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US: Neither healthy nor caring

Every effort to make health insurance an integral part of the US social fabric has been thwarted by well-funded consortia of insurance companies, pharmaceutical interests, physicians' groups, and their ideological allies
Amit Sinha Cary, North Carolina

The United States leads the world in medical innovation. In 29 of the past 34 years, an American (or a scientist working in America) has either won or shared the Nobel Prize in medicine. Healthcare is the country's largest economic sector, accounting for over $2.26 trillion in 2007 - roughly four times the amount spent on national defence. More is spent on healthcare in America on a per capita basis ($7,439) than in any other nation in the world.

Yet, a recent study that analysed 37 measures like access to care, quality of care, and health outcomes concluded that despite spending twice as much per person on health, the US ranks lowest in healthcare among the top 19 industrialised countries of the world. Dismal statistics support this conclusion: 47 million Americans (one in six) have no insurance at all; 16 million are under-insured, that is, despite having insurance, their policies will not cover certain critical emergencies or pay more than a pre-determined maximum. Routine medical tests cost thousands of dollars. A typical week's stay in a hospital would run upwards of $50,000. Not surprisingly, due to the exorbitant costs, most uninsured people cannot afford the medical care they need. As a result, 18,000 of them die prematurely each year.

In addition to their ever-increasing monthly insurance premiums, insured Americans are also required to pay a portion of their medical expenses. This "co-pay" and "deductibles" have been steadily growing over the years as insurance companies try to preserve their margins. In many cases, prohibitively high co-pays/deductibles force people to postpone, sometimes indefinitely, the medical treatments they require. Health insecurity seems to be a shared experience for a majority of Americans. There is a palpable concern that they could be just one sickness or injury away from financial ruin. Most would agree with Walter Cronkite's assessment that "America's healthcare system is neither healthy, caring, nor a system".

If not addressed immediately, things are only going to get worse. At the current rate of increase, it is estimated that by 2018 healthcare expenditure in the US will consume 20 per cent of the nation's Gross Domestic Product (GDP) or $4.4 trillion ($13,000 per person per year). To comprehend this astronomical number, consider that at the official exchange rate the entire 2008 GDP of India was $1.24 trillion. Clearly, something is very wrong. How can a prosperous country like the US endanger the welfare of its citizens and threaten the bottomline of its corporations?

The simple answer is: the stranglehold of special interests on its civil polity. Throughout the 20th century, every effort to make health insurance an integral part of the American social fabric has been thwarted by well-funded consortia of insurance companies, pharmaceutical interests, physicians' groups, and their ideological allies. In 2008, together, they spent $485 million lobbying Congress, and gave $167 million in campaign contributions to politicians. Between them, they engaged 3,568 lobbyists in Washington - an astounding 6.7 lobbyists for each member of Congress, all sharing a singular focus to maintain the status quo and aggressively stymie any attempt at reform.

Calls for universal health insurance in America were first made without success almost a hundred years ago in 1912. Since then, the issue of the right to adequate medical care for all has resurfaced every few years, and each time it has been smothered by industry interest groups. Their modus operandi has been consistent: a) Attack the messengers and brand them as radicals; b) sow fear, uncertainty, and doubt (FUD) in the minds of the American people through media collaborators and sympathetic think tanks; and c) launch a frontal attack through allies and agents in the US Congress to quash the policy initiative. So far, it has worked like a charm.

For instance, when President Harry Truman proposed a "national health programme plan" that would "include all of American society" after the War in 1945, the American Medical Association (AMA) immediately denounced it as "socialised medicine" and called Truman a "follower of the Moscow party line". After a few years of ponderous existence in the halls of Congress, the Congressional subcommittee tasked to evaluate the proposal called it a "communist plot" and officially killed it.

Similarly, in 1993 when President Bill Clinton appointed his wife, Hillary, to lead the effort to reform healthcare, both husband and wife immediately came under intense personal attacks from predictable quarters. The opponents quickly dubbed it "HillaryCare", and howled that it was a, "Great Leap Forward into socialism". Nothing scares Americans more than the spectre of a soul-less government-run healthcare system in which feckless apparatchiks play god and choose who lives and who dies. Within a year, the Clinton healthcare plan was also dead.

It does not require a genius to understand the motivations of vested interests to preserve the status quo. Currently, of each dollar that is spent on healthcare in the US only 21 per cent goes to physician services. Despite a staggering 31 per cent of it being wasted on administrative costs, the percentage that goes to profit is between 25 and 30 per cent. As a result, the insurance industry in this country has ballooned to become a $700 billion-a-year behemoth.

In 2008, the combined revenues of the top 15 pharmaceutical companies were $421 billion, $250 billion of which came from prescription sales. On average a physician in America earns $159,000 a year - more than three times the median household income in this country.

Then there are for profit hospitals, handsomely compensated industry executives, and the perennial Wall Street expectations of ever-increasing returns on investments. Politicians' dependency on industry for campaign contributions is acute considering that the cost of winning a race for the House of Representatives averages $1.1 million and a senate seat almost $6.5 million. Once elected, they faithfully return the favour by doing their paymasters' bidding in the corridors of power. A retired executive of a major insurance company recently declared, "There is a lot of money to be made off sick people in America."

The recent election of Barack Obama to the White House has again raised great expectations across the land. After all, as a candidate, Obama had vigorously promised that if elected, he will ensure a "Quality, Affordable and Portable Coverage for All". However, as soon as he introduced his reform package in Congress, it ran into a buzz-saw. Despite his party's comfortable majorities in both houses of Congress, Obama's proposal got bogged down in disingenuous bickering.

The campaign unleashed to discredit Obama's initiative by the aforementioned entities promises to eclipse anything seen in the past. Obama is now routinely portrayed as Hitler incarnate in conservative media. The Rightwing radio personality, Rush Limbaugh, recently compared a White House health office logo to a Nazi symbol. A congressman who supports the president had a swastika painted on the entrance of his office. Former Alaska governor, Sarah Palin, called Obama's plan "evil" and claimed that it would create a "death panel" that would deny care to the neediest of Americans. Even the legitimacy of the Obama administration is being questioned by Rightwing zealots by claiming that he was born in Kenya.

To blunt this onslaught, the president and his representatives decided to talk to the public directly in "town hall" settings. To prevent that, opponents began exhorting people to disrupt these events. "Attend Obama Care Townhall near you" and "Become a part of the mob!" bellowed a talk show host on Rupert Murdoch's FOX News Network.

A strategy memo circulated by a partisan group instructed people to "Pack the hall" and "Yell out and challenge the Rep's statement early". It further advised "Get him off his prepared script and agenda," and "Stand up and shout and sit right back down."  Predictably, these meetings have been reduced to a farce. All this has taken a toll. The President is reeling as erstwhile popular support is diminishing. A recent poll found 49 per cent of Americans now disapprove of Obama's healthcare reform and 43 per cent approve it.

Alexis de Tocqueville once remarked that in a democracy, the people get the government they deserve. It remains to be seen if the American people will be persuaded by this predictable blitz to go against their own interests, or if this time they will rise up and secure a more humane healthcare system for themselves. The outcome is far from certain.

Amit Sinha runs an IT company and is based in the US