New York, with its vestigial social democratic culture, is less committed than most cities to private affluence at the expense of public squalor, but it’s still hard to find a public toilet in Manhattan. A few years ago, New York was about to sign up a company to provide the type of automated toilet common in other cities. Threatened legal action demanding that these toilets meet standards for disability access flushed the deal away. The result is that everyone – disabled or walking – has to cross their legs.
The landmark healthcare debate in Congress shows similar behaviour on both sides of the political divide. The Roman Catholic hierarchy, whose flock includes millions of the uninsured, decided that dying was a better option than getting insurance from companies offering abortion services. Catholic Democrats on Capitol Hill joined the Republicans to hold the healthcare bill to ransom unless abortion was excluded. It is typical of such posturing that the Republican Party’s own staff insurance was revealed to include just such services.
On the left, Dennis Kucinich, the most left wing but poorest in cash and charisma of the Democratic primary contenders, voted against the narrowly passed bill in the House of Representatives because it did not include a public option. The lobbyists have laboured mightily to exclude the one option that would make sense.
Since being an American conservative entails believing at least three impossible things before breakfast, we should not really be surprised that many of the states fervently opposed to “socialised medicine” have actually socialised alcohol. The state government has a monopoly on liquor distribution. Even more relevant are the actuality-conflicted protestors who demand: “Keep the government’s hands off my Medicare” – the latter being the Canadian-style single payer health insurance programme for millions of American pensioners and disabled of all ages.
Nor do such “fiscal conservatives” often mention the defence budget. But it is almost a constitutional convention in Washington that no one ever cavils at money for killing foreigners or letting domestic defence contractors make a killing out of the Pentagon budget, even if the sums dwarf health spending.
With similar dissonance from reality, the so-called “Blue Dog” Democrats, who profess worry about the budget deficit, are most concerned about the public option, whose cheapness could undercut the massive profits of the health insurance and drug companies. However, if a few other Democrats had joined Kucinich’s politically correct gesture, it
would have wrecked the only chance since the New Deal to bring any sense into American healthcare.
The bill is deeply flawed. A single payer system is insurance in the best sense. It spreads the risk and costs across the entire public. The public option would at least allow the uninsured to buy the equivalent of what pensioners in the United States have from the government.
Instead, the current string-and-sealing-wax effort mandates the purchase of insurance from money-grabbing and inefficient private companies, which set their premiums on strictly commercial grounds. In 45 states, they refuse to cover you for “pre-existing” conditions. In any case, if you are old and more at risk, you pay more. Under the current bill, if you do not put money in their pockets, the government will fine you.
There is a trade-off. In return for some
40 million compulsory new customers, the salivating insurance moguls promised they would drop some of their current inhumane practices – such as deciding that, because you did not mention your adolescent acne on your application form, they will not pay to treat the cancer you have just discovered.
Despite all these pertinent points, Kucinich was wrong to oppose the bill. Establishing the principle is far more important. The House bill goes to a conference with the Senate to merge with its version, where some of the idiocies can be dispensed with. Admittedly, there is a chance that some new ones could be added. Still, whatever the wording of the final law, for the first time it brings the US somewhere close to middle of the 20th century in making it the government’s business to ensure access to medical care for its citizens.
Without taking the piss too much, we return to the Manhattan toilets. Surely it’s a better tactic to build the toilets and then campaign for disability access? Precisely because Kucinich is correct about the inherent inefficiencies and injustices of the bill, there is now scope for improvements.
When the drug companies and the insurers show their true colours – putting the government more and more in the red – legislators can and should put the squeeze on them. They can introduce a public option and ensure it has the capacity to use its bargaining power with private providers to reduce costs and widen access. It’s the American way: get a toe in the door and then push hard.
What could keep me awake at night is nightmares about “new” Labour acolytes – the type who love primaries because they worked on Barack Obama’s campaign for a bit – trying to get the National Health Service to emulate the deeply dysfunctional deal being slapped together in Washington. It might be better than the present American system, but if someone raises the Titanic, that’s no reason to book a cruise in it.
