Wednesday, 5 August 2009

Germany, and Reason, Ignored in US Healthcare Hysteria

I’m sometimes accused by commenters on this blog of wishing to make Europe into the US, and while it is true that I often yearn for European politics to be a bit more self-assertive, ambitious or efficient, make no mistake - I would never wish for European politics to devolve into the kind of mob hysteria US political discourse has sadly become.

The current debate going on in America over Obama’s attempt to overhaul the broken US healthcare system has been particularly hard to watch in this regard, and makes me feel pretty fortunte that I live in Europe. The way this healthcare debate is unfolding in the US is not only shockingly unreasonable, it’s getting downright scary. And unfortunately, what’s been occurring around the heathcare debate isn’t an isolated incident - it’s reflective of the dangerous road the American right wing is heading down.

The worst part is that the illogical hysteria surrounding the debate is drowning out any kind of reasonable argument. The scare stories being floated in the US media about single-payer systems in the UK and France would be missing the point even if they were true – what’s being proposed by Obama isn’t a single-payer system but rather a multi-payer combination of public and private plans, much like exists in Germany. But astonishingly, Germany hasn’t been mentioned at all in the US debate, even though it currently has a system very similar to the one being proposed, while the British and French systems don’t even resemble the Obama plan.

A ‘Plot to Kill Old People’

The health insurance lobby in the US has launched a full-on campaign to sink Obama’s efforts at health care reform. The plan that is working its way through congress is to add a public option to the list of private insurance options available to the American public. Currently the US has a completely private system for those under 65, the only non-universal healthcare system in the developed world, in which nearly one in five Americans under 65 don’t have any healthcare at all.

Not having healthcare can bankrupt a person if they get sick or have an accident, and it happens often. In fact, medical debt is the principle cause of bankruptcy in the United States.

Healthcare in the US has developed in an uncoordinated fashion over the past half century after the US government was unable to come to an agreement over a national health plan (Medicare, in which the government insures all people over 65 through a single-payer system, was a compromise enacted in 1965).

People under 65 have traditionally been insured through their employer. This means if you lose your job, you lose your health insurance (so if you get hit by a bus two months after losing your job, you’re facing a $30,000 hospital bill and no income!). But as healthcare costs have risen many small businesses have been unable to offer their employees health insurance any longer, leading to a dramatic rise in the number of uninsured. Even people who are insured face ever-rising deductable costs every time they visit a doctor, and their insurance companies can deny them coverage at any time by claiming that they had a “pre-existing condition” before they enrolled in the plan.

So to put it mildly, the system is a mess. Yet what Obama and congress are proposing isn’t a complete overhaul - it’s more of a reform. The private insurance companies would continue to exist, and everyone who’s already insured could keep their existing plan if they so wish. But a new player would be introduced into the market, a government-funded public insurance plan that people can opt into. Additionally, everyone would be required to have insurance, and regulation of the insurance industry would be tightened to prevent insurance companies from denying people coverage because of pre-existing conditions or charging exorbitant deductable charges.

However the insurance industry fears that having the US government as a competitor will eventually drive them out of business. So they’ve mobilised their media outreach, finding people in countries with single-payer universal healthcare systems like the UK, France and Canada, and trotting them out to do interviews with US media outlets about their horrible experiences. These strange, wild-eyed European defectors tell stories of being denied treatment and having to go to the US in order to have desperately needed operations to save their lives.

Or, they tell tale of public hospitals with dead people lying on the floor all over the place. I wish I was making this up. To hear the stories that have been spread in the US media, the NHS in England is effectively a government euthanasia program that kills people once they reach old age Republicsn Congressman Louis Gohmert has said under the reform seniors "be put on lists and force them to die early.”

This group that’s spreading word that the healthcare reform bill will kill old people have even been given a nickname, the “deathers” – a reference to the mob of people claiming that Obama wasn’t really born in the US – the “birthers”.

Of course, all of these tales have been proven to be absolute lies by reputable organisations, yet these people keep appearing on US cable news.

Harnessing the Mob

Now the healthcare lobby and the Republicans have gone a step further, actually organising mobs of angry 'birthers', 'deathers', 'teabaggers' and other assorted crazies to show up at open town hall meetings that Democrats typically host during the August recess. These mobs have been instructed to scream down the representatives as they try to speak. It’s absolutely insane, and getting quite scary. Take a look at this clip from the Rachel Maddow show.

Right-wing lobby groups are organising these mobs, telling them where the town halls are, and instructing them to block all discussions. They refuse to allow anyone to speak. If actual townspeople at these town halls try to ask a question, the mob shouts them down with chants of "just say no". Congressman Boehner, the Republican House minority leader, has praised these mobs and encouraged them to continue.

The Republican party is now aggressively harnessing the energy of the “teabaggers” –a group of mostly lower middle class Americans who are angry at Barack Obama’s election and were organized into protests by GOP groups earlier this year under the mistaken belief that Barack Obama’s budget was making their taxes go up (Obama is actually lowering their taxes or keeping them the same). It’s also harnessing the energy of the “birther” movement, a group of angry white Americans so incensed that Barack Obama was elected that they have developed a conspiracy theory that he wasn’t actually born in the US and is therefore ineligible to be president.

Republican congressmen and talk show hosts have given credence to the conspiracy by saying Obama has never released his Hawaii birth certificate – even though he has and it’s been on his website since the campaign.

So it’s a two-pronged attack by the right: organising mobs of crazy people to disrupt town halls where Democrats are attempting to explain heath care reform to their constituents, and getting fake healthcare scare stories into the media

Better European Comparisons

But beyond the fact that these random Canadians, Brits and Frenchmen being trotted out are just flat-out lying and are actually being put out there by the health insurance industry, the reality that everyone in America seems to be missing is that even if these stories were true, they are completely irrelevent to the current US healthcare debate. Canada, France and the UK all have single-payer systems – where you walk into the doctor’s office and never see a bill. That system is not on the table in the current debate in the US. What is being proposed is a combined public/private universal health insurance program much like exists in other European countries, most notably Germany.

Germany’s system would be the more obvious comparison, yet it has not been mentioned at all by the US media, which continues to focus on single-payer systems that have no relevance to the current debate.

Germany has a universal multi-payer system with two main types of health insurance: the public fund and private funds. Everyone is mandated to have healthcare, which is provided by the public fund to people below a set income level for a low rate. So, the wealthy can pay for exceptional private health coverage if they want to, or they can pay a small amount for the state insurance (many opt to do this). The end result is that everyone is covered and Germany spends 10% of GDP on health care, compared to 16% in the US.

Alternatively, the US media could use the example of Switzerland, although I’m not sure I would use that as a glowing model considering it has the highest health care expenditure in Europe. But they also have universal healthcare in a combination of public, subsidized private and totally private healthcare providers, where the insured person has full freedom of choice among the providers in his region.

Unfortunately, using comparative examples that make sense have not been part of the debate around this issue, which has instead focused on the hysterical screaming of the right. US policy, much like hotdogs, is always something that can be a little stomach-churning to watch being made. But lately the level of vitriol being launched by an increasingly desperate Republican party has been downright disturbing. Outright lies? Fake experts? Organised mobs? Is this America or a banana republic?

The most troubling part is that these tactics are working. Recent polls have shown that 42% of Americans now think Obama’s healthcare plan is a bad idea, and 69% of Americans are concerned their care would suffer if they were on a government-run plan.

They say citizens get the government they deserve. Perhaps it can be said that they also get the healthcare they deserve. If the American public can be so easily manipulated by the powerful forces of the right, even when it jeopardises their own health, I don’t know if there’s much hope for real reform in that country. It's very sad to watch. One thing is for sure – the behaviour exhibited over the past several weeks has not been a proud moment for American political discourse. These are dangerous tactics the American right is using, and they can easily spiral out of control. In the mean time, they are blocking meaningful discussion over how to reform a healthcare system whose dysfunction has reached crisis proportions.


Björn said...

This video is really frightening. Sometimes it's hard for me to believe the depths to which politics in your homeland have sunk. Aren't there any reasonable Republicans left who would stand up and say that organising mobs to disrupt town hall meetings is wrong??

simon newman said...

I was going to say that the Birthers wouldn't be fussed if Obama was white rather than black. It would probably be more accurate to say that they wouldn't be fussed if he weren't a black nationalist, since I can't see them getting worked up about Colin Powell's birth certificate.

Steven said...

Simon, how is Obama a black nationalist??

Proud Brit said...

Even if what Obama is proposing is more like Germany's system than Britain, I for one would still like to defend the NHS from the made-up accusations of the American right. The British are very proud of their healthcare system and rightly so. It may have its problems but they pale in comparison with the problems of the US healthcare system. It's not surprising though that Americans would believe these preposterous lies about our healthcare system when they know nothing about countries other than their own.

Anonymous said...

Very interesting post, I would be interested to hear what you think about the latest evelopments with Daniel Hannan betraying the UK on US media

Kathleen said...

Thanks for this article! I have been wondering all this time why Germany has not been mentioned during the "debate" on US health care. Although G's system, begun by the conservative Bismarck so long ago, is not without flaws, as an American user in the system I am pretty happy with it. Waiting time is no problem, the hospitals I have seen are clean, the staff considerate. Why can't a nice innovative country like the US do a blow-by-blow comparison of German health insurance to ours--and then improve upon it? Is that a no-brainer or what? Also kudos for the many fascinating reference links!

Chris in North Carolina said...

Thank you for your have struck a bull's eye. Millions of Americans like me are disgusted and saddened with the low level of the debate and the reality that so many Americans seems incapable of seeing through the insurance industry's scare tactics. Sadder yet is the fact that many American simply don't give a damn about their fellow countrymen enough to support reform. I believe the political system in the U.S. is completely dysfunctional, and we are headed for a civil war. I know that sounds far out, but there is a deep and fundamental rift between conservative and liberal America.

Brian said...


Couldn't agree with you more some may think we are the crazy ones but that is cool, I brush it off cause I am crazy cause I care about my country & a country great as of our shouldn't have a health care system that can leave families to fight through hard times like a 3rd world country. Also I am not about the greed that has infested our nation, making money is important of course but we have been infested by Greed for money for far to long to the point that our Gov't cares more about money & fights for their money & not us, yet people cry we can't betray our forefathers if you ask me we already have, Corp Opression, Corrupt Gov't runs a muck. Wasn't Corruption & Opression on us that led to our Revolution & our birth, How far we have already strayed & people gonna cry we can't stray stupid very stupid. Now they defending a broke system & crying what about the insurance I already Have, they to Naive to realize that in 5-10 Years the insurance they have maybe Gone??? Employers want to cut Benefits cause of the increasing prices, if you pay for it the way it goes up you think you can afford it when it goes up more, do you think if you get sick they won't jack up the prices so high as a way to force you out of their system they will. These People are gonna wish they had a saftey net when that happens, the under insured & un insured will become worse & worse all this can lead to civil unrust & the drift you mention of between the parties is good for Democracy that is how Democracy flows a drift in Ideas, but with the size of the Drift & no real republican leaders ship you can bet your ass a civil war will unfold sooner or later. The Poor & Middle Class could benefit as well as employers from the health care plan, Wages would have to increase some what, wages can be kept a low point which offset by a benefit package of Vacation time & of Medical Coverage, if you take the Perk from the Hands of employers to uses as incentive then they will have use pay raises, higher wages & advancement oppertunties to employees to attract new ones & maintain current employees other wise they will Jump ship. It could really Help the middle class, the working folks that put in to this country everyday.

John said...

A very intelligent article. Also, the Dutch system has mixed public and private health care options. On the whole, people in Germany and the Netherlands are very happy with these systems. They feature very humane care for the aged and everyone is covered.

Right-wingers often tout the US system as the best in the world. Depending how you define "best" there is a certain truth to this statement. It is true, that wealthy dictators from many countries come here to get treated with the best high-tech medicene in the world. Having stolen money from their own people, they can afford the high quality, high-tech US medicene.

But this precisely illustrates in what way the US does not have the best medicene in the world. If a large percentage of people do not have access to basic medicene because of being uninsured, under-insured or their insurance has reached its maximum life-time coverage, what good does it do them not to be able to afford these services?

Of course, one can argue that you don't care about other people, and say you are satisfied because your insurance is good and you have enough money to pay for extra services, but in the long run society pays for people who do not get basic services when they end up in the emergency room because their conditions have worsened to a life-threatening stage.

Jeff said...

As a Brit, its disappointing to see the NHS subjected to so much misinformed comment in the USA. My own experience is this - four years ago at age 64 I was diagnosed with Leukaemia, admitted to a NHS hospital and commenced treatment the same day. I received excellent in-patient care for a total of five months including a period in a critical ward with 24 hour one to one nurse supervision; if I had to pay the many thousands of pounds all this cost it would have ruined me financially. Even if I had medical insurance, I would have been concerned about running out of benefit. The only minor problem I had during the whole time was having to spend just one night on a bed in a treatment room rather than a ward. No human institution is perfect and the hospital's meals were far from Michelin five star, but the knowledge that good medical care is available without worrying about paying for it is a great comfort, even if waiting is sometimes involved.

Shaman said...

As an american living in Australia for the last 10 years, with our universal health care coverage (a combination of public and private if you want it), I have been horrified by the stories of my aging parents dealing with healthcare in america. My mom pays hundreds of dollars for medications she would get here for pennies, and even though she has medicare, she still needs to get approval for alternative therapies her doctor wants to recommend - but never gets the approval because her supplemental insurance company doesn't want to pay.

I think it's a little too easy for the young and/or never seriously ill to think that because they've never experienced a problem that everything must be ok. If only they would stop and ask: what if it was your mom, or your uncle or your neice or nephew. Would you care then?

I am shocked at people I consider friends, who I thought would be intelligent, informed and considered, getting sucked in by the media frenzy. I am horrified at how my parents struggle with healthcare, and I am ashamed of the country of my birth.

Healthcare is not a traditional good or service. You can't shop around - when you need it, you need it or you die. Any country that ignores this is simply barbaric.

martha said...

I recently came accross your blog and have been reading along. I thought I would leave my first comment. I dont know what to say except that I have enjoyed reading. Nice blog. I will keep visiting this blog very often.


Anonymous said...

I am in search of the comparison to Germany since I only recently heard about how Germany's Health Care works. After reading this blog, I did not get any facts (at least none that were cited where I can do the verify myself), but there was some interesting opinions and thoughts about overseas Heath Care.

One of the single biggest issues I see is a very obvious opposition to "right wingers", "teabaggers", and even the racism charges. I am a firm believer that people have a poor position when they attack the persons making the argument and not discuss their positions.

Speaking of misinformation. Most "right wingers" actually do not support the current system that we have in the US and want reform, just not the current reform being proposed. Where are the discussions about Tort Reform, allowing insurance companies to cover people across state lines, and Health Insurance regulations (all three of these examples have been brought up in the congress from the Republican side).

There has been many discussions, amendments, and many different health care proposals, and keep one thing clearly in mind, the Democrats have control right now. So they are the party that can push legislation through without one single vote from the Republican side. Which begs the question, why isn't this reform working out.

So to be clear, I WANT reform, but I do not want this current reform.

As a side note, At the time of this post, the Baucus bill passed the Senate and it is still not covering 21 million people, not addressing Tort reform, having the "Cadillac Tax" penalty amongst a list of other questionable issues.

I am of the opinion that this is not the better of the two evils.

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