in Misc., Opinion pieces

US healthcare reform in turmoil

I was out for dinner with a New Yorker friend of mine recently. She’s British, but she’d brought along an American friend and I happened to mention to him how much I was digging President Obama. Things deteriorated from there. “Obama is a socialist!” the heads of the rest of the table turned, as the conversation up until that point had been about interior furnishings.

“I don’t think that you appreciate what a socialist is” I replied. “You should try living in France; America doesn’t have a party of the left. All you’ve got is centre and right”. The conversation then moved onto healthcare, which was proposed as an example of where liberal economic theory fails to deliver. Our American friend was undeterred by this argument.

“It’s possible to get free healthcare in the United States” he opined. “People come into a hospital sick and get treatment, and once they’re in, the hospital can’t throw them out”

I’ve been thinking about this curry-fuelled conversation over the past few days whilst reading about Obama’s troubles in pushing healthcare reform, something he considers to be the most important aim of his presidency. To the European bystander, US healthcare would seem to be in desperate need of attention. Despite the United States being the world’s richest country, millions of its people do not have healthcare cover and anyone who’s seen Michael Moore’s film Sicko will know that even those with cover can find themselves severely financially compromised by the payments they are forced to make. The system costs more per head than anywhere else in the world, but yet is only rated 37th in comparison to other countries. The effects have been felt beyond that simply of the individual; the struggling General Motors sites the healthcare costs of its staff as a significant contribution toward its instability (link to Washington Post but no longer available).

Why then are some American right so vociferous in their opposition of reform? Meetings of members of Congress who are trying to promote Obama’s plans are frequently being disrupted and Congressman David Scott had a swastika painted outside his office. It seems that healthcare reform is being equated with increased state invention in the lives of citizens something that is, in the minds of some, directly comparable to fascism. Former Vice-Presidential candidate Sarah Palin – whom, for what it’s worth, I entirely loathe – is not shy of this imagery. She wrote on her blog, in a gross characterisation of the Obama proposals:

…the America I know and love is not one in which my parents or my baby with Down’s syndrome will have to stand in front of Obama’s ‘death panel’ so his bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society’, whether they are worthy of healthcare. Such a system is downright evil.

Here and elsewhere the NHS has been getting caught in the crossfire.   Palin is presumably referring to NICE’s attempts to decide whether expensive drugs provide value for money.  Republican senator Chuck Grassley has also confidently said that, under the NHS, Senator Edward Kennedy would be left to die untreated for his brain tumour.

Misinformation must be blamed for the violent reaction to the possiblity of health care reform, but if I was an American I would be more concerned about the wider issues. If the society that the Americans have built is simply not coherent enough for people to wish to contribute toward the health of their fellow humans then it is in urgent need of reevaluation. Those without healthcare should not simply be the disparaged “them” of my dinner companion’s discourse. For universal healthcare to work “us” is the most important word.


I should point out that I do not consider myself to be “anti-American”.  An interesting read on the subject is The Eagle’s shadow: Why America fascinates and infuriates the world by Mark Hertsgaard.  Also BBC North American correspondent Justin Webb wrote this interesting piece for Radio 4’s From our own correspondent recently.

Independent: Is US healthcare so bad that it needs a lesson from Britain? – Q&A
Guardian: US Healthcare
Guardian: Debate over US healthcare reform takes an ugly turn
Guardian: ‘Evil and Orwellian’ – America’s right turns its fire on NHS
Guardian: This NHS row is paralysing progress – if you only read one of these links make is this one

BMJ Blogs: Is it unpatriotic to criticise the NHS?


Addendum Mark Mardell on From our own correspondent

Write a Comment



  1. I think that this is a somewhat biaised article, i have friends and family who work and use the health care systems in both countries.( most of my class mates are in the USA). I like the universal health care but all too aware of its limitations.
    I think the fear in most americans who are tax payers are not unfounded. The issues with universal health care include
    — waiting list
    —- prioritisng health care and rationalising who and what is entitled to what.
    —-inequality despite universalization
    I have always found the idea that a young mother who has worked with her partner all her life to fund a system would be denied herceptin to improve her chances of remission from cancer as part of cost benefit ratio when if her contributions were put into health insurance from the start she would have got the best medical care in the world and more.
    Use of thrombolysis still occuring in some areas instead if angiogram as cost cutting measure.
    In the USA For a society in which individual suruvival against all odds with the settlers is celebrated and personal acheivement is rewarded, universal healthcare is not something that would be appreciated except by non tax payers.
    remember a lot of migrants from europe in this century to America moved away because they wanted a society where individuality is recognised and not dwarfed by social concerns and this is the basis on which the country became the world’s leading power.
    other issues:
    maybe if we all paid for our health care , there would be
    —greater individual responsibility for health for ie binge drinking, obesity, risky life style and holidays when you know its going to affect your health insurance.
    If i buy an aston martin and park in a dodgy neighbourhood where it is vandalised i anticipate increased costs nest year for my car insurance.
    —Less abuse of the NHS….we know the amount of DNAs we getin our various clinics.
    —doctors are individuals more accountable towards the patients as opposed to a faceless body( libel payments are usually enough to keep any in check)
    comparing france and the USA is like bananas and pears, completely different,in france the expectations from the health care system and demands are less intense than what an American wants even expectations in the different parts of UK differ ie. london vs Barnsley.
    Even france vs Uk differ
    France workforce for instance will be mainly francophone limiting the amount of exodus that could occur gegraphically meanwhile the Uk has relies heavily on foreign anglophone workforce esp in hospitals outside the major cities who are easily attracted by greater prospects in canada, Australia, middle east and India which have private health care.
    So many questions with no answers
    The truth is there is no ideal system and i think it should be left to the public to decide what is best in a democracy, I am Barack Obama’s biggest fan but i think public opinion as in the voters should determine the degree of health care reforms.

  2. Yes, I agree with anne. This is a biased article written with a socialist worldview. Think of all the bureaucracy and inefficiency you put up with in the NHS (often in the name and fairness), the lack of control you have over your career and life choices, and the high taxes that you pay – all in the name of promoting the mediocracy.

  3. actually mental health nurse has me wrong, the NHS is not mediocre at all, i have more control over my career than my friends who work 90 hour week in the US, i have the flexibility and choices they dont have with a better work-life balance. im just saying there are pros and cons to it all. I love having universal health care and i continue to hope for its sustainability, but that if the americans choose otherwise. good for them dont push it. by the way, mental health nurse might want to check what socialist means in the dictionary and find that its actually something positive before brandishing it around like its a curse

  4. I’ve consistantly had a brilliant service from the NHS. I have private cover but no reason to use it.

    The US would be lucky to have what we have.


  5. Anne: What you’ve said sounds nice in theory but there is an “inconvenient truth” which is that Americans pay twice as much for their healthcare and yet they are significantly less healthy, on average, than British people.

    If I offered to sell you a car for $5000 and someone else offered you a worse car for $10,000, and when I pointed that out he started calling me a socialist or whatever… wouldn’t you be a little skeptical?

  6. I think the fear in most americans who are tax payers stem from some part ignorance and part factual knowledge about the limitations of universal health care including
    — waiting list
    —- prioritisng health care and rationalising who and what is entitled to what.
    —-inequality despite universalization as a way to cost cut.
    ie. Herceptin issue,
    – universality taking away individual responsibility for one’s health in a nation where individual acheivements are rewarded and celebrated. Still no perfect system, each country has to work out what suits them.

  7. There do seem to be a significant number of members of the American Right who set out to prove every negative stereotype snarky Brits and Europeans might have about Americans being stupid correct. Only someone truly knuckleheaded could honestly believe that Obama intends to introduce ‘Death Panels’ to decide if members of society should be allowed to live or not, but Palin oddly appears to be playing to a genuine constituency.

    Equally odd is exactly why the word ‘socialist’ is regarded with such horror by some. Did your dinner companion not realise that the ruling party in this country is (allegedly) a socialist one?

  8. Dead right – I saw a piece on Newsnight yesterday, and it was amazing the amount of BS being talked about the NHS in America. ‘Death panels..?’ The answer to Palin (an entirely different sort of comedian to Michael) is of course ‘what about all those parents of children with Down’s, or a hundred other conditions, who CAN’T afford healthcare insurance?’ Spot the difference.

    On issues like this, the gulf between the USA and Europe has never been wider. And amen to that, frankly

  9. America will be so lucky when it finally does have universalized health care. Unfortunately it’s usually the idiots who are the loudest and most ridiculous and capable of the most astounding leaps of logic (really? death panels?), but it is changing. Obama has inspired many people in this country, and really, the change is palpable, in some places anyway. Obama and his supporters have 8 years of damage and anti-thinking (read, anti-intellectual elitism!!) to fix, so it might take a while.

    I don’t know too much about the NHS, but talking to some UK friends, it seems awfully enviable to not have to worry about whether or not it’s financially convenient for you to become ill, be in some sort of accident, or, for some people, have to choose between eating or saving your sick kid’s life. In many cases, people can’t even qualify for health insurance if they have “preexisting conditions”–let alone whether or not they can even afford it. Oh, you’re already sick?–we’re sorry but we only insure healthy people.

    And, no, individuality, personal responsibility, respect for one’s own life and the lives of others *are not* sacrificed when practicing compassion. Basic, human compassion…ooh scary socialism!

  10. I am so grateful for the NHS. I worked with an American who was half British, half American and she said that British people don’t understand that every time you visit your doctor in America, your health insurance premiums go up. She said it is like when you use the AA or the RAC – every time you call them out for help, your car insurance premiums go up.

    When we are healthy we give doctors a very wide birth as nobody likes going to see doctors and being prescribed medicines.

    My niece slipped in a pool of water last autumn and banged her head and was in a coma for days and had operations that cost at least £60,000 each time. We are all very grateful for the NHS. We are so fortunate in Britain. Why are we the lucky ones? I still don’t know. When you think that but for an accident of fate, we could all have been born in sub-Saharan Africa – why are we the lucky ones?

  11. I wish the NHS would sue. I get so sick of hearing about the “horrors” of socialized medicine in the U.K. and Canada. My retired mother was spewing this propaganda the other day about socialized medicine when I asked her what she thought Medicare was. She admits that this system works quite well for her. Yet is unwilling to provide it for others. How Republican of her.

  12. Videos titled, “Autistic Adult in Crisis Goes Unnoticed” and “Shocking Patient Neglect of Autistic Person” on youtube warrant immediate attention to dangers of managed care and general hospital medical mismanagement of severely autistic patients in California. What we witness here is a FAILURE to care, as in from the heart. There is little intrinsic motivation for many nurses, doctors to really HELP their patients, especially complex ones that require complex care management. So do we need healthcare reform? DO we really need to change a system, when the real problem is heart care reform? As in value, dignity and respect for persons with special needs, the elderly, sick, infirmed, disabled, blind lame? WHERE are the miracle workers of today? Where are those that go the extra mile to help patients?

  13. I don’t even understand how I finished up right here, however I believed this submit was great. I do not know who you are however definitely you are going to a famous blogger in the event you are not already. Cheers!