Established in 1948, England’s National Health Serivce, has grown to become the largest and oldest single-payer healthcare system in the world. Though it has been in a constant state of re-organisation and “efficiency gains” since the 1980s, it remains one of the finest achievements the UK has ever made. When looking at government-sponsored healthcare in this way, the battle raging in the US over “Obamacare” is hard to comprehend.
Unlike all other industrialised nations, America has no guaranteed universal health care, yet it is the richest nation on the planet. Some 60 million Americans have no health insurance – which is approximately one-fifth of the country’s population. Surely, this would be a national scandal and politicians of every stripe would be falling over themselves to pass the legislation needed to provide a national safety net? Not so.
Obamacare seeks to offer (near) universal health insurance coverage to Americans and to be affordable because of its universality – most people are healthy and their premiums offset the cost of those needing care, but of course, public money needs to be spent to ensure that society’s most disadvantaged members won’t slip through the net. The existing situation of private health insurance and public schemes such as Medicare and Medicaid will continue, but loopholes allowing insurers to cease protection if a claimant becomes sick will be closed. Coverage will also include prescription drugs, pregnancy, mental health costs and other services that had been optional in some plans before. Certain additional charges for check-ups, cancer screening and other preventative services. must now be included. The enabling legislation was brought in in 2010.
Republican Regret
Republicans clearly don’t like the concept of Obamacare; despite the fact that it was based on a plan developed by Mitt Romney, former Governor of Michigan and Republican Presidential candidate. The Republican controlled House of Congress has passed 40 bills designed to repeal the legislation or cripple the programme; all of which have been rejected by the Democrat controlled Senate. Republican objections seem mainly to stem from a fundamental objection to “big government” and because they fear it may harm the economy and, ironically, health care.
The problem came to a head at midnight on Monday since that was the deadline for voting through a budget which would avoid a partial shut-down of the US government; the first since 1995-6 (also at the hands of the Republicans).
Republican consent required that Obamacare be deferred for twelve months and was a price that neither Senate Democrats nor the President was prepared to pay. The upshot is that up to 700,000 public employees risk being laid off and will have no certainty of back payment when the budget impasse is resolved. A raft of public services, payments to pensioners and veterans have been delayed; museums national parks and even government Twitter feeds were shut down. An even bigger risk will present itself if no bipartisan agreement can be reached on raising the debt ceiling (whose deadline is October 17, 2013) since this could leave America unable to honor its obligations.
The average cost of Obamacare to individuals is said to be $328 and the poorest Americans will enjoy subsidies to offset the cost which the public purse must pick up, of course. In the European Union, it has been estimated that corporate tax evasion (immoral perhaps, but perfectly legal) costs the 27 EU nation states $1.3 trillion per annum – put in perspective, this is more than EU states spent collectively on health care provision in 2008. The population of the EU is about 740 million; more than twice that of the US. US corporate tax evasion is estimated to be worth $385 billion. The cost of providing free “Obamacare” coverage to the 60 million American citizens currently without healthcare coverage (many of whom could pay their own costs) would be a shade under $20 billion. Surely it should be possible to provide an acceptable standard of affordable health care for all in the world’s wealthiest economy.