current debate.

Germany has a universal multi-payer system with two main types of health insurance: the public fund and private funds. Everyone is mandated to have healthcare, which is provided by the public fund to people below a set income level for a low rate. So, the wealthy can pay for exceptional private health coverage if they want to, or they can pay a small amount for the state insurance (many opt to do this). The end result is that everyone is covered and Germany spends 10% of GDP on health care, compared to 16% in the US.

Alternatively, the US media could use the example of Switzerland, although I’m not sure I would use that as a glowing model considering it has the highest health care expenditure in Europe. But they also have universal healthcare in a combination of public, subsidized private and totally private healthcare providers, where the insured person has full freedom of choice among the providers in his region.

Unfortunately, using comparative examples that make sense have not been part of the debate around this issue, which has instead focused on the hysterical screaming of the right. US policy, much like hotdogs, is always something that can be a little stomach-churning to watch being made. But lately the level of vitriol being launched by an increasingly desperate Republican party has been downright disturbing. Outright lies? Fake experts? Organised mobs? Is this America or a banana republic?

The most troubling part is that these tactics are working. Recent polls have shown that 42% of Americans now think Obama’s healthcare plan is a bad idea, and 69% of Americans are concerned their care would suffer if they were on a government-run plan.

They say citizens get the government they deserve. Perhaps it can be said that they also get the healthcare they deserve. If the American public can be so easily manipulated by the powerful forces of the right, even when it jeopardises their own health, I don’t know if there’s much hope for real reform in that country. It's very sad to watch. One thing is for sure – the behaviour exhibited over the past several weeks has not been a proud moment for American political discourse. These are dangerous tactics the American right is using, and they can easily spiral out of control. In the mean time, they are blocking meaningful discussion over how to reform a healthcare system whose dysfunction has reached crisis proportions.

Pan-Europe healthcare plan delayed

Though proposals were expected today on the controversial new plan that would make it easier for patients in Europe to travel to other EU countries to receive healthcare, a European Commission spokesman said this morning the proposals have been put off, citing “agenda reasons.”

The idea behind the plan is that patients should essentially be able to “shop around” Europe for their healthcare, having operations done in countries where the wait time and expertise most suits their needs, and then having their home healthcare system foot the bill. So, for example, a UK resident who needs a surgery but is facing a 4 year wait to do it at an NHS hospital, could travel to France and have the operation done sooner (and maybe better), and then get the NHS to foot the bill.
But the plan has been enormously controversial, and the UK is particularly opposed to it because some fear it will spell the “end of the NHS” because the system would be forced to transition to a more insurance-based continental system.

For this reason the proposals have been hitting consistent delays, being drafted and redrafted, and the proposals today were expected to offer countries like the UK the option to pre-approve such out-of-country treatment and to opt-out. Of course, the proponents of the plan say this would negate the very purpose of it.

Mark Mardell had an interesting package on the BBC last night about a woman who faced a four year wait for gastric bypass surgery in the UK, so she opted to have the operation performed in Belgium where there was no wait for £5,000 (insert joke about the weight difference between continentals and Brits here). He's detailed more about this issue in his Euroblog today.