A healthy debate

If there's one thing all the Democratic candidates agree on, it's that something needs to be done about America's healthcare system
January 20, 2008

"I can't understand why a capitalist country is talking about socialist issues," said one undecided voter to me at the Iowa caucuses at the beginning of January. But in US politics, socialised healthcare is the issue that just won't go away.

America is one of the only western industrialised nations not to offer universal healthcare to its citizens. According to the Democratic candidate John Edwards, over half of US bankruptcies are caused by medical expenses, even though two thirds of bankruptcy filers have health insurance. The Democrats have made figures like these the backbone of their political speeches to lure voters, and all three leading candidates have some form of plan that they claim will see virtually all Americans enjoy healthcare coverage.

The Republican opposition to universal healthcare during the 2008 race has focused on cost, choice and bureaucracy. The campaign slogan first used to oppose the Clintons' healthcare plan in 1993—"If the government choose, you lose"—is being resuscitated. Yet even the Republicans acknowledge the need for healthcare reform, and are proposing a free market, consumer-based system, with tax credits for healthcare for those who cannot afford insurance.

But while the numbers of uninsured—now estimated at between 45-47m—are increasing, the Democrats suggest that only universal healthcare can solve America's healthcare crisis. The three frontrunners agree on much. All say they will preserve the existing system so that those Americans with coverage need not worry that it will be taken away from them. All plan to focus on preventative medicine—facing epidemics of obesity and chronic diseases, the US spends only four cents out of every healthcare dollar on prevention. And all three pledge to clamp down on insurers who make it impossible for people with pre-existing health conditions to afford coverage.

Yet there are differences in the way the Democrat frontrunners say they will achieve universality. Of all of the candidates, Hillary Clinton's plan is the most comprehensive and inclusive. She says she wants to expand choice and ensure affordable coverage. She will make sure that wealthy employers dig deep into their pockets to provide insurance or contribute to the cost of national healthcare. She will also take care of small businesses by providing tax credits, and will create subsidies for low-income people. Both she and Edwards will make it compulsory for Americans to purchase insurance.

Barack Obama emphasises the cost of healthcare to poor families. Through subsidies and regulation of the insurance market, he hopes to make healthcare affordable to all, thus making a Clinton/Edwards-style "individual mandate" unnecessary. Being brought up by a single mother, he has explained that the 9m children that do not have health insurance are at the centre of his health campaign.

What about funding? The Democrats have been quick to explain that those with deep pockets will cover the tab. The plans will be subsidised by employers and the government, but will largely be paid for by rolling back tax cuts for people earning over $250,000 a year and by savings in the existing system.

For many Americans, particularly Republicans, socialised healthcare means two things—higher taxes and longer waiting times for operations. These are not imaginary issues. In countries with universal coverage, like Britain, France and Canada, all have higher taxes and much longer waiting times than those offered by premium American healthcare.

But this must be weighed against the tens of millions of Americans who are either without insurance or are clinging to their jobs for fear of losing it. Assuming a Democratic victory at the presidential election in November, change will come, but will that mean universal healthcare or will the next president face the same hurdles as the Bill Clinton administration? We shall see.