The Affordable Care Act (Obamacare) came into force in the USA in June 2012 to regulate health insurance and curtail some of the worst practices engaged in by the for profit health care industry. The aim was to make affordable health care available to more Americans. This included establishing minimum standards for health insurance, and better regulation of insurance companies such as stopping them charging more according to gender or health status, or refusing coverage for people with pre-existing conditions. In October 2013 Republicans blocked funding of the federal government unless there was a delay in the implementation of Obamacare. The US was brought to a standstill for 2 weeks in an attempt to blackmail the Democrat government into dropping or at least delaying Obamacare. Whilst the tactics did not work and a budget was agreed, the bigger issue remains unresolved.
And it is not just politicians who dislike Obamacare. A Reuters-Ipsos poll from last year found that approximately 56% of Americans are against the Act and that a majority of older people oppose it whilst those under the age of 40 are more likely to be in favour of the changes. Three quarters of democrats and only 14% of Republicans support the law. How is it that a law designed to ensure that more Americans have access to quality, affordable healthcare is so disliked?
At the present time as many as 48 million Americans have no health insurance cover and people are dying through a lack of basic care. The US is ranked last (out of 16 industrialised countries) when measuring preventable deaths. Similarly, a survey of chronically and seriously ill adults in the US, UK, Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden and Switzerland found that sick adults in the US had the highest problems paying medical bills and were most likely to go without care because of the cost. Given these figures it is difficult to see how anyone could be against reforms aimed at increasing access to healthcare. However, Obamacare speaks to wider issues within US politics. Debates about whether it is Socialist or Communist in the US press detract from the fact that healthcare is about shared humanity and solidarity, not ideology.
A quick trawl on the internet provides a number of myths about Obamacare which have been circulating through the media. In 2010 it was reported that all Americans, (or at least those using State regulated provision), would need to be micro-chipped so that they could be monitored. It was also reported that illegal immigrants would receive free healthcare and that Congress was exempted from Obamacare. In 2009 Sarah Palin, former governor of Alaska, announced that, under Obamacare, death panels would be appointed to decide which older Americans deserved healthcare and a chance to live and which did not. Three subsequent polls found that almost 9 in 10 Americans had heard this myth and approximately 3 in 10 believed it.
These myths tend to originate in right wing media outlets and draw from anti-state, libertarian thinking. The rhetoric abounds, such as “government run agencies are inefficient and corrupt and there is no reason to think a government run health insurance system will be any different” or the allegation that “patients will demand more drugs and care of they don’t have to pay for it and costs will spiral for everyone as tax payers will be required to pay for this”. “Not-for-profit organisations already provide health care and it is illegal to refuse emergency care so these categories of people are already covered for basic care – Obamacare does nothing new for these groups”. These arguments hinge on a fear of big government. But they also draw on an ‘us’ and ‘them’ mentality. Why should I have to pay for someone else’s healthcare through my taxes? Particularly as those people have failed to make provisions for themselves, and are likely to be greedy and consume more healthcare (that I am paying for) if they are not required to pay for it. Advocates of the positive social impact of these healthcare reforms have been unable to shout above the clamour of individualist objections.
And what of the UK? – the coalition government is moving inexorably towards a privatized, insurance based healthcare system in the UK in the model of the pre-Obamacare American system. We are bombarded with media stories telling us about the failures of the NHS: increased waiting lists; overflowing A&E departments because of inadequate Primary Care provision; poor nursing quality; basic needs of patients being ignored; unnecessary deaths of elderly patients. And alongside this the NHS is being sold off service by service with land and buildings sold to bankers and equity investors. At one stroke attacking the financial foundations of the NHS and at another attacking public belief that a tax based national healthcare system is sustainable. Pollock states:
“Since 1948, the NHS has been the model for universal heathcare on the basis of need and free at the point of use. In 2012, parliament in England passed a law effectively ending the NHS by abolishing the 60-year duty on the government to secure and provide healthcare for all. From 2013, there will be no National Health Service in England, and tax funding will increasingly flow to global healthcare corporations.”
The NHS only continues to exist as a brand that the government plans to franchise around the world. The promise of solidarity upon which it was founded is gone. But what we do have left is a belief amongst the majority of the British people that healthcare is a right and not another service to be bought by those who can afford it. Solidarity still wins over individualization at least in the realm of healthcare. And whilst that sentiment remains we need to fight to stop and then reverse the erosion of the NHS or we too may need a UK equivalent of Obamacare in decades to come to restore that which we have lost.