Tuesday, 11 August 2009

In which I declare America Week officially open

Posted by Tania Kindersley.

All right, my darlings, I am back. My guests are gone, my pitch is sent across to my co-writer for fine tuning, my desk is metaphorically if not literally clear. I am ready to rumble.
I have had low level angst about not doing more blogging over the last ten days or so. I find this oddly psychologically interesting. What can it matter if there is a little hiatus every so often? And surely it is too much to ask for people to read constant, dense bombardments from the front line? No one is paying me, there is no small print. And yet, I feel there is a kind of contract in this blogging. Having set up the thing, and been lucky enough to get some regular readers, I believe that I am under some obligation to provide quality content. This is absurd of course. The point of blogging is that there is no contract, there are no rules; it is, in the best spirit of the internets, a freeform medium. But I can’t escape the feeling that if you are kind enough to give me your precious time, I owe you the good stuff.

In this spirit, I declare America Week officially open. As some of you may have gathered by now, I am geekily obsessed by American politics. I followed the elections, right back to the first shots of the primary battles in the snows of Iowa in 2007, like they were some great gaudy sporting event. I had to learn a new set of rules and an entire new vocabulary. I thought I knew quite a lot about America, having spent my life watching American films, listening to American songs, reading American novels and poems and plays. I liked to think that Britain and America were two great cultures united as much as divided by our common language. I thought we admired and understood each other. Once I became steeped in American politics, in its startling details and odd scandals and unexpected rituals and too strange to make up cast of characters, I realised that all this time I had known nothing about the country at all. It was as if I was starting all over again.

I have resisted writing about this too much because I felt it was bad manners to expect you to join me in my obsession. Now I think: what the hell, let the big dog bark. It is silly season; the Today Programme is running items about tortoises. Let’s have some big, meaty cultural and political questions to keep August lively. There are so many of these questions that I am going to divide them up over the next few days, otherwise this post will be so long that it will make your eyes explode. Today’s instalment concerns the vexed matter of healthcare. That sentence might sound horribly dry and off-putting, but stick with me. It is Shakespearian. It is a four act opera. It has produced events so shocking and peculiar that I have to scrabble hard to find any explanation for them.

To understand the labyrinthine matter of Americans and their sickness and health would take an entire book, possibly in two volumes. The basic skeleton of it is this strange fact: alone among the industrialised nations, America does not provide its citizens with healthcare. The very poor and the very old are cared for by the state. All the rest must have health insurance. This may be bought privately, but is expensive, and is usually provided by employers. There are several problems with this: if you lose your job, you lose your healthcare, so suddenly you cannot have that operation you need. There is also a health gap: there are about forty-seven million Americans who are not poor enough to qualify for state help, but not rich enough to afford insurance. Beyond the problem of the uninsured, who just hold on by their fingernails, hoping they do not fall ill, there are the limits and exceptions and devilish small print of the health insurance business. It’s not just the upfront stuff: it is stated clearly that you have to pay part of the costs of your treatment, often running to thousands of dollars. It’s the insidious unspoken stuff, told by indignant whistleblowers whose job it was to comb policies line by line to see if there was any way the insurance company could get out of paying. A woman was recently denied treatment for breast cancer because she had once received medication for acne. Then there is the racket of pre-existing conditions: you may be refused insurance because you are too thin, have once had a yeast infection or have high cholesterol. And finally, there is the cost. An average insurance policy would cost a person about $4300 in the US. Here, a PPP policy costs £307.12. For £5.90 a week, less than the cost of a packet of cigarettes, I can get private hospital rooms, an operation any time I need it, and swanky Harley Street consultants in three piece pinstripe suits. The only exception is psychiatric treatment, so if I go nuts in the night I am in trouble. But then I have the dear old NHS to fall back on.

I could blind you with numbers about the bloated healthcare costs in America, the number of bankruptcies related to illness, and the high price of drugs. But it seems that the one number you need to know is that the World Health Organisation ranks the US at 37 in quality of healthcare. Opponents of reform say, over and over, as if someone laminated it on a card for them: ‘We don’t want to be like Europe. We don’t want a system like England.’ (For some reason they leave Wales and Scotland and Northern Ireland out of it; too Celtic, not socialist and scary enough, I don’t know.) The very word Europe stands as a terrifying shorthand for slavering, leftist, big government coming to refuse your operations, tell you what pills you may take and let you die in agony on a mixed ward. The massive irony, so big you would need to build an extension to house it, is that the number one country in the WHO ranking, the five-star ocean-going fur-lined healthcare system of the entire world, which makes its citizens so happy that their only complaint is that it is too lavish is.....France. The crazy cheese-eating surrender monkeys, when they were not wafting about smoking Gauloises and being too intellectual for their own good, actually took the time to build nice gleaming hospitals to which all their citizens have access. Even the creaking old lady that is the NHS, which the right wing in America points to as a death service rather than a health service, and about which we Brits like to bitch and moan, puts Britain twenty places above America in the world health rankings.

Even reciting these bare facts leaves me shocked all over again, like Mary Whitehouse hearing someone say fuck on the television before the watershed. In the face of this startling state of affairs, you would think that when an American politician mentioned healthcare reform everyone, from left and right, up and down and round the houses would shout YES YES GIVE IT TO US NOW. There would be parades and dancing in the street. No one, not even a grasping multi-national corporation making billions of dollars of profits a year, would want to see American citizens dying because of the terrible holes in the health service. (Depending on whose figures you believe, somewhere between 18,000 and 22,000 preventable deaths occur in the US each year, six or seven 9/11s; I have absolutely no way of explaining why this is not front page news.) The citizens would rise up in delight and relief and bake cakes and send flowers. Or at least, this is what I would think. Instead there is bareknuckle political fighting, last ditch resistance from vested interests, confusion among the populace, a very, very strange moral equivalence from the media, almost as if they collectively want the President to fail because it makes the story more interesting, death threats, intemperate insults from talk show hosts, blatant lies from Sarah Palin, shouts of fascism, mobs bussed in to town hall meetings with instructions to disrupt the proceedings and shout the other side down, cowardice from so-called blue dog Democrats, yelps of socialism (‘Well, Hitler was a socialist,’ says Rush Limbaugh, who is a very peculiar man inexplicably popular on the wireless; ‘it was called the National Socialist Party.’), violent denunciations of all forms of government programmes, and accusations that it is all part of Obama’s evil plan to kill your granny. I am not making that last one up for comic effect. It was stated in terms by an elected representative on the floor of the House.

This is when I realise that I do not understand America and how it works. It is the greatest power in the world. It has more money, more Nobel Prizes, more brilliant technology than anywhere else. It has a dream, dammit. One of the things I like about America is that it is not just a country, it is an idea. And it is a truly marvellous idea. The idea is that all men and women are free and equal and entitled to life, liberty and the pursuit of happiness. A corollary to this enchanting idea is that anyone, be she never so humble, be he never so obscure, can rise to the very pinnacle of national life. Barack Obama, the black son of a single mother, proved this idea rather brilliantly in the last election. Obama is the American dream, walking and talking and wearing a sharp suit. And now people are calling him a Nazi. (Oh, and a racist, too, just for good measure, although you would think that if he is such a staunch student of Hitler that goes without saying.) The reason he is being accused of fascism is not because he wants to herd people into camps or insist on racial purity, but because he would like to fix a system which puts the mighty United States only two notches above Cuba in the world health ranking. He would quite like (call him old-fashioned) for twenty thousand odd of his compatriots not to die because they don’t have insurance. He would like, dangerous radical that he is, for people to pay less for life-saving medicine.

If a great country has a crappy system for guarding its citizens' health, it seems only logical that you would want to change that system. There is something about the extreme reaction of the opponents of healthcare reform that suggests they are very frightened. You don’t go around screaming Nazi and talking of government ‘death panels’ if you are feeling calm and confident and good about yourself. What I genuinely do not understand, and can find no answer to, no matter how much I read on the subject, is exactly what it is that these people are so very scared of.

Excellent links for further reading:

For an overview: http://www.huffingtonpost.com/guy-t-saperstein/the-only-good-option-for_b_253339.html

The lovely, clever Eugene Robinson of the Washington Post gives a balanced view: http://www.washingtonpost.com/wp-dyn/content/article/2009/08/10/AR2009081002455.html?nav=emailpage

Sarah Palin thinks Obama is coming to kill her children, and the odd moral equivalence of the media: http://www.huffingtonpost.com/dean-baker/governor-palins-crazed-he_b_256136.html


The tremendous Rachel Maddow with a serious and rather scary analysis of what is really going on:http://www.msnbc.msn.com/id/26315908/#32337676

And for a special treat, the always majestic Jon Stewart and his 'little box of crazy': http://www.huffingtonpost.com/2009/08/11/jon-stewart-vs-town-hall_n_256272.html


  1. Well, I can't explain it either. I've lived in 2 countries with nationalized healthcare and *loved* it and in the US. What I've noticed is that a) not all Americans oppose nationalized healthcare. San Francisco has actually set up its own city-wide program because enough people in that city believe nationalize healthcare is a very good idea.

    Americans are raised to believe that they can rise above their humble beginnings, but I've found that often brings with it a selfishness. "I worked hard and rose above, why didn't you? Well now I don't want to share any of my money with you, since I worked so hard for my money and you did not work as hard as I did." I have heard this actual comment. As a whole, I think many voters do not understand tax hikes and vote against anything that suggests their taxes might be raised.

    But on the other hand, I have met a few Canadians (who have nationalized health coverage but no options for private health insurance) who idolize America's system. Again it is motivated from selfishness. This person's father was diagnosed with skin cancer, but would have to wait 6 months to be treated because the doctor had a waiting list. In dreamy America, if this Canadian had the money, they could just waltz in tomorrow and be treated. But there's the rub, in Canada money doesn't buy you special privileges. If the system works anything like Australia's, a small early-stage skin cancer is not as high on the priority list as a big melanoma. To tell you the truth, I really like the medical equality of Canada. Though I do find it disturbing that people can't get GP's in Toronto, apparently there just aren't enough.

    So I think Americans have mostly only heard of the Canadian system and worry a bit, mostly out of selfishness. No one wants to be the Jade Goody statistic, most women don't need a smear test before age 25, but she wasn't one of them. I think they would prefer to sacrifice the health of others (those poor people who don't work hard enough) for their own well-being.

    And why aren't all these poor people who don't work hard enough crying out in excitement at Obama's plans? They're either out working, they're disillusioned by the system, or they just don't realize that they can do something to say "yes, please do this".

  2. Ah, the word I was looking for was meritocracy. After posting my comment I happened across a very good TED talk by Alain de Botton, which speaks to some of the problems with a meritocracy. I particularly saw these issues of "losers" rather than "unfortunates" in the US.
    It's called "A kinder, gentler philosophy of success"

  3. 'What I genuinely do not understand, and can find no answer to, no matter how much I read on the subject, is exactly what it is that these people are so very scared of.' I do so agree with you on this issue. It seems so strange that the weathiest country (say) in the world does not want to provide a national health care to all its citizens.

    Excellent post, I really enjoyed reading your thoughts on the matter.

  4. Okay, sorry to keep commenting on this, but I thought that maybe someone might be interested, maybe?

    I've seen a lot flashing past on facebook, mostly friends of friends, but there are a lot of them worried about where the money is going to come from to pay for this universal healthcare. I get the feeling that they don't understand that universal healthcare means that they won't have to pay the very large monthly sums of money (and their employers won't either) that they currently pay. Plus they're scared that suddenly they're going to be paying for all these other people's healthcare, on top of their own healthcare.

    I just thought you'd like to know why they aren't jumping all over it. (I completely disagree with them, and I think that they're wrong, but it's what they're saying) Oh Media outlets, why can you not get excited about universal healthcare?

  5. Tania, your astute analysis of our pathetic, bizarre and ridiculous U.S. health "care" system and the current debate should be required reading for all the wingnuts shrieking their way through town-hall meetings. Sadly, those people appear to be illiterate. I may move to England shortly. Thank you for your thoughtful, spot-on post.

  6. As an outsider who has lived in the US for some amount of time, I can confirm the pathetic quality of health care that they provide.

    Things work only if you are young, reasonably healthy and have a job. Even then, you spend ages waiting to get an appointment with a doctor. If the said doctor refers you to another specialist, you wait for another couple of months...and so the story goes.

    I come from India and even though it is a 3rd world country, anyone has complete access to any physician they want. If you are sick today, you can meet a doctor and get tested and treated today - and all for a quarter of the amount you would spend in US.

    The hospitals and clinics are not swanky, but they are there, and they are accessible to all - rich or poor.

    Although treatments for major illnesses like cancer etc. can still break the bank, at least you are not being given the run-around for minor complaints.

    It is a well-known fact that most Indians who live in America combine their annual vacations with dental treatments, health check-ups, and stock up on over-the-counter medication, which is insanely expensive in America. What a holiday huh!

    The reason most senators in America are against Obama's bill is simply because the Insurance lobby is so infamous and all-pervasive. That's why it is so difficult for such decisions to get made.

  7. To all - thank you so much for fascinating comments. You have achieved just what I always want on this blog - an excellent and informed discussion. (Always imagine Mrs Merton's voice in my head: Now let's have a heated DEBATE.)


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