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Michael White: Mitt's gamble

I doubt if you have much time to worry about how Florida’s elderly American voters have been feeling this week. But it may affect the careers of NHS staff and patients, as well as the private sector outliers trying to grab a larger slice of Britain’s healthcare industry.

Why so? Because the usually-risk-averse Mitt Romney last week chose Midwest congressman Paul Ryan as his running mate in the Republican bid to recapture the White House from Barack Obama. And Mr Ryan is widely admired by the US right for his intelligent rigour in demanding deep cuts in federal spending.

Yes, that includes healthcare, basically by forcing elderly recipients of Medicare and Medicaid (for the poor) to fend for themselves in the insurance market, with federal aid limited to capped block grants.

That’s why it’s of interest to Florida voters - and ultimately to us all. The coming electoral battle is a big one and Britain is more exposed to American ideas than most of Europe - for better and worse.

Court battle

In late June, the US Supreme Court finally ruled that Obama’s landmark 2010 Affordable Care Act does not breach the sacred 1787 constitution, with the arch-conservative chief justice John Roberts unexpectedly voting with the 5-4 centrist majority, to the fury of the right and scorn of fellow judges. Romney says he’d repeal it anyway.

Roberts concluded that Obama’s insistence that everyone be required - and helped - to buy health insurance or be fined amounts to a tax and that Washington can lawfully levy taxes. The White House and 50 million uninsured Americans are not yet out of the woods.

Compromises on law excluded the government-backed insurance option which many Democrats wanted. The health insurance industry - unlike most US fat cats - is backing Obama in November.

Nor does it bear down heavily enough on the costs imposed by hospitals, doctors, the drugs giants (George Bush was very generous to them) or the costly paper trail.

Healthcare costs 15-17 per cent of US GDP - nearly double the UK rate. It’s brilliantly innovative, but unfair and inefficient.

Obama’s reforms already stop insurers refusing customers with “pre-existing conditions” but the system won’t be fully in place for years. It’s also widely unpopular, a threat to “liberty” - America’s equivalent of “Brussels”.

Voter scare

Ryan’s arrival as No 2 on the ticket brings all this into focus, allowing Democrats to scare voters with what he might get the malleable Romney to do in office instead of what Obama has done - and not done - to revive the ailing US economy.

The gamble scares right-wing pundits while liberals admit Ryan is personable, though hardly the Washington outsider he’s presented as being. He arrived at 22, was elected at 28, as much a professional politician as a Cameron or Miliband.

Where public intellectuals as grand as the FT’s Martin Wolf are utterly scornful is in deriding Ryan’s famous budget plan - a “libertarian Disneyland” where tax cuts for the rich pile on the Bush-era deficits and justify spending cuts which help the needy most but also the middle class. It is fantasy talk.
Containing healthcare costs, not slashing them, is the real challenge everywhere.

I would contend that this battle matters to us, not because David Cameron wants to emulate Ryan, though clever fools like John Redwood would like him to, but because the background noise about US market excess will make it harder for the UK private health sector to impress a sceptical electorate of the merits of a more mixed NHS economy. Ironical, but that’s life.

Michael White writes about politics for The Guardian.

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