Why is the US having trouble with health reform?

So various US publications have waded into the health reform debate with comparing the US with the UK’s NHS.  These commentary, as many other bloggers and those on Twitter, are of varying degrees of stupidity, ignorance and general lack of insight.

It is worth keeping in mind that for decades, there have been comparisons between Canada’s healthcare system (very similar to the UK’s NHS, but there are very important differences, too) and the US.  The Americans have these debates constantly and the various lobby groups are well-equipped to flood the ether with their rhetoric. There is a deep-seated concern about ‘socialised’ medicine, about the role the state usurping individual responsibility, and about power and control.

And the spirited defence of the NHS will no doubt continue apace.

But underlying the debate is the unanswered question of why does the US have so much trouble with reforming its healthcare system in the first place.

One reasons is that Americans seem have a lot of trouble with what are called free-riders.  Because their system is insurance based, those who do not take out/cannot afford health insurance, get a ‘free ride’ on the taxpayer, through the federally funded Medicare/Medicaid programmes for instance.

By and large, Americans philosophically are liberal in their outlook, and believe that individuals should make the most of their gifts, so the system rewards, and celebrates success, and while not necessarily punishing failure, ignores it as long you pick yourself up and get on with improving your life.  Ideologically, that means that it is hard to grasp that everyone may have an interest in the general welfare of individuals, AND that the responsibility for the general welfare is the responsibility of government. Practically that translates into a political ideological debate about the role of the state.

Why does that matter?

The US politically is a different system from parliamentary democracies. In the latter, political parties stake out ideological territory (left, right, socialist, whatever) and the electorate chooses.  In the US, the United States itself IS the ideology.  The political parties are interpreters of this founding ideology and the electorate chooses within that ideology from the political parties.  That explains in part why there is a narrow range of political choice on offer in US elections, and why, under the skin, all political beliefs flow back to the founding ideology of the US Constitution, and its revolutionary roots.  The US believes it is the definition of democracy, so why would one have varying degrees of political persuasion if you’ve already solved the hard problem.

That means that the health reform debate is predicated on historical consensus about the political objectives of the US as a democratic entity. One of these principles challenges the role of government, another principle addresses individual liberty and third focuses on how the US interprets the public interest and general welfare.  The third principle is NOT interpreted by the state (as in the US, the state is a creation of the people), as it is parliamentary systems (where the state exists independently of the people — read Hobbes).  In the US, the resolution of a political debate amongst competing interests determines the public interest as the state does not have an independent existence and so cannot have its own guiding principles.

Why should this matter?

Because in the US, these debates nourish the democracy itself. The discussion is not esoteric but fundamental to the concept that Americans have of their country.  Such debate in UK, France, Germany, Canada, etc, with universal health systems, will invariably invoke principles to resolve the issue, that can not work in the US political arena.  The difference, of course, is that while the Americans will have the debate, other countries will sit complacently by while their governments pursue reform policies which should be challenged and debated outside the government.  The differences are subtle, but important.

One thought on “Why is the US having trouble with health reform?

  1. Jacques - Toronto

    Scholars and health care experts miss the mark totally when debating the merits of one system over another well they fail to recognize the degree to which racial stereotypes in America affect opinions and public policy on socialized care and assistance. If the debate was only about reform and the best system, this would hardly be an issue. After all, the facts are undisputable that the US system if inefficient and spends more money on only a segment of its population when other countries do it for less and for their entire population. In the US, race is a factor in everything.

    The issue has less to do with the model or the media’s ratcheting of the right wing capitalist independent free market ideology and the anti big-government rhetoric than it does with American value system and their thinly veiled racism that sees non “real Americans” receiving an underserved publicly subsidized benefit.

    Americans value hard working individualism and associate themselves with the image of the thick skinned white American pioneer, self sufficient “pull yourself up by your britches” white Marlboro Man, independent of government meddling, and living up to dreams of their white forefathers who wrote a constitution with an ideology of white Christian supremacy.

    Its not that Americans are selfish or uncaring, but they are discriminate and when they see their identity changing, a segment of the population is ready to resist change and demand that we “go back to the way things were” and the way “our forefathers intended”. During the depression and right up to the 60s, the images of the underclass in need of social and charitable assistance were primarily whites, like those in soup kitchens, bread lines and Appalachian shacks.

    After the baby boom, whites have seeing their birth rates decline, and in the face of illegal immigration and increasing non white immigrants, “real Americans” fear they will now become a minority and be treated as such. “Real Americans” are insecure, feel threatened and are looking for assurance that they will be more entitled than non-whites. Providing socialized care to new Americans only adds insult to the shrinking “real (white) Americans” as they perceive lazy non-whites as undeserving immigrants, Mexicans, Hispanics, Blacks, Indians, and Muslims taking advantage of American goodwill. Real Americans would likely be more in favour of a public option if only American born persons were entitled.

    Until the definition of “real Americans” includes all Americans and they raise the veil on racism and white nationalism, the US will continue to struggle with health care reform or for that matter, any kind of regulatory reforms, even if it’s for their own good.

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