Michael White: the US healthcare debate

I hope so. Success for Obama would boost a presidency the outside world admires, but also bolster comprehensive healthcare systems like the NHS, underpinned by the state: the best model for developing countries.

You don’t know about recission? It is the racket whereby insurance firms retroactively cancel policies on the doubtful grounds that policyholders were not wholly frank about their condition

Thanks to attacks on the NHS we all know it has been a brutal summer for the Obama plan. The president is now attacked by left Democrats like Howard Dean for his tactical retreat over a “public option” insurance. Republicans call him a socialist-Nazi who will introduce “death panels” to decide which old folk are left to die. That phrase was popularised by Alaska’s Sarah Palin, who should not be forgiven for it. But it is supported (“Ms Palin has exposed a basic truth”) by the leader writers of the Wall Street Journal and many others who should know better.

WSJ ran a lengthy explanation of the NHS’s quality adjusted life years calculations to decide who gets what treatments. It concedes that all systems ration healthcare, by ability to pay (the US way), by waiting list (NHS), by restricting certain treatments (the National Institute for Health and Clinical Excellence’s contribution) or via less innovation (most EU states).

“In the end no one is denied actual care,” says WSJ of the US model, which leaves 46 million citizens uninsured and millions more fearful of losing their job and health insurance. Odd that, because when US health insurance executives testified in Congress in June they defended “recission”.

You don’t know about recission? It is the racket whereby insurance firms retroactively cancel policies on the doubtful grounds that policyholders were not wholly frank about their condition. It saves them millions, but it leaves the poor and unlucky to an uncertain fate. I would not call it a “death panel”, but you might.

Obama’s strategy has been shaped by the failure of the Clinton reform in 1993. Bill and Hillary’s top-down plan ignored Congress and the health industry, hospitals, doctors, insurance and pharma firms, who combined to defeat them.

In 2009 the White House has consulted everyone. Even the insurance industry is more co-operative now employer sponsored cover is dwindling. If the federal government would fund more insurance they would love the extra business.

But most of Obama’s Democrat allies favour a “public option” insurance model to provide some competition, a “hybrid solution” rather than an NHS style “single payer” model; this to reflect US culture. People satisfied with their insurance can keep it.

That offer does not satisfy feral critics who know Obama wants to protect the uninsured, but also to bear down on the ruinous cost of US healthcare, its high tech hospital care and drugs: 15 per cent of GDP - double ours.

Echoing the UK debate, he also wants more preventive care, better electronic records, better outcomes, healthier lifestyles, better handling of chronic care.

Sounds good to me, but in angry “town meetings” across the country the right has marshalled ordinary folk against reform, their suspicions easily roused against a “government takeover”, although Washington already spends billions (ineffectively) on health for the old and poorest.

Obama now says the “public option” is not essential to a compromise between the rival bills, some cautious, some radical, in Congress. He has set a 15 October deadline. Half a loaf better than none? That is the question for all but the diehards.