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“America just caught up with the rest of the world. Now everyone gets free healthcare! Why are they so angry?”

“I thought you were supposed to provide for the poor. Why are people against the Bill?”

“Wait–I’m confused. Didn’t Obama just do a good thing?”

The British can’t see what the fuss is all about and it’s really not their fault–America’s non-stop party squabbling is not helping. Barack Obama signed the US healthcare bill as law, the entire country went into a rage and if you’re not American, you probably don’t understand why…

BECAUSE nobody is explaining ANY of it properly.

Let’s break this down, nice and simple.

The United States government has never paid for health care. Never–in it’s entire life. Why? Because it’s not in The U.S Constitution, the foundational legal doc for America’s existence. In the name of freedom and independence, The Constitution encourages taking total personal responsibility for oneself (health care and all). Well, the first people to take advantage of that freedom were health insurance companies–the ‘shops’ of healthcare, if you like. Americans ‘shop’ for the best doctor or dentist, they always have; they’ve never known any other way. Gradually, health insurance companies became competitive. If someone couldn’t afford to shop, the government wouldn’t pay for you but they’d help you try to get ‘discounts’, so you wouldn’t stop trying to afford shopping.

This sounds sadistic to the British. Why? Because the British government cut out all this ‘shopping’ business: it promised to pay for health care–no shopping or competition involved. In Britain there’s only government-funded hospitals, government doctor’s surgeries (offices) and government ambulances. (Unless you’ve chosen to pay private insurance.) Nobody in Britain remembers life before the NHS because the ‘pay-for-a-doctor-or-die-in-the-street’-method, was considered primitive and inhumane. Since 1946 the NHS is how it’s ‘always’ been. The biggest disadvantage of the NHS is that you can’t buy a ‘better’ doctor–you just take what you’re given. But if everyone else in the country is also at that disadvantage then, none of us will ever know or want any different, right?

From day one, Britain and America’s models have been as different as chalk and cheese. This is the first difference between our countries that nobody bothers to explain.

The only universal healthcare America has, is what the British would consider ‘discount’ schemes. These are Medicaid, which covers low income families and Medicare, for over 65’s and the disabled. Medicare is 100% federally-funded/managed; Medicaid is 50% state-funded, 50% federally-funded and 100% state-managed. Medicare is an automatic entitlement (i.e you grow old, you claim it), Medicaid is determined by eligibility (i.e show proof of income, we’ll decide if you pay all/part of the fee). Both are in trouble. Why? Because the Health Insurance companies are getting more expensive. Medicare is claimed by fewer people these days, but it is also bankrupt because insurance companies are expensive ; approximately 4 people’s taxes pay for 1 person’s Medicare. Medicaid is also increasingly expensive because states charge high premiums for revenue, making it inaccessible anyway. Neither work.

Still with me at this point?

So what do you think happened? There are an estimated 308 million Americans to provide for. They’re all fed up with the greedy health insurance companies. The government’s ‘help’ programs are failing. Everything’s been badly managed and has spiralled out of control. Then along came Barack Obama.

Of all the changes Obama promised to make during his presidential campaign, healthcare reform was the biggest. To quote: “I’ll make our government open and transparent…No more secrecy, that’s the commitment I’ll make to you as president. And when there’s a bill that ends up on my desk as president, you the public, will have 5 days to look online and find out what’s in it before I sign it, so that you know what your government’s doing…and you can decide whether your representative’s actually representing you.” Now that sounded like change we could all believe in. Inspirational stuff.

Except when he became president, he did the exact opposite of all these things.

Last year a healthcare reform bill 1500 pages long was written, in obscure legal jargon, which an average man cannot read nor understand. In November 2009, this bill was hurried through the House of Representatives without the public getting to read it. On Sunday 21st March 2010, the House voted 219-212 and Obama signed the bill as law. The public were only given 36 hours to read it online.

The American public, even some of Obama’s staunch supporters, were furious. Every step of the way.

To pay for the new reform, the Obama administration says it is taking $500 million from Medicare. Hold on, isn’t Medicare bankrupt? That’s right–it’s a hollow wall. As a result of this bill, health insurance companies are raising their rates and collecting federal funding at the same time. Hold on, aren’t health insurance companies already rich from overcharging people? That’s right–they’re still the controllers of health care. The reform doesn’t take effect for 3 years. The total predicted spending costs are currently at $2.5 trillion. Hold on, didn’t Obama say he would cut people’s taxes to help recover from the recession? Yes, that’s what he said. America’s national debt is already past $700 million and the country is still in a recession.  This can only mean one thing: the American people would have to pay for it…all.

As a friend of mine said, “…He put out a bill that most people can’t stomach in this economic climate…He tried to do too much all in one go.”

To think that the health care reform bill has created one problem, is wrong. It creates several separate problems. The country has gone berserk and torn itself down the middle because many Americans are fiercely against any sort of government dependency. Many believe that a move like this bill, is an enormous and dangerous step backwards. America’s emancipation from British rule was to abolish government dependency, establishing an American government which would represent and preside over the people, not provide. Because once upon a time, a British government once said it would provide for it’s American colony…it robbed them instead. America never forgot that.

And that dear friends, is what all the fuss, is all about.

house-of-representatives

I am writing this article sat slack-jawed, on the edge of my seat, in front of the television as we speak. Considering that nobody, not you nor I, has been allowed to actually read just what is in this piece of legislation, I have just witnessed the House pass the proposed $1.2 billion US Health Care Reform Bill. 218 Democrat votes in favour were counted, the number needed to pass the bill; a seemingly full Republican house voted against the Bill…save for one rather “interesting” vote in favour from a Louisiana representative. Forgive me, but I think there is some truth in the matter when I say only God knows what’s been passed in the fine print. Realistically, the Senate are the next body who will be able to make a difference to this result.

A rather unfortunate problem which also recurrently surfaces in British parliament in such similar scenarios, is that the party providing opposition to the reform has insufficient evidence to suggest any provision of a viable, structured alternative strategy to improve the ailment. This is the silence into which the Republican vote falls. The statistics indicating exactly how this will affect the American population are mindblowing. A reported 96% of under 60 year olds are proposed to be covered by this new centralised healthcare, leaving the remaining one-third of 18 million Americans excluded without healthcare (including legal aliens and American residents like myself. Ho hum.). The conscientious person amongst us asks, so where does the money come from for this? Good question! Funding is expected to come from further cuts from the already pitifully suffering Medicare program, (which certain groups insist, laughably, is in excellent operation…oh, pull the other leg will ya!). Of course this does not leave out the role of the average taxpayer (read: you and me); people earning $500,000 per annum can expect higher taxes of a juicy 5.4% surcharge. Not that I take this issue at all lightly but at this stage, I really have to laugh. Wasn’t it America all those years ago, who declared freedom from the British government on the basis of “no taxation without representation”, yet today the American governmental system insists on overtaxing it’s people for a type of healthcare that a majority did not necessarily ask for?

I have deliberately held off for months, from writing about this whole healthcare palaver. And with good reason. As a British person who was born under the British NHS, living in the US, I’m often expected to be the “voice of experience” amongst the opinions of a squabbling America. The additional advantage I would also have in this “seat of authority”, would be the lack of political subliminal influence which comes with being born in America. Two very important points I should bear in mind as a writer. This calls for great thought before offering my thoughts on this topic.

The one question I am constantly asked is, “What’s it like to live under centralized healthcare?” Realistically this is about as useful as asking the average, non-passport-holding American, “What’s it like living in a big country?” The answer to both of these is the same: “How would I know? I don’t know any different!” You want to hear the goodness and light version? Yes, the British people have access to ambulances any time they want, Emergency Room treatment anytime they want, frequent doctor appointments anytime the want, visits to specialists at at no extra surcharge and subsidised prices on medication and dental visits. Yes, we do have these benefits as a right. But it is by no stroke of the imagination, free. No, no, no. The British are well aware that regardless of whether they go to the doctor every 9 years or every 9 weeks, the payment for the NHS automatically comes out of their paychecks every month. It is a mandatory tax that can never be revoked, reimbursed nor contested.

At the last census, just under 61 million people live in the UK. My doctor’s office in West London has always been packed with people. It used to be that when doctors took their annual leave, your appointment would be rather inconveniently, rescheduled 3 weeks later due to backlog. These days if you want to see your NHS doctor or even your NHS dentist at your convenience, normal appointments have at the very least, a 3 week waiting list. It may shock the average twinkly-toothed American to hear this, but a general, rather silent check-up at an NHS dentist (see Ricky Gervais film ‘Ghosttown’ for a parody of the sour British dentist!) takes approximately 5-8 minutes; during which, you must request a “clean and polish” if you expect one, for a fee. And if I am being completely frank with you, in all my 29 years of being alive, an NHS doctor’s visit has never lasted longer than approximately 5-6 minutes, regardless of the severity of the illness – I am an asthmatic. Both my parents and records at my local London hospital will bear witness of the numerous times I have sat, unattended, in a dingy waiting room in Accident & Emergency (US: ER) having a 6 hour acute asthma attack. I vividly remember being partially collapsed against my mother, who sat from 11pm-5am with a blue-faced daughter gasping for air, while my father walked the corridors looking for a doctor, only to be told to wait his turn. Many a time I returned home untreated. The only benefit I’ve obtained from such experiences, is that I laugh in the faces of those who tell me asthma kills: if that sort of talk were true of all asthma sufferers, then I cheated death over 8 times in one year in 1988; many times more after that.

All Britons have triumphs and defeats within the NHS. If it hadn’t have been for the NHS, my dad might have died of blood poisoning when he was attacked by a Great Dane canine, who sunk his teeth so far into my father’s thigh he almost made a colander out of him. If it had not been for the NHS, the survivors of the July 7th “7/7” London terrorist bombs of 2005 might not be alive and well today. If it had not been for the NHS’ subsidised medication, I would have never outgrown my asthma as far as I have today. I do not overlook the successes of the British healthcare system at all. HOW- EVER. Unless you are in the minority who can afford privatised British healthcare, British people do not know any other kind of “better” healthcare outside of what they’ve experienced with the NHS. They cannot be faulted for saying the NHS “delivers a high standard of excellence” because the majority of us have no experience of some other “higher standard” healthcare! To many Britons, my descriptions are not unusual nor surprising. To many Americans they are horrifying; serving as ominous forewarnings for some.

Many agree that the current state of American health insurance is a mess which needs cleaning up. Is centralized healthcare a good idea for America? The future is uncertain and the outlook shaky from this point forward. Instead of hurrying unrevealed bills through the system, this presidency needs to tread very carefully to gain solid success with healthcare reform. Like democracy, it may certainly work in theory but in practice, you may lose a mouthful of teeth before there are any left to gnash.