In Bad Repair

ON 23 MARCH, United States President Barack Obama signed a landmark healthcare bill into law. According to the Congressional Budget Office, the non-partisan watchdog of government spending, the legislation will cover 32 million uninsured Americans. Anyone who’s ever seen the inside of an American hospital emergency room—where the indigent and uninsured suffer through panic attacks and nurse gaping wounds—can probably agree this is a significant achievement. I’d be more excited by the bill, but I am fatigued by the two years of dirty politics that preceded this announcement. I was also hoping for more substantial change.

When I left New York City for India in September 2009, the debate over healthcare reform dominated the news. Viewers were subjected to the paint by numbers, liberal/conservative point/counterpoint ping-ponging that passes for political discourse. Under the guise of equal time, TV journalists provided Republican talking heads airtime to present factually incorrect doomsday scenarios.

The conservative opposition to the bill could broadly be segregated into pro-market arguments (the deceptive) and conspiracy theories (the insane). The former view held that we should not focus on healthcare at a time when the economy needs fixing. This premise was floated despite the clear correlation between businesses having access to affordable healthcare and a robust manufacturing sector. Take, for example, the effect of socialised medicine on the automobile industry. Michigan, the state most associated with building cars, had been losing ground to Ontario, the neighbouring Canadian province, for the past decade. The difference is clear: building cars in a location with socialised medicine offered a benefit of approximately 1,525 dollars per car (2005 numbers). Expressed another way, US car companies are spending more money per car on worker’s health insurance than they are on steel.

More ludicrous were the more conspiratorial justifications to oppose the bill. They were too numerous to mention, but the most notable were the so-called death panels—an unseen bureaucrat getting between you and your doctors to seal the fate of your sickly grandmother. In one ad, a government bureaucrat carrying a dossier that read ‘Federal Health Police’ snuck into an examination room and separated the doctor from the patient. The ad conveniently ignored the real barrier in the US between patient and doctor: health insurance bureaucrats. At best, big insurance’s layers of bureaucracy make many insured Americans pay out of pocket rather than fight their insurance company. At worst, there are cases like that of Nataline Sarkisyan, a 17-year-old from Los Angeles who desperately needed a liver transplant and died because her insurance company, CIGNA, refused to pay for treatment.

The overwhelming majority of the resistance to health reform was actually ‘astroturfing’—well-crafted opposition from the healthcare lobby designed to look like a grassroots movement. The real power behind many of these so-called conservative activists came from groups like Conservatives for Patients Rights (CPFR), which funded the health police TV spot. CFPR is a front group run by Rick Scott, a former business partner of George W Bush. Scott is the former CEO of the HCA Healthcare Corporation, a for-profit hospital chain. During his tenure at HCA, the US Federal Bureau of Investigation raided HCA hospitals in five states. Three HCA executives were charged with fraud. Scott got off lightly. He was ousted by HCA’s board, which later paid the government 1.7 billion dollars in fines.

Scott and his fellow ideologues tapped into a uniquely American sensibility: an irrational fear of big government. The Reagan-era ideology that small government is better means that Americans fear socialised medicine so much that many are not willing to seriously examine the inherent flaws in the private insurance model. To these people, it doesn’t matter that the rest of the developed world has realised that profit and making people well are incompatible.

At some point, the discourse became utterly dispiriting. So, fearing that I would hurl my TV across the room, I just switched it off. For me, healthcare wasn’t some abstract conversation that applied to masses of poor people waiting for primary care at the mouths of hospital emergency rooms. As a self-employed journalist living through the recession (and the complete implosion of the magazine industry), the need for healthcare and drug coverage was more immediate. Maintaining my coverage as my freelance assignments dried up was driving me deeper into credit card debt.

Even though I was insured, I still had to pay the portion of my fees that the insurance didn’t cover. This is the deductible, or the co-pay. I still owe my psychologist and my attention-deficit hyperactivity disorder specialist close to 1,000 dollars combined. In some cases, I didn’t have the 25 dollar co-pay. But, more often, specialists in New York simply refuse to deal with health insurance companies because they’ve grown tired of fighting with them for their money. And instead of paying 10 dollars to meet with specialists, as in India, the fees in New York routinely top 150 dollars for a half-hour consultation. So, even when patients have insurance, if they want to see the best doctors in New York, they will be paying out of pocket—one more example of health insurance bureaucrats getting between patients and their doctor of choice. Healthcare and the stress associated with it had a demonstrable effect on my sanity and output; it was also exhausting.

There were many moments when I wished I was back in Canada, where I’d grown up. The US’ northern neighbour features a system where drugs are affordable and the government provides coverage to all its citizens.

For someone who has never lived in the US, the actual depth of the problem is impossible to explain. After all, for many Indians—especially the upwardly mobile—America is synonymous with advanced degrees, innovation and forward thinking. So I’ll leave it to the aforementioned specialist, who charged me 10 dollars and who asked and answered a crucial question. “Does America have a health insurance mafia?”

“Yes.”

That’s why I’m also saddened by the death of the so-called public option, which would have forced private insurers to compete with a government-run insurance company with a mandate to cover as many Americans as possible. The premise that a free market system is better than a government-based model is just another sad example of outmoded American exceptionalism. The reality is that the top health insurance companies function like a cabal to artificially inflate costs. The whole insurance-based model is the problem. Insurance companies earn maximum profits by taking in monthly premiums and paying out as little as possible. This is as true for companies who insure homes—and look for loopholes when natural disasters strike—to companies who insure humans.

The passage of Obama’s bill hasn’t slowed down the campaign of misinformation. The other day, I received an unsolicited email from the Tea Party, a grassroots moment in league with the CFPR. It read: “I realize we must redirect our justifiable anger and outrage into a focused and straight forward effort to stop the Global Marxist take-over of America.”

Thankfully, Obamacare offers a mandate to provide mental health coverage.