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This weekend will most probably give us the answer to America's healthcare conundrum: is President Obama going to be Alexander the Great, the man who cuts the Gordian knot? Or is he going to end up as just another severed head, stuck on the palisade as a warning to the foolhardy?
On the campaign trail, Mr Obama was highly committed to healthcare reform. But as President he had kept a certain distance from the whole process, hoping to effect some kind of bipartisan approach.
To his supporters, this was frustrating. Whether he can now deliver will be a crucial test: either proof that his political skill has not deserted him, or a heavy blow to add to the pressure already exerted by drooping approval ratings.
On Christmas Eve last year the Senate passed its own version of a healthcare reform bill. The President received no support from any Republican. Then, in January, Senator Edward Kennedy's old seat fell to the Republicans and the Democrats lost their super-majority. From now on their legislation could be filibustered into oblivion.
For a while the White House sounded as if it was backing away from the health bill. Mr Obama waited for the dust to settle. Then he became suddenly and vigorously involved, as if he could see his reputation depended on it.
The Bill must now be amended in the House by a process called budgetary reconciliation, which means it can only be tinkered with on budgetary matters. Dissenting Democratic congressmen are being begged to swallow their pride and support it. At some time in the future there will be opportunities to make improvements, they are being told: but if we don't do this now, the Obama presidency could be fatally weakened for the next three years.
To call the Bill divisive is an understatement. The Catholic bishops, for example, are dead set against it, even though they are supposed to have a mission to the poor and sick. They don't believe the bill is strictly enough expressed to prevent federal funds being used for abortions.
But what have we here? A total of 59,000 Catholic nuns contradicting their bishops. Here's what the nuns say: “Despite false claims to the contrary, the Senate bill will not provide taxpayer funding for elective abortions. This is a real pro-life stance, and we as Catholics are all for it.”
Aggressive support, in other words. And you can understand why supporters of the bill get aggressive. Healthcare is a desperate business in the States. Live here for any length of time, talk to people from all walks of life: it's not an issue that you might choose to go and visit — it comes looking for you.
I spend an increasing amount of my time in New York. I don't see, walking down the street, the full effects of mass unemployment — I would have to go looking for that in places like Detroit. But the healthcare problem is the one that comes knocking.
At its most benign, it makes people seek out and stay with jobs they may not want for the sake of the insurance that the employer can provide. That may not be an ideal situation to be in, but you could call it one of life's necessary compromises.
At the next level down come all those who, not having permanent employment, must arrange for their own insurance. Given that you have income, you must set aside several hundred dollars a month. You insure your house and your car. Why shouldn't you insure yourself? That's the American system.
If only it were that simple. What happens, at this level of minor financial discomfort, to those who have a “pre-existing condition”? How do I insure myself if I am a diabetic, or prone to some other chronic disease?
From this level (you can afford insurance but have difficulty getting it) you can look down to the next, and see the catastrophe in store when you can neither qualify for insurance nor afford it. And now the bills begin to arrive.
You might think that the nearer you approach this desperate point, in which your whole personal wealth can be wiped out over a weekend, the more you would support the notion of universal healthcare, whether public or private.
But America is full of people who, economically vulnerable though they are, see healthcare itself as a bigger threat to their well-being than chronic disease and consequent penury. The Republicans hold this threat over the heads of Mr Obama and his fellow Democrats: if you pass this bill, you will get slaughtered in the elections later this year. But many Democrats realise that they will be slaughtered if they don't deliver on their promises. There's a handy slogan for this philosophy: Winning beats losing.
And here's the second part of the healthcare conundrum. What if the reforms go through and people find that the sky did not fall in? What if, in time, this vulnerable and highly nervous (not to say hysterical) fraction of the electorate begins to get used to better healthcare. What if this act of “fiscal irresponsibility” turns out to bring down costs — which is what it is designed to do. What then?
There are systems of care for the elderly and for armed forces veterans which are both functioning and uncontroversial. And it is striking that, as things stand, people hate having to deal with their health insurance issues. Why should they mourn the status quo?
These are the sort of considerations that might weigh with those dissenting Democrats as they ponder their duty this weekend. Strangely enough, there might be political advantage in doing the right thing. Run with the bishops? Or hunt with the nuns? That's the conundrum.
Reader views (1)
If Democrats wanted to pass the Bill they would have done it long ago. The Republicans may express their opinions, but they do not have real power, not now. Democrats still hold the majority. It is the American people that wants a more transparent Bill, not one done behind doors. We are a true democracy and a Republic and WE decide what is best for us. The Congress works for us and their vote should reflect what we want and not what the President wants. If Democrats hesitate it is because of the American People, and not because of the opposition of the minority party
- Maykah, Florida, USA, 19/03/2010 12:28
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