A plea in support of Mr Obama’s perfectible health-care bill

A lot of us have been saying for a long time that much of this, much of this is not about health care at all. And I think a lot of those people today demonstrated that this is not about health care… it is about trying to extend a basic fundamental right to people who are less powerful.

(Rep. James Clyburn (D-S.C.), commenting after members of Congress were spat on and shouted at with racial slurs: Huffington Post)

I’m sometimes unsure on which side of the Atlantic I’m most disconcerted by people’s entrenched prejudices.

In France, where I lived, at considerable cost to my personal finances, for many years, the vast majority of my friends were deeply hostile to a courageous initiative by M Sarkozy, soon after he was elected President of the Republic in 2007, to cap total (direct) tax paid by any individual to the central government at 50 per cent of annual income. Clearly, the average Frenchman—and this includes rational, liberal people with decent jobs—regards it as an absolute right of the government to confiscate any amount of someone’s income above a certain level, and a sign of gross injustice if it doesn’t. The fact that owing to the existence of high social security contributions that are nothing more than thinly-disguised income tax, the real marginal tax rate in France must be easily the highest in the OECD changes nothing to that surreal posture whatsoever.

Though disconcerted by the French addiction to tax-and-spend which is patently leading that once-wealthy country on the road to bankruptcy, I’m even more appalled by the so-called Tea-Party‘s (being English, I find that choice of name totally inappropriate, by the way) stunningly aggressive hostility to Mr Obama’s health care bill, threatening gun violence if it is passed. In scenes not seen since the 1960s, members of Congress were spat on and insulted:

Tea Party demonstrators threatens gun violence before the House's vote on Mr Obama's health care bill
If Brown Can't Stop It, a Browning Can: Tea Party demonstrators threaten gun violence before House vote on Mr Obama's health care bill. Photo (cc) cjbrenchley on Flickr.

Equally unnerving is the news that some states are preparing to challenge health-care reform in the courts with, if some reports are to be believed, some change of succeeding.

I feel very strongly that it is a scandal that in a society as rich as the United States, anyone should be denied health care for lack of means. That such a self-evident human right, entrenched in European legislation since the the Beveridge Report, should lead to such opposition in the United States is incomprehensible.

It is true that the cost of health care, as a proportion of national income, has risen astronomically since 1945. This is hardly surprising, since life expectancy has also increased considerably. As a result, people today live longer, and considerably more agreeably, than previous generations, which would not have happened if both those developments had not occurred. The admittedly not negligible cost of universal health care in OECD countries, which is the price to pay for this, can and should be met in two really obvious ways, without which the standard of living to which our parents have grown accustomed cannot over time be maintained:

  • since people live so much longer and stay in good health so much longer, there is every reason why they should work longer (yet another obvious fact to which the French seem to be blinded);
  • a reasonable balance between wealth-producing and non-wealth-producing generations can only be maintained if governments provide strong support for families with children so as to combat population decline.

I was certain, when Mr Obama was elected, that his presidency would rapidly become embattled because I saw no way that the irrational enthusiasm that swept him to power could be sustained. But while I think France would benefit from a dose of Tea-Party libertarianism to shake it out of its absurd love affair with big government, and am certainly not impressed, on the whole, by Mr Obama's first year in office, I am just as equally convinced that the America must embrace universal health care.

That the details of its implementation are perfectible is not acceptable grounds for indefinitely postponing the implementation of a system that has existed elsewhere, in more or less imperfect forms, for over six decades. A compromise solution such as that presently before Congress is better than none at all and if legislators waited until a bill were perfect before enacting it their task would become impossible, especially in a system as rife with checks and balances as the American one.

It’s obvious that much of the criticism of the measure is nothing more than a selfish and a hypocritical way of staving it off altogether. It’s not even as if what the Tea Party is defending is anything of which to be proud: economists examining the subject have known for years that the US health-care system is grossly inefficient, with beneficiaries of health insurance insulated by tax exemptions and health-care providers incited to overcharge for their services. The result is that those covered by insurance overpay for services whose cost, if determined more rationally, would fund equally good cover for a larger number of people. The Economist’s concise and scrupulously fair leading article on the subject is well worth reading to understand these basic facts, starting with this one:

This newspaper loathes needless government intervention. But it also thinks that it is wrong for a country as rich as America to have tens of millions of people without health insurance. Beyond them is the much larger number of people who fear falling into that position through losing their jobs; and the larger number again who cannot get affordable insurance because they have an existing medical condition, or because they are too old, or because they have exhausted the “lifetime caps” imposed by insurance companies. The health-reform plan represents the last chance, perhaps for decades, of erasing one of the least creditable differences between America and the rest of the industrialised world.