When US Affordable Healthcare Act (Obamacare) was introduced in March 2010, it was unpopular. Healthcare affects everyone, and is a very emotional subject. Even though almost nobody thought the previous situation was satisfactory, there was natural fear about what the changes would mean. Republicans also did their best to take advantage of that fear. In fact Obamacare was probably the main reason they did so well in subsequent elections.
It didn’t help that former president Obama’s best known line on the subject: “If you like your doctor, you can keep your doctor,” turned out to be wrong. Another quote, “If you like your healthcare plan, you can keep it,” became Politifact’s “Lie of the Year” for 2013.
The Democratic Party didn’t do a good job of introducing Obamacare, and too many mistakes were made with the roll out.
Nancy Pelosi on Healthcare
On the passing of Obamacare, then speaker Nancy Pelosi said:
You’ve heard about the controversies within the bill, the process about the bill, one or the other. But I don’t know if you have heard that it is legislation for the future, not just about health care for America, but about a healthier America, where preventive care is not something that you have to pay a deductible for or out of pocket. Prevention, prevention, prevention—it’s about diet, not diabetes. It’s going to be very, very exciting. But we have to pass the bill so that you can find out what is in it, away from the fog of the controversy.
(Source: Wikiquote.)
That’s good, but the one part of which everyone remembers is, of course:
… we have to pass the bill so that you can find out what is in it …
Nancy Pelosi, Democrat, California. (Source: Wikiquote. Click pic to go to source.)
Naturally, opponents of the Bill latched onto the phrase. It is one of the main reasons hatred for Pelosi on the right is as virulent as that for Trump amongst moderates and liberals. However, it has proven accurate. (Pelosi though, continues to be vilified. Her reputation is beyond redemption now with conservatives.)
Initially, a majority of USians were in opposition to Obamacare. However, as time has gone on and they have found out what’s in Obamacare and what it means for them, there’s been a big change. Now, according to Gallup, a majority (55%) approve of the Act.
In addition, a majority disapprove of the Republican plan to replace Obamacare. In fact, only 17% approve of the Republican plan: The American Health Care Act.
The lowest level approval for Obamacare ever fell to was more than double that.
US Attitudes to Healthcare
Ironically, it was the election of President Trump that has brought this attitude to wider attention. One of the things Trump frequently spoke of at his rallies was that he would get “beautiful healthcare” for everyone. He referenced how great the universal healthcare systems in other countries, specifically Scotland, Canada, and Australia, were. His promises included making sure no one would lose out, and Medicare and Medicaid would not be cut. And he got the vote of Republicans in droves.
The Republican party, and until recently a large proportion of Democrats too, have a working assumption that USians are in opposition to healthcare for all. This is actually not the case. Polling organisations have finally come to this realization too.
Since Trump’s election, Quinnipiac University has been asking this question in their regular surveys:
How important is it to you that health insurance be affordable for all Americans: very important, somewhat important, not so important, or not important at all?
The results have been consistent – USians, virtually universally, want EVERYONE to be able to have affordable health insurance:
(Source: Quinnipiac University. Click graphic to go to source.)
The selfish Bills that Republicans are trying to pass into law are not what their constituents want. The idea of affordable healthcare for all is not a liberal conspiracy – it’s everyone who wants it.
Killing the Poor to Cut Taxes for the Rich
What the passing of Obamacare did was make healthcare a topic of conversation in a much bigger way. USians began to find out just how far behind the rest of the world they are when it comes to the provision of healthcare. Many now know that USians have a shorter life-span than those in most countries with universal coverage, and they’re paying more than those in other countries too.
They, or their friends and families, began to get the care they desperately needed. The lives of people who were suffering began to improve. Further, it was the extremely wealthy who were paying for it, not the middle-class as Republicans had lead them to believe. And the wealthy weren’t suffering because of the extra taxes put on them in Obamacare – they kept on getting wealthier throughout Obama’s administration.
Now, the Republicans are planning to take away the care of 23 million of those that need it the most, and getting rid of the extra taxes on their wealthiest compatriots. Even the most partisan of Fox News hosts, Tucker Carlson, can’t support that:
(See here for a transcript.)
The Problem with Republican Governments
The problem with voting for the GOP is that their philosophy is basically anti-government. You can’t do something well when you don’t like it. They spent years wasting taxpayers money putting forward dozens of Bills to repeal and replace Obamacare when they were sure that President Obama would veto them. Now that they actually have to do something constructive, they’re incapable of it.
A majority of Republicans probably know that it makes economic sense to introduce single-payer healthcare. (I wrote about that here: ‘America’s Healthcare Problem‘.) However, they hung their hat on the catchphrase “Repeal and Replace” and they’re stuck with it.
Instead of doing the constructive thing and, from the start, working with their Democratic colleagues to fix the problems with Obamacare, all they knew was to be obstructionist. Now 23 million USians are going to lose coverage. Some of them will die because of it.
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Who could possibly oppose “affordable care for all”? Euphemisms always poll well (it’s why they’re called euphemisms). It does not follow that Americans want politicians and bureaucrats running hospitals and medical offices.
Americans are appalled at the depravity of government-controlled medicine….
http://www.dailymail.co.uk/news/article-4644268/Charlie-Gard-s-parents-lose-final-appeal.html
To be an American is to be for good government — and that means the least government.
That case you point to is not driven by the government, it’s driven by doctors, who simply think that further treatment for that baby won’t achieve anything. Parents are often unrealistic and grasping at straws (though that is understandable).
If anything, medicine in the Western world errs on the side of being too interventionist in hopeless cases. Something like half of all health spending is spent on people in the last 6 months of their life.
The doctors are government agents, acting under government policy and oversight. From the hospital web site: “Great Ormond Street Hospital for Children (GOSH) is part of the NHS…. Our work as a hospital is based on the strategic direction established by the Department of Health (DH)…. At a local level we receive guidance from NHS London. NHS London is a health authority that governs NHS bodies.”
The parents are being blocked by law from using THEIR OWN RESOURCES to seek treatment in another country (a country where doctors don’t work for the government). It may be a difficult case, and one may or may not agree with the parents’ decision, but it is unconscionable to deny them and their son their civil and human rights.
There are more than 65 million people in Great Britain, millions of whom are cared for by the NHS every day. Whatever the ins and outs of this case, it is only one. How one case proves your point I am at a loss to understand.
While you bleat on about one case where you don’t believe some of the best paediatricians in the world know best, millions of your compatriots can’t even get access to a paediatrician for their children.
In New Zealand, all healthcare of every type at every level is free for all children. The richest country in the world can’t even commit to free care for its children, though its happy to force them to be born in the first place.
I worked in Quality and Risk Management in the biggest hospital in the southern hemisphere for more than 10 years in NZ’s equivalent of the NHS. I do know something about this subject beyond just being an observer. The single-payer model does better on every measure than a competitive one when it comes to the health of a society. Healthcare is simply not suited to the competition model. There are things for which that is true. Another is the running of the military.
“Healthcare is simply not suited to the competition model.” Capitalist ideologues, and there are some many hear in the US, simply cannot accept this simple and obvious fact.
My understanding is that every human being ever born was “forced to be born”, so I’m not sure why that’s remarkable.
Anyhoo… Same as anything else in this world, modern medical care is fundamentally an economic activity, a system for allocating resources. You may find the truth distasteful, but it’s a business like any other. No amount of wishful thinking will make it otherwise. And political meddling does not make things better.
Not every woman is forced to be a mother, which is how I should have expressed it.
Just because medical care is an economic activity, doesn’t mean it should be part of the free market. When someone is sick, they are frequently not in a position to make an informed choice, such as they are when it comes to what restaurant to eat at. When you’re unconscious and bleeding to death in the road, there’s no way to say who you want to look after you or even whether you want to be looked after.
And it is just not fair that wealthy people get better care than poor people, or those born with chronic medical conditions. In your perfect world, there will be a lot more people born to live a life dealing with a chronic condition too because you want to forbid abortion for any reason. Most of those people will never have a chance to make it in life in a world where they have to pay for their own care or die. In NZ and Britain, everyone is looked after equally, no matter their economic status.
And it’s not about political “meddling” as you put it. It’s about the best decision being made for the people rather than insurance companies.
Insurance companies, private hospitals etc are there to make a profit. That automatically raises the cost of healthcare. In systems like NZ’s or Britain’s, there is no insurance company or hospital adding their cut.
Also, governments that make bad decisions in regards to the provision of healthcare get voted out. That cannot happen in your system. The insurance companies have patients by the throat, literally. The most common reason for bankruptcy in the US is healthcare costs. That’s almost never a reason for bankruptcy in NZ or Britain.
Yes, the NHS is government run, but the decisions in this case are being made by doctors for medical reasons, and by the court assessing the child’s interests.
That is not what is happening. The doctors think that the treatment the parents are asking for is not in the best interests of the child. The High Court agreed with that. What the High Court sees itself as doing is weighing up the interests of the child against the wishes of the parents.
You can disagree with the court over what is in the best interests of the child, but it is not a case of the court seeing itself as over-riding the child’s civil and human rights. The child has no capability to express his own wishes or exert his own rights; therefore the court must ultimately act on his behalf and decide what is in his best interests.
Under UK law it is not the case that the parents’ views are final (otherwise they could perform FGM on a baby girl).
Excellently expressed. This is the same thing that would happen in NZ in this situation. Someone has to be on the side of the child, and we all know parents aren’t always the best judges of what is the best thing to do.
An area of potential conflict is immunization. Parents may say no thinking its best for their child. Society (courts) need to assert the child and public interest and say sorry, but yes.
The legal regime seems as odious as the medical one. In the court opinion I see no indication that the parents were found to be abusive, negligent, incapacitated, or unfit in any way. They simply disagreed with the government doctors. Under those circumstances, the decision ought to be theirs alone. That a court could intervene to impose its own judgment is unspeakable.
Why? You could say exactly the same thing about parents who want to practice FGM on their daughter, as Coel pointed out elsewhere, or make a good marriage for their child. It’s just their opinion vs the government’s that FGM or arranged marriage is wrong.
That’s a red herring. You’re comparing a difficult and unprecedented medical decision with an illegal act that is not is not a therapeutic procedure, and that can objectively be characterized as abuse.
Immunization similarly is a red herring. You can’t administer a drug to an adult against her will, except in very narrow circumstances. As the child’s surrogate, the parent has the duty to make that same decision on the child’s behalf, and — absent a finding that she, the parent, is unfit — has the same right to refuse a drug.
Again, I emphasize that no court found — nobody even claimed — that Charlie Gard’s parents were in any way abusive, negligent, incapacitated or otherwise unfit. In other words, no rational basis was offered (or required, apparently) before their natural rights were summarily vitiated.
As for arranged marriage, I’m not sure I see the point. Marriage should be limited to adults of legal age. Whether they are marrying to please their parents is their business.
I don’t think you see the point I’m trying to make. Children have rights as individuals. Being a parent is not a right. A parent should not automatically, just because they are a parent, be able to make decisions that are not in the best interests of the child. Loving them, thinking they are doing the best for them, doesn’t mean they are doing the best thing. Lots of parents believe some stupid stuff about immunization and are convinced they are doing the best thing in not immunizing their child. They are wrong. It is best to immunize. A law requiring immunization is in the best interests of children whose parents have screwy beliefs about immunization. Those parents are not necessarily bad parents in any way, they’ve just made a bad decision.
The doctors know Charlie Gard’s condition better than the parents and are making the best decision on his behalf. Just because his parents are good parents, doesn’t mean they know the best thing for their child in all circumstances. The doctors are advocating on behalf of Charlie, and the court is mediating the impasse. They have decided that in this instance, the doctors are correct. That doesn’t make Charlie’s parents bad parents.
We’re way passed the point where we see children as the property of the parents, such that the parents desires are final. Nowadays the law limits the discretion of parents — all parents, not just those declared unfit.
Under UK law:
A parent cannot tattoo a child
A parent cannot impose FGM
Parental use of corporal punishment is strictly limited.
Parents have some discretion over education, but only within limits; the rights of the child to an education take precedence.
… and lots of similar restrictions.
Where the unanimous medical opinion is that a procedure will not benefit a child, and where there is likelihood that the child would suffer because of it, it is reasonable for a court to rule that it is not in the child’s best interests.
Parents can desperately clutch at straws in such circumstances.
The American ethos on health care seems to be to always try any intervention, regardless of whether it is likely to work, so long as someone will pay for it. The decision of whether to try the intervention thus comes down to whether someone is stumping up the cash.
In the UK the decision is instead about whether the intervention will benefit the patient.
The American system is not one that the rest of the West regards as an admirable role model (that’s understatement; the objective evidence is that it has easily the highest costs and among the worst overall outcomes).
@HH:
>”Children have rights as individuals.”
True. Every person is created in God’s image and is endowed by God with inalienable rights, including the right to life, at all stages of development from conception through natural death.
>”Being a parent is not a right.”
Not so. Everyone has the right to form a family, and the state must respect the family unit. See the Universal Declaration of Human Rights, Article 16.
>”A parent should not automatically, just because they are a parent, be able to make decisions that are not in the best interests of the child.”
Nobody is infallible. But the parents are responsible for the child they brought into the world. The judgement is theirs alone to make, absent a just cause to take away their natural rights. Disapproval does not constitute a just cause.
>”The doctors know Charlie Gard’s condition better than the parents and are making the best decision on his behalf.”
The government doctors may mean well, and they may know all about Charlie’s “condition”. But it is his parents who know and love the *person*, and the decision properly belongs with them.
1. An embryo is not a person. That people are created in God’s image is a belief, not a fact. Besides, I thought you disapproved of those who tried to depict God as an actual being. I guess, as always with religion, it depends on the circumstances. How do you know anything was endowed by your God. No one has ever proven He even exists.
2. The right to form a family is NOT the same thing as the right to be a parent. It’s not what this means. Also it creates the widest possible definition of family, and does not specifically mean nuclear family, though that is, of course, a possible version.
3. Parents are responsible for their children. That doesn’t mean their wishes should automatically be pre-eminent. Do I really need to go over the immunisation example again? Of course disapproval is not just cause – I never said it was.
4. In NZ and Britain, as I’m sure is the case in the US, doctors are required to act in the best interests of their patients. That is what they are doing here. I’m sure Charlie’s parents are doing the same. As they have come to different conclusions, both cannot be correct. The courts have decided that the doctors are correct.
This is not some conspiracy to undermine parental authority in general. It is a case of doctors who are caring for a patient wanting what is best for that patient. Loving your child and wanting the best for them does not mean you’ll always make the right choices. If you are making a bad choice when it comes to medical care, it is surely the responsibility of professionals to step in.
When you advocate that all embryos should be brought to term, don’t you say that you are speaking for the future child in those cases? Here we have an actual child, and the rules have changed.
@Coel: Vive la différence, but I have to say this sad case has done nothing to increase our esteem for the UK medical and legal establishments.
>”The American ethos on health care seems to be to always try any intervention, regardless of whether it is likely to work, so long as someone will pay for it. The decision of whether to try the intervention thus comes down to whether someone is stumping up the cash. In the UK the decision is instead about whether the intervention will benefit the patient.”
I’m curious for what purpose OTHER than benefiting the patient you think that someone would be willing to “stump up the cash”?
Follow-up question: Which approach would you say is likely to produce greater and faster innovation: the stingy conservative one, or the roll-the-dice, reap-the-rewards one? (You don’t have to answer — but you’re welcome.)
Happy Independence Day.
Sorry Coel, but even though this isn’t directed at me I want to say something on this:
The reason for a lot of the unnecessary interventions in the US is PROFIT.
i.e. Making money by taking advantage of sick people.
There is no incentive to change that either, and there will be even less if the GOP health bill goes through because medical professionals will want to continue to increase how much they earn with 23 million less people paying the bills. That’s a lot of unnecessary tests to pad the hospital bill with.
1. I agreed with your proposition that children have rights. When somebody is agreeing with you, isn’t it bad form to quibble over their reasons for doing so?
2. I don’t even want to know where you’re going with this weird tangent. Perhaps you can address and defend your claim that there is no right to be a parent, and cite some mainstream support for that view? I can’t imagine there is any.
3. Do I really need to go over the immunization red herring again? No one can be forcibly vaccinated (indeed that would constitute assault). Requiring immunization records as a condition of government school attendance is not the same as actually compelling vaccinations. (Just another reason to avoid government schools, albeit a bad reason when there are so many good ones.) More importantly, the rationale for requiring immunization is the *public’s* interest in controlling communicable diseases (which actually does not require that *every* person be immunized). There would be far less public support if, as you suggest, the justification had to do with imposing the state’s view of the *child’s* best interest.
4. “If you are making a bad choice when it comes to medical care, it is surely the responsibility of professionals to step in.” No. I am presumed to be competent to make my own reasoned medical decisions unless and until it can be demonstrated otherwise. Additionally, I am presumed to be competent to make reasoned medical decisions on behalf of another as long as my actions are not neglectful or abusive.
Your acquiescence to authority and state power, and discomfort with individual liberty, would seem to be at odds with your professed devotion to the Enlightenment.
On the other hand… whereas protecting the right to life is the most basic legitimate duty of the state, and it therefore has a duty to intervene to protect anyone who is threatened with direct and intentional killing, when it comes to abortion you change the rules, and the child’s best interests go right out the window.
Your belief that an embryo is not a person is just that — a matter of belief, not fact or reason. Once upon a time an embryo grew up to be New Zealand’s preeminent blogger. Do bloggers have a right to life? If so, when do they acquire it? By what occult ceremony or magical incantation do they acquire it? And here’s the real mystery: If that embryo was not the same person as the blogger, then who was she, and where is she now?
With most of these arguments we’re just going around in circles, so I won’t go into them again. Also, the abortion issue is really a bit outside the scope of this post and I shouldn’t have gone there. However, it’s a topic we’ll have the chance to discuss again in the future.
NZ’s preeminent blogger, Whale Oil, is male btw, and I’m sure you would like his opinions much better than you like mine. However, even the politically conservative are largely socially liberal in NZ.
I am not acquiescing to the government. This is not a government decision, and it is only your beliefs that are making it one. The doctors and the parents have a different opinion as to what is best for the child. Therefore the court is deciding what is in the best interests of the child. They happened to agree with the doctors. Exactly the same thing happens in the US in these situations.
Just as you don’t get my pov, I don’t get yours. Where is it written that being a parent is a right? For example, you don’t think same-sex married couples should be able to be parents even though there is absolutely no evidence a child suffers in that situation.
I doubt Mr. Whale Oil received any votes in the US presidential election, so he has nothing on Homilies.
Unrelated to the previous exchange, may I point out that the primary reason that doctors and hospitals practice so-called defensive medicine (unnecessary tests and procedures) is to mitigate the risk of exorbitant malpractice claims. That’s an area where your yen to criticize our system would find warrant. (Also, while profits are not a dirty word, it happens that less than one in five US hospitals operate on a for-profit basis.)
That said, I believe Coel’s point had more to do with innovative and unproven therapies rather than unnecessary testing.
We can agree on that definitely – the litigious nature of US medicine makes things very difficult for your doctors. I can understand why some of them do unnecessary tests because of that. But I vaguely remember work done on bill-padding by US hospitals when I was still working, which is why I mentioned it.
I agree that many US hospitals are run by organisations that are officially charities and therefore are not required to make a profit. However, they can and do make a profit. In countries like NZ, churches are not involved in hospitals, tertiary education etc because there is no money in it. In the US, there is the potential to make a profit for their church. They don’t have to, but they do, and they certainly don’t run at a loss. Our hospitals can run at a loss if they’re required to in order to get the job done because they can get extra funds from the government. This is especially important in natural disasters, unexpected severity of the flu season etc.
See: http://www.gosh.nhs.uk/frequently-asked-questions-about-charlie-gard-court-case
It’s also worth those who are “appalled at the depravity of government-controlled medicine” actually reading the court decision:
http://www.bailii.org/ew/cases/EWHC/Fam/2017/972.html
Much as I love America and had a great time when I lived there, there are certain topics on which Americans are collectively insane and just cannot discuss sensibly. These are gun control, abortion and health care.
When it comes to life and liberty, God forbid we should ever succumb to being “sensible”.
Unlike everyone else, I can delete and change comments when I stuff up! 🙂
This WaPo article is a good one on the topic. I recommend the video it starts with: GOP health-care talks center on stark question: Help vulnerable Americans or help the rich?
The explanation for what seems like bizarre behavior on the part of republicans – denying reality, sending grandma home from the nursing home – seems accurate. David Brooks, in the NYT, has a good analysis of this phenomenon. Republicans are stuck in their ideological bubble espousing less government at all costs. Thus they are unwilling and unable to discuss with democrats in a reasonable way to advance medical care in the US. Brooks says, republicans are fixated on their concept of GOVERNMENT, but have no vision of how SOCIETY should evolve.
I agree. Their priority does not seem to be doing the best for the people, which is what government should be about. In other countries the arguments between different parties are about the best way to achieve that goal. Therefore they can find ways to compromise and work together. With the Republicans its about imposing their ideology on everyone else. It’s why the GOP is rarely going to be successful getting legislation through because the Tea Party wing, for example, are always happy to hold the rest of their party to ransom if they don’t get their way.
There are a number of forces holding the US back from moving forward politically. Racism, income inequality, corporate money driving politics, poor education system(uninformed voters). Republicans have no real vision of how society should run other than a vague Ayn Randian, confidence that unfettered self-interest is good and altruism is destructive, yet, they are maintained as powerful influences by those insidious forces.
My head spins when you accuse the OTHER side of “imposing their ideology on everyone else”. Are you really oblivious to the fact that it is YOUR position that we must take power, resources, rights and freedoms AWAY from families and individuals, and give it to politicians, judges and bureaucrats — on the theory that the latter are more likely to make decisions you approve of?
As a Canadian I have a lot of friends and family in the US. I feel so bad for them for what’s happening but so happy that many Americans are starting to demand universal healthcare. This is how it happened in Canada. In my dad’s youth, there was no universal healthcare. Then, Tommy Douglas, the leader of a province, tried it out. Doctors protested, some moved to the US, some went on strike, but people got to chose between the new funded system or a private one and they picked the public one. It moved across Canada in this way.
I think the Americans are on the right track and I’ve told them so when I’ve talked to Americans when I’ve travelled there.
Perhaps Canada can be our model, or California.
I’m thrilled that California is trying it. It’s a big enough state with enough problems that there can’t be any excuses made not to roll it out across the country when people see that it works. This could be the start of the change in the US.
What’s the bet it will be the same states that drag the chain as in inter-racial marriage, desegregation, marriage equality, slavery etc.?
The geography you specify(the South) is defined by the Civil War, as is so much of politics here. That war ended in 1865, but lingers on like a crippling disease.
Check your news feed, and don’t hold your breath. Unfortunately for Texas (which greatly benefits from California’s chronic political stupidity), it turns out that not even that left coast lunatic asylum can afford to quadruple its outlays in a futile bid to revive the glory days of socialism.
I wish California well. With the demise of Republicans as a political force in CA and its stewardship under Jerry Brown, gridlock has been vanquished and political functioning revived on a spectacular scale. This has happened in multiple areas from economy to environment. The comparison of California (where Republicans went extinct) to Kansas/and or Texas (where democrats have suffered a similar fate) has been addressed by the most eminent minds, (Paul Krugman, Robert Reich etc). Heck, even Bill Maher has a monologue on the “Real live experiment”. Not that I believe in Maher’s eminence but it takes a mere comedian to make the point… In contrast, Texas is in the toilet. New Yorker piece “America’s future is Texas”, details a mindset where Texan politicians poop in their pants about the Californication of America while their own state gets taken over by right wing crackpots. To capture in a nutshell where Texas is headed their child mortality rate now exceeds that of many third world countries, where the uninsured rate is sky high, where if you are a public servant to whom integrity and evidence are sacrosanct your job is imperiled, and where Jesus juice gets shoved down everyone’s throats day in day out. Yes, Texas is the densest turd at the bottom of a septic tank. I wish CA well. In the end a single payer system is vastly superior both in terms of health outcomes and cost to society. But it involves higher taxes in place of the prohibitively expensive health premium contributions by employee and employers, tax subsidies to employers and a multitude of other costs. The citizen will be better off in the end but we all know the sort of fear mongering CA law makers will face.
If they’re giving tax breaks to employers, does that mean insurance is still tied up with jobs in California? I think that’s a mistake in the design of their system if it is. It puts a brake on wage negotiations and labour market dynamics, advantages big companies over small ones, and reduces wages overall. Although perhaps anything else was too big a change for people to cope with all at once.