The unhealthy unwealthy

OPINION: One of the most nauseating gimmicks in the United States debate on healthcare reform came when Republican John Shadegg held aloft a baby called Maddie and projected his voice as if she were some ventriloquist's puppet, writes The Southland Times in an editorial.

"Maddie says 'don't tax me to pay for healthcare that you guys want' ..."

Maddie believes in freedom and patient choice, Mr Shadegg told the House. (Maddie also believes, as satirist Jon Stewart later pointed out, that if you shake your keys in front of her and then put them behind her back, they cease to exist.)

In the end, Maddie's undeniable cuteness didn't quite distract attention from the sheer ugliness of the existing health system in the United States, and the reform bill passed. Attention now turns to the Senate, where more inglorious tactics are to be expected. If President Barack Obama can pull this reform off, then he will have achieved a rare feat.

The world's pre-eminent democracy still doesn't have a comprehensive national healthcare plan. The Government provides coverage for the poor, elderly and military veterans, while most other Americans rely on private insurance. However, there is a cruel gap that any true democracy should find intolerable – 56 million people uninsured and dark insurance industry practices to denying coverage because of medical conditions, and the charge of high premiums on the basis of gender or medical history.

The bill passed by the House would expand coverage to 96 per cent of Americans – taking in 36 million who at present are uninsured. It would ban many of the existing coverage restrictions and would strip the industry of its exemption from federal anti-trust restrictions on price fixing and market allocation.

Can't have that, can we? Vested interests have fought reform tooth and nail, and have done so with chilling success. Former president Bill Clinton suffered one of his worst defeats in healthcare, and was punished by a Republican takeover of the house and Senate in 1994.

President Obama's victory in the House now shifts attention to the Senate, where his reforms will be once again decried as a "jobs-killing, tax-hiking, deficit-exploding" bill.

It is indeed a huge reform, but the scaremongering has been extraordinary.

The case against reform, predicated on the fancy that the Government wants to interfere too much in the private health sector, sits badly with the concerns of the day.

With unemployment climbing above 10 per cent, and the jobless finding that they have lost their company health insurance, the thought of some governmental dabbling, some restraint on insurance company practices, and a climate in which consumers could more easily shop for coverage, holds plenty of appeal.

It is a complex piece of legislation; its 1990 pages entail a 10-year, $1.2 trillion transition.

Whether it truly needs to be so labyrinthine is something that New Zealanders can only wonder about. And there's no denying that parts of it may not fit well with the archetypical American psyche. Within it is a degree of compulsion: most people would be flat-out required to carry insurance. However, federal subsidies would be available for people who could not afford it.

The law does not, as so many Republicans insist, threaten to destroy private healthcare. It does, however, go some way towards keeping the industry a good deal more decent than it has needed to be for many decades.

It represents, potentially, progress of a historic scale, addressing a problem of historic infamy in the United States.

- © Fairfax NZ News