Tuesday, March 23, 2010

Underwhelmed by "reform"

While I was focusing on the government's plans to dig up our national parks yesterday, there was an even more dramatic political landmark in the US: the US House of Representatives passed President Obama's healthcare reform package 219 - 212, extending healthcare to 32 million Americans.

This is an enormous change in the US, and it means Obama will go down in history not just as the first black President, but also as a President who actually did something. But to foreign eyes, the "reform" seems somewhat underwhelming. In NZ, as in the rest of the civilised world, if you get sick, you get treated, and the government pays. Oh, there may be some waiting if surgery is "voluntary" (meaning "not immediately life-threatening"), but that's the general principle. Healthcare is seen as a public good, like sewers and a fire service and a welfare system - something necessary for people to get on with their lives. Private health insurance is for stupid people who don't know they don't need it (alternatively, snobs who don't want to mingle with the hoi polloi), or for people with cosmetic surgery addictions.

The US sees healthcare as a private good, and so their health infrastructure is centred on privately-owned insurance companies and hospitals. Obama's reforms work within this framework rather than tearing it down, and so the expansion is achieved primarily by requiring people to buy insurance, coupled with tax credits to help them do it. There is some expansion of government-funded healthcare, but its mostly a giant subsidy to the insurance industry.

(Oh, and the price of this reform? Preventing federal subsidies from being used for abortions. But if all insurance programs are (or are potentially) subsidised, then this means that abortion will suddenly become a lot less accessible. Oh, it will still be legal - just unavailable in practice. Thanks, Obama).

As healthcare goes, this is a crazy way to do it - a bastard hybrid of public and private which will primarily benefit insurance companies. And it makes you wonder why the government didn't just set up its own "insurance" provider / health funding agency, and avoid paying for the profit of grasping insurance companies. These Americans really are crazy...