Posted tagged ‘healthcare reforms’

Obama has another go at health

February 23, 2010

Public health and the availability of healthcare in an affordable and efficient way are top priorities for people in most countries. Governments respond to that by ensuring that they, too, are seen to prioritise healthcare. And yet it is a political graveyard, whatever country you may want to consider. The only politician that I can remember in my lifetime, in any country of which I have knowledge, making some political capital out of the health brief was Charles Haughey, when he was Minister for Health in Ireland in the late 1970s. He somehow managed to side-step the hot issues and dodge the usual bullets, and was admired and lauded; and for what? He offered every member of the population a toothbrush. Smart move.

Every other politician who has tried health has regretted it. Brian Cowen and Mary Harney in Ireland; Frank Dobson and many others in the UK; Hillary Clinton and, now, Barack Obama in the US. The problem is that everyone wants to be protected and cared for, but without big bills when disease or ill health strikes. And nobody knows how to square that circle. The only way to do it securely is through insurance that has been properly assessed on an actuarial basis, but unless there is some ‘risk equalisation’ (meaning that the cost of insurance is not related to the likelihood of illness) it becomes prohibitive; and if there is risk equalisation it becomes unprofitable for insurers. There is no way of winning in this game.

And yet, as civilised countries, we must find a way of addressing this, as we cannot go back to making people live insecurely in fear of the consequences for them and their families of serious illness. So we must continue to try, and more politicians will have to be offered up on this altar.

Let us hope that Barack Obama – whom the world needs to be successful for all sorts of reasons – is not one of these. After a lot of political jousting over the past year on the back of proposals made by his Democratic Party, he has now come forward with his own proposals for health reform. In the United States this is vital not least because of the large numbers who are currently outside any system of healthcare. If I read his plan correctly, he is hoping to achieve progress through compulsory insurance for all in a setting of a regulated industry with capped premiums (so presumably some risk equalisation). Whether this can work remains to be seen. But much more important right now than whether the figures might add up is whether it can work politically. There would be damaging consequences if this plan fails. So I am not thinking too much about whether this is a viable way of managing healthcare, I am just hoping it is accepted and is implemented, so that Americans can get proper cover and so that Obama’s political capital rises again. These are tricky times, and what happens to US healthcare may affect us all in unexpected ways.

Letter from America

November 6, 2009

This post is coming to you from Washington DC, where I am on a very short visit in order to attend two meetings. As ever, it is fascinating to be here, as you get to see at first hand the trends and events that are influencing opinion in the United States.

As I arrived in the city yesterday, I came upon the tail end of what was apparently a major demonstration, aimed at persuading Congress that the planned healthcare reforms were unacceptable. As you may have guessed, the demonstrators were overwhelmingly of a conservative Republican persuasion, and some of the posters they were carrying displayed a depth of opposition to the reforms that, to me at least, was baffling. One poster carried the message that the reforms were likely to ‘bury for all time the principles of the American constitution’. Really? Another still much more alarming poster suggested that the proposed reforms justified a call for ‘waterboarding Congress’, a rather chilling reference to the alleged torture applied against terror suspects during the years of the Bush administration.

I confess that I find it very hard to understand this depth of passion, bordering on fanaticism, about something that may be right or wrong (right in my view) but which really should not draw out this kind of response. Social reforms should always be discussed rationally, not hysterically. But healthcare has become the touchstone of the Obama administration, and the ability of Congress to adopt the measure (planned for Saturday) will tell us a great deal about the capacity of Barack Obama to chart a reforming course.

The other thing that struck me forcefully was an article about last year’s Republican Vice-Presidential candidate, Sarah Palin. She has never quite left the news since the election, though the coverage of her oscillates between support and ridicule. Conservative film critic Michael Medved, in commenting on Palin and her forthcoming book Going Rogue, suggested in an article in USA Today:

‘A nation that proudly offers fresh starts and open doors regardless of old world titles or family connections should reject snobbery based on either academic attainment or aristocratic ancestry.’

Leaving aside entirely the matter of Sarah Palin’s personality or achievements, it struck me as very significant that the writer was equating academic qualifications with feudal concepts of society. Is he right? Are academic institutions the purveyors of social elitism? Is knowledge divisive if celebrated? The aristocracy of intellectual performance is perhaps a feature of the academic world. Do we need to re-think this, and find a way of valuing knowledge while avoiding any suggestion that it elevates the holder? Are attempts to open up access to knowledge to everyone doomed, so that we will always be left with a privileged elite? These are genuine questions which, perhaps, we do need to answer. And our lack of skill to date in answering them may explain some of the reservations about academic institutions, in Ireland as much as in the United States.