Obama’s pledge of universal health coverage is no more

In Obama’s State of the Union address, the president acknowledged mistakes made in his first 12 months in office and pledged to persist with health insurance reform. So where has Obama got to with his health reforms and how has his promise of universal health insurance coverage changed and diminished?

“After nearly a century of trying — Democratic administrations, Republican administrations — we are closer than ever to bringing more security to the lives of so many Americans. The approach we’ve taken would protect every American from the worst practices of the insurance industry. It would give small businesses and uninsured Americans a chance to choose an affordable health care plan in a competitive market”.

This quote from Obama’s speech very much reflects Obama’s bi-partisan approach to politics and desire for unity. In the first line he talks about democrats and republicans being closer than ever – many Americans who were wholly behind Obama a year ago feel that, in regard to healthcare, he has compromised far too much to republicans and vested interests .

Then he says “we are closer than ever to bringing security to the lives of so many Americans”.

However a year ago he promised coverage for every man woman and child – yet the bill as it currently stands (and it’s not through yet) will leave 17 million uninsured, and in America health insurance is crucial.

• If you don’t have health insurance, and currently 47 million Americans do not, it is very hard or impossible to access healthcare due to the exorbitant costs. Those who are not insured tend to be the working poor.
• There is a very competitive insurance market in America and these profit driven providers compete for the healthier, younger people as they are more profitable.
• The insurance companies refuse to cover people with pre existing conditions such as asthma, heart disease and diabetes as they drive costs up – which reduces their profit.
• The CEOs of the five largest insurers are paid on average $8 million a year EACH.

It is issues such as these that Obama was referring to when he said that the Affordable Healthcare Act “would protect every American from the worst practices of the insurance industry”. But that is exactly it – the bill as proposed would prevent insurers from taking on just the young and the healthy and excluding certain people depending on health status. But look closely at the language, he is not saying he will eliminate all bad practice, simply that he will take out the worst.

In the next sentence he says, the plan “would give all Americans a chance to choose an affordable healthcare plan in a competitive market”.  This is where he really has fallen down.

The original plan proposed that every state would have a federal/public insurance plan that would be cheaper than the private plans which would make it more affordable to people and drive down costs but this has been abandoned in the compromises.

Yet one cannot over estimate what Obama is up against – unbelievable opposition. The Republicans have driven a campaign against him – they describe Obama as a communist and a socialist and the reforms as unconstitutional. Republican Jim Demint has said that the healthcare reform will take away freedom.

We also know that $1/2 billion have been spent by healthcare lobbyists lobbying against Obama’s reforms. The republicans are against it wholeheartedly. The private profit driven insurance companies are against it and now many democrats are against it because they think Obama has given away too much. The previous six attempts to reform healthcare in America from Roosevelt to Clinton have failed.

So what happens from here?  Some think that this watered down version which will leave 17 million Americans uninsured and drops the public element, will go through. Others say it’s the first step in the right direction, not the perfect bill an important step which can be improved. 

Marcia Angell (well worth looking up and reading), a medic, Harvard lecturer and critic says “It simply throws more money into a dysfunctional and unsustainable system, with only a few improvements at the edges.”

Paul Krugman suggests that Obama’s policy and political judgement is poor, something which is evident in his healthcare plans, and that compromise is leading to broader, shallower legislation that could be easily challenged.

Republicans say that if the legislation goes through they will repeal it as soon as they are in power.

Scott Brown, the Republican who was elected to Ted Kennedy’s seat in Massachusetts last week is a significant shift in power relations. Brown, the pick up boy, won a seat in a state where democrats had a 3 to 1 majority and where they have tried to do what Obama is attempting for America – universal coverage and bringing health insurance costs down.

They have failed as Obama will. Those in Massachusetts are unsatisfied because not everybody is covered (200,000 remain uncovered) and they continue to have rising health care costs. Why? Because they have failed to cull the dominance of ‘for-profit’ providers.

America spends more than any other country on healthcare yet it has poorer developing world health outcomes than 40 other countries in the world and fares particularly badly for poor people and African Americans.

But we know why – there are rising healthcare costs in America because profit-driven  providers are more interested in profit than healthcare, because ‘for-profit’  healthcare leads to poorer health outcomes, because ‘for-profit’ providers over -provide unnecessary health care for the well and do not provide enough for the sick.

But crucially, Brown’s victory in Massachusetts means the democrats no longer have a 60-40 majority in the Senate so they will have to compromise further on bill.

Scott Brown, a man who is in favour of water-boarding, campaigned very effectively against the healthcare bill.

Obama’s  ideal for universal coverage as envisaged a year ago is long lost.

America’s healthcare coverage is dividing the nation, yet Obama is criticised for being both too radical and too compromising, This is an issue that will not go away.