Azeem Ibrahim: Big business fears Obama's plans to radically reform healthcare in US

Published on Tuesday 8 September 2009 22:26

WHY has Obama's healthcare plan made so many people so angry?

It seems to me that most of the British coverage of the US healthcare debate hasn't done a particularly good job of explaining what Obama wants to do, and why so many people are so angry about it.

Rather, it has concentrated on areas where the debate on the other side of the Atlantic has touched on things which are familiar to us Brits, such as a Conservative MEP saying on a US chat show that the NHS was a terrible mistake, or a chat show host telling Americans that if the Democrats get their way, Americans should get ready to fix their own teeth with superglue, because that is what one man in Liverpool did.

At best, this has touched off patriotic feelings among British people proud of the NHS – or at least unwilling to see it maligned unfairly by Americans.

It often seems like many right-wing Americans think Britain must be crazy to be happy with a healthcare system run by the government, while the unspoken sense in Britain is that the USA must be crazy to tolerate a healthcare system in which 46 million Americans don't get healthcare.

And so I offer a primer on the US debate, and why it has aroused such fierce opposition.

Broadly speaking, there are three things Obama wants to fix.

The first is that not everyone gets healthcare. The US Institute of Medicine estimates that in 2006, the numbers dying because of lack of health insurance reached 22,000.

US citizens have their healthcare paid for in one of three ways. Most people who work have health insurance paid for by their company. If you are over 65, the government pays for insurance for basic health needs. And if you are poor enough the government pays for certain treatments for you, although the exact rules are different in each state.

The second problem is that healthcare in America costs too much relative to other countries. A recent survey by the policy journal Health Affairs found that 24 per cent of Americans said they did not get medical care because they couldn't afford it, compared with about 6 per cent in Britain.

Thirdly, he wants to improve the quality of the care.

So far, there are a mixture of ideas about how to deal with these problems, but they have all made a lot of people very angry. Town hall meetings about healthcare across the country have been inundated with concerned and furious citizens, many of them scared that the government plans to institute "death panels" to decide who among the ill will be allowed to live and who will be left to die, or alleging that the Democrats want to encourage euthanasia to save money.

It seems to me that there are two things going on here.

The first is that healthcare reform would open up health insurance companies to more effective competition, and they fear it. Many are lobbying hard and trying to muddy the argument with scaremongering stories. In fact, many of the angry people at the town hall meetings were actually members of organised groups, paid for by vested interests.

One of them – Conservatives for Patients' Rights – was founded by the former CEO of one of the biggest hospital operating companies in the country at a time when it was operating a massive fraud, ripping off patients and doctors, and paying kickbacks to healthcare providers, before being punished by the biggest fraud settlement in American history.

The health industry is spending nearly one and a half million dollars to lobby against reform every day. Naturally, this is driving a lot of the opposition.

The second reason for genuine opposition to healthcare reform, I believe, is that many Americans take suspicion of government and a belief in individualism much more seriously than we do in Britain.

Americans are much more receptive than we are to the idea that the government is a danger to healthcare.

President Obama is due to make a big speech setting out his position on the debate this week; it remains to be seen how much of his reform package he is able to push through both houses of Congress, even with Democrat control.

&#149 Azeem Ibrahim is a Research Scholar at the International Security Programme, Kennedy School of Government, at Harvard University and a World Fellow at Yale University.