Universal Healthcare: A Domestic Issue?

Despite the current kerfuffle over Tom Daschle’s tax problems, I have every hope and expectation that in the coming years, perhaps months, we will start to see a real effort by the administration to solve one of the most pressing crises currently facing the USA - rising health care costs and the rapid increase in the uninsured.

Equally inevitable is that as part of this process we will start to see Conservatives and obstructionists of all sorts piping up to demonise OTHER health care systems that currently have universal coverage. Ranting and raving about the supposed failures of European and Canadian systems seems to be the first club at hand when the opposition reaches tries to beat back any effort at reform. And this view is widely believed by the American public - in fact, my mom told recently that she is very concerned about the quality of health care if America adopts universal cover.

This is an area where I, and Americans Abroad generally, have a useful point of view. After all, many of us have lived under the US healthcare system AND under those supposedly disastrous European systems that folks back home seem to find so worrying. So, from a patient perspective what is better; European style of American style health cover?

Well, the first thing to say is that there is no such thing as “European style” health coverage - countries across the continent all have different delivery models for their universal health care programs. In Britain, somewhat unusually, we have a single institution - the National Health Service (NHS) - that delivers all public sector health care. Other countries, Germany for instance, have an insurance model whereby third party providers offer the health services, but ultimately they are all paid for out of a single pool of taxation.

In fact, virtually the only things the different health systems in Europe have in common with each other are:

1) They are much cheaper than the US system.

2) They cover everyone, or almost everyone.

3) They deliver a better quality of care.

Here in Britain, for instance, we spend about 8% of the country’s annual GDP on health care, compared to 15% in the US, and yet the overall health of the population is similar, with perhaps even a slight advantage for the UK. For that 8%, we cover every single person living in the UK (including immigrants, like me).

You will frequently hear people point out that in Britain there are often waiting times for many medical procedures - this is absolutely true and is indeed a serious problem relating to the limited resources of the NHS. They are required to make some difficult decisions about how to spend their limited funding, and this does mean that sometimes people don’t get care as quickly as they should. The system can definitely be improved.

However, remember that this is based on a spending only a little more than HALF what the US is spending on healthcare as a percent of GDP. If we were willing to spend an equivalent amount - 15%! - to what they are spending in the States, we could virtually eliminate waiting times and many other inherent imperfections in the current system.

That is not to say that an NHS style system is right for the USA - I don’t think it is. But having lived under both systems I can tell you that if given the choice of living under the NHS or under the US insurance system, I would have no hesitation in choosing the NHS, even if only for career reasons. What do I mean by career reasons? Well, I recently parted company with my former employer and am working as an independent consultant. This career move would have been impossible for me in America - I would have had to either cling desperately to my previous employer at all costs, or to take a 9 to 5 job (ANY job) just to ensure I am covered. Living under universal health care has allowed me the freedom to pursue my own happiness. That’s surely something that Americans everywhere support.

If you are an American living in Europe, now might be a good time to pick up the phone to your relatives back home and give them the real story about your experiences with health care overseas. I bet they’d love to hear from you.

(Cross posted to www.eurobamablog.com)

Funny... Because It's True!

Demonstrating its usual finger-on-the-zeitgeist flair, The Onion has an article this week entitled:

Inauguration Crowd Moves To White House Gates To Watch Presidency Happen

Which, upon reflection, isn't really so far from the truth. I mean, maybe we aren't glued to the front gate of the White House, but aren't we all watching the Obama Presidency with the same intensity some of use (ahem) used to feel for our sports teams? A friend of mine called me yesterday to tell me how excited he was to recieve the e-mail from President Obama. "I know it was probably churned out... but still! It's great."

'Tis.

Obama Confirms Existence of Actual Women: Pictures!

Thanks to Feministe for this striking photographic discovery:

Bill signings:

The Partial Birth Abortion Ban Act of 2003:




And the Lily Ledbetter Fair Pay Act of 2009:

But not getting carried away...

On the other hand, the Republican party stills seems to be a place where it is considered disgraceful to disagree with Rush Limbaugh in any way, even when he hopes for the country to fail. So there's still work to do, I guess.

Over the past week, the fealty of GOP lawmakers to hate radio host Rush Limbaugh has become increasingly clear. They have been reluctant to criticize his comment that he hopes Obama fails, and those who have spoken out have been forced to retract their statements and beg forgiveness from the hate radio host.

Today on Fox and Friends, Sen. John McCain (R-AZ) further circled the wagons, saying that Obama shouldn’t have made critical remarks about Limbaugh (which were made in a private meeting with Republicans and then leaked to the press)...

Credit Where Credit is Due

Yesterday, the Republicans went through the process of chosing a new RNC leader. Given the opportunity of voting for one guy who belongs to an all white country club, or another guy who thinks "Barack the Magic Negro" is both fine humor and a fab Christmas gift, they instead chose the African American former Lt. Gov. of Maryland, Michael Steele.

Now, I don't know much about Steele (except that a Republican of any color is something of a rare beast in Maryland...) - maybe he's a decent guy, maybe not. We'll see. But considering that until very recently the Republican party seemed to basing its hopes for restoration on a food fight over how great it is to be racist this may be a small step towards them becoming less achingly embarassing.

Which, I should clarify - would be a good thing. A country in which politics is fought out between one party who controls both sides of government and another that is wholely unserious is not a very health country. I'll always be a Democrat, but I'd still rather that Republicans were a serious party.

As I Suspected...

It looks like the family planning provisions stripped out of the Stimulus will be reintroduced shortly in new legislation.

A source present at today's White House signing ceremony for the Lilly Ledbetter bill tells me that President Obama gave assurances that the family planning aid would be done soon -- perhaps as soon as next week, when the House is set to take up a spending bill that would keep the government funded until October.

A little note to those who were, understandably, concerned about losing this battle - sometimes a tactical retreat is the best way to position yourself for victory in the overall battle. Especially when it's clear that you have another path to conquering the same territory.

Obama's going to let us down, I'm sure, but I don't think this is one of those times. Trust, but verify.

Lily Ledbetter Act, Continued...

As usual, Barack has put it best:

But equal pay is by no means just a women’s issue – it’s a family issue. It’s about parents who find themselves with less money for tuition or child care; couples who wind up with less to retire on; households where, when one breadwinner is paid less than she deserves, that’s the difference between affording the mortgage – or not; between keeping the heat on, or paying the doctor’s bills – or not. And in this economy, when so many folks are already working harder for less and struggling to get by, the last thing they can afford is losing part of each month’s paycheck to simple discrimination.

So in signing this bill today, I intend to send a clear message: That making our economy work means making sure it works for everyone. That there are no second class citizens in our workplaces, and that it’s not just unfair and illegal – but bad for business – to pay someone less because of their gender, age, race, ethnicity, religion or disability. And that justice isn’t about some abstract legal theory, or footnote in a casebook – it’s about how our laws affect the daily realities of people’s lives: their ability to make a living and care for their families and achieve their goals.

Ultimately, though, equal pay isn’t just an economic issue for millions of Americans and their families, it’s a question of who we are – and whether we’re truly living up to our fundamental ideals. Whether we’ll do our part, as generations before us, to ensure those words put to paper more than 200 years ago really mean something – to breathe new life into them with the more enlightened understandings of our time.

Lily Ledbetter Act to be Signed Today

This is a great day to be a woman in America. Hmm.

Actually, this will be the first day for a couple of years in which your employee cannot systematically pay you less than a male colleague for no good reason whatsoever, without fear of consequences. So maybe my threshold for "great" is a little low. Still, tomorrow will suck less than today for women and employees across the USA, and that's a pretty good day in the White House.

My Discussion with John Podesta

Fresh from his work as co-Chair of Obama's transition team, John Podesta has returned to the Center for American Progress to answer questions about his time there. I'm please to say that my question was one of the ones he took the time to answer (thanks for that, John).

My original question was as follows:

John,

Firstly, congratulations on a hugely successful and smooth transition process. I know that you had already given a lot of thought to how the inherent instability of a Presidential Transition can be overcome, and that careful study really showed in the systematic approach you guys took.

My question is this: did you exclusively approach the process by looking at the list of jobs and searching for candidates, or did you also look at the structure of cabinet level positions to maximalise efficiencies? For example, I know that a decision was taken to elevate the UN Ambassador position back up to Cabinent level, but did you ever consider scrapping or massively reorganising Cabinent level positions? Specifically, did you consider eliminating the Department of Commerce and subsuming its responsibilities under other departments? What about breaking the Department of Homeland Security back into its constituent parts? What about combining the Energy and Environment portfolios?

Were you thinking along these lines at? Why or why not?

Many thanks,

Karin

That was abridged to, “Did you ever consider scrapping or massively reorganising Cabinent level positions?”

I thought his answer (which starts at 3:18) was interesting.



Summarising the response, I think what he is saying is that they were looking at ways of making the offices as effective as possible as quickly as possible, so the only reorganisations they looked at were those that were necessary to make departments function in the near term. However, I do think he made clear that there may well be reorganisations to come, but that they will led by the Cabinet Secretary and will occur once they have had an appropriate period of review.

Noteworthy - I was interested in his suggestion that maybe FEMA (the Federal Emergency Management Agency) might be taken out of the Department of Homeland Security.

Good stuff.

The Stimulus and Republican(ism)s

If you have been following President Obama's efforts for an economic stimulus package, you will probably be aware of a few key facts:

• The President has agressively reached out to Republicans in the House, trying to get their buy in to the stimulus, in the hopes of achieving a broad bipartisan consensus on the bill.
• As a result of those discussions, Obama agreed to have certain provisions of the bill removed, including one that would have allowed for states to provide contraceptive services to women without seeking a waiver for this purpose. (And by the way, Obama has signalled that he still wants this passed, but is happy to do it in a different bill - as he should. This approach will not only make affordable contraception available to women who need it, but will save $400Million from state budgets that are getting squeezed right now.)
• The stimulus passed the House yesterday - without a single Republican vote. Despite both President Obama's direct negotations with Republicans in Congress and his willingness to remove provisions of the bill that he favors but they oppose.

Disappointing, but what does it all mean? There are two ways of looking at both Obama's actions and at those of the Republicans in the House.

Obama's Approach

Already, I've heard from a bunch of folks who are frustrated - even angry - that Obama made compromises trying to win Republican votes that were not, in fact, forthcoming. I get that frustration. One way of looking at Obama's Approach is to say he tried and failed to win Republicans to the stimulus, and gave things up in the hope of achieving this. Effectively, this view sees the outcome as a net loss for Obama and a net gain for Republicans.

I don't see it this way.

Obama has passed a good Stimulus package - admittedly he took out a few items I liked (not only the contraception, but also for instance some much needed funding to restore the National mall). But there are still lots of really good things in there - stuff that is going to make a big difference to folks who are struggling to stay afloat, and that will calm some of the panics and help get people spending again.

Meanwhile, Obama made it as clear as possible that he is serious about working with anyone who is serious about working with him - he's willing to listen, and adapt where it is reasonable to do so although he will stick by his guiding economic philosophy. A case in point of this is he refusal to strip out tax rebates from those whose incomes are so low that they never paid income tax. Obama believes that a stimulus should distribute money to those who are most likely to spend it. Lower income people are more likely to spend that money quickly, so apart from humanitarian reasons, they are pragmatically the best people to quickly stimulate the economy. Win win.

Nothing that Obama did in his effort to reach out to Republicans in any way harmed the bill's fundamental effectiveness - even his decision to offer significant tax cuts as part of the bill wasn't really something he surrendered to Republicans, but is in line with his belief that the money should be spent as quickly as possible, and more money in people's pay checks is a quick and efficient way of doing this. Capital Gains tax cuts, however, which Republicans wanted and Obama refused, are NOT a good way of doing this. So he made a sincere effort to work with these people, but stuck by his core philosophy. Mature leadership, and I think it came off that way to most people who were following it.

The Republican Approach

On the other hand, Congressional Republicans have achieved... what exactly? Well, they didn't stop the bill; it passed the hourse easily and will pass the Senate, apparently with bipartisan support. They managed to block a couple provisions from appearing IN THIS BILL, although most of them - including the contraceptive waivers they were so offended by - will almost certainly be included in another bill sometime soon.

They didn't get the permanent tax cuts for the wealthy that they were looking for. And, by the way, those Republicans who are waxing indignant about how shocked, SHOCKED they are that the stimulus spending will increase the deficit are being transparently hypocritical - their tax cut would have increased the deficit just as much (raising spending and cutting income both hurt the budget) but would have benefited different folks.

Which brings me to the crux of the matter. The only thing Republicans really acheived here is making thier actual point of view crystal clear to the voters - the Republicans don't want deficit spending to stimulate the economy. They don't want it so much that they were even willing to disagree with President Bush and harm John McCain's campaign last summer to try and stop it from happening. After an open trough pork buffet during most of the Bush administration, precisely at the moment when the economic cycle has turned around, to the point where almost all economists agree the deficit spending is our best chance for a recovery, they just plain don't want it. Tax cuts yes, spending no. Principled stupidity?

Or, perhaps the explanation is more cynical than that. Perhaps the plan is to distance themselves from the recovery plans as much as possible in the sincere and desperate hope that it will fail. The calculation, 100% political, may be that the Republicans' best chance for a comeback is the hope for an ongoing economic crisis that they can blame entirely on Democrats. Malevolent scheming?

Inspired by Obama's policy of presuming good faith from the other side, I'm going to hold fast to the assumption that the Republicans in Congress are acting from misguided principle rather than the unpatriotic hope that the country will fail.

Either way, it seems to me that they have won nothing in this battle.

OK, So I'm a Geek...

But I love this map of the West Wing office assignments. Calculating on proximity to the Oval Office plus office size, David Axelrod is now the second most important man in America.

What explains the massive difference in office size between Jim Messina and Mona Sutphen, considering that they are both Deputy Chiefs of Staff?

And how come poor John Favreau, the outstanding chief speechwriter is down on the ground floor instead of with the communications team? And what's the deal with the Office 21 "yet to be assigned"?

Anyway, I'm delighted to see that Our Chief of staff Rahmbo isn't superstitious - office number 13 should be good luck for him.

The First Black President

(Cross Posting this from the EurObama blog, where I am now guest blogging...)

Just a few days ago I returned from a dizzying trip to DC where I was able to both attend the inauguration events and to hang out with my family. Both of those things have got me thinking about the meaning of race in this election, and this Presidency.

Throughout the campaign, I always tried to walk a delicate balance in talking about Obama’s race - acknowledging the historic nature of his candidacy, but also making it clear that the election was about a wider range of issues, and that we wanted to appeal to the widest possible range of voters. Personally, I always felt awkward about the issue. As, let’s face it, a white northern girl who is younger than the Civil Rights movement, it seemed like anything I could say would be potentially inflammatory, condescending, or just tone deaf.

But I was very struck by the reactions I had from so many strong Democrats - folks who really wanted Barack to be President - who nevertheless felt that it was simply impossible: couldn’t be done. One Party stalwart told me flatly that America was too racist to elect him. These people always astonished me, not only because I never saw the country that way (sure, there’s racism in America, lots of it, but I just don’t think they make up a majority in this day and age) but also because I didn’t see Obama that way. Sure, he was black, comfortably and confidently African-American - despite his mixed race heritage - but I never looked at him and saw him exclusively or even primarily as a black man. There seemed to me something de-humanising about this determination to look past his intelligence, his obvious sense of empathy, and his sheer talent to see primarily his race.

The people who said these things to me are the opposite of racists - some of them were active in the civil rights movement themselves, and all of them care deeply about achieving social justice in America. But their insistence upon the racism of those “other people” - the ones who were going to make it impossible to elect him - despite all evidence of Obama’s high favorability rating, his ability to win over white voters across the country, his own eloquent speech on race in which he acknowledged the hard legacy of race but also talked of an america that can change… The stubbornness with which some of my friends continued to see him as first and foremost a black man frustrated me.

But my thoughts on this have evolved a little bit since my trip - not because of anything I saw on stage at any of the inaugural events, but because of the faces in the crowd watching it with me.

Now, I should say - before I moved to London I lived in Washington, DC for a lot of years. It’s a great town - walkable, with a thriving cultural scene, good restaurants and great public transport. But there are a few obvious disadvantages to life in the District. Crime is one. Homelessnes. But also, in a more general sense, the prevailing sense of disconnection between the citizens of the city (90% African American) and the Federal Government, which not only works there but has a bizarre amount of legal control over the city. The citizens of DC co-exist uneasily with the Federal City. Not necessarily angrily, but distantly, and for all the year that I was there it felt like there was an almost palpable sense of Us and Them. A certain distrust, not unjustified, that the federal people had anything like the best interests of the District in mind. And bear in mind - I’m not talking about the Bush administration. I lived in DC under Clinton, who as you may recall was at the time talked of as “the first black President”.

Except, of course, he wasn’t. Barack is, and the difference was astonishing to me. Looking around the faces on the Mall, it was clear that many of them were locals - not something I remember from previous big DC events. On the Metro I got into a friendly dispute with a young African American man who insisted on offering me his seat (”Please, take a seat.” “Oh, no really I’m fine. You take it.” “No, go on…”). The elderly African American man and his twenty-something daughter who were sitting behind me during the ceremony struck up a friendly conversation and exchanged phone number with the two cowboy-booted white Texans next to them. At the sandwich bar, when I accidentally took a seat that one African American woman was saving for her friend, she brushed off my apology and together we found a third chair. Collectively, the folks I met in DC seemed more confident, less defensive, and absolutely bursting with pride and joy. They acted like they OWNED their country. Because they do. It was beautiful to see.

My aunt lives in Lynchburg Virginia, hotbed of the Old South. When she first moved there an acquaintaince chastised her for her friendly relations with the African Americans she worked with, saying, “you don’t know how to treat your blacks.” She was, obviously, appalled. And saddened, as she realised that the black people around her had a habit of not making eye contact, not striking up conversations with the white folks around them.

Well I saw my aunt this week, and she is amazed at the transformation in the people around her - especially in the African-Americans who, she tells me, are holding their heads high, making eye contact, intiating conversations.

It may be that this change is because, when they look at Barack Obama, the primary thing that THEY see is a black man. And if so, then good. It’s about damn time.

Our President...

Watch his inaugural address as many times as it takes to sink in. Yep, he's really the President. Hail to the Chief.

I'm baaack!

Hello again my fellow Obama Londoners! I'm back from my excellent adventure, and will be blogging more about it shortly (with pictures!) but in the meantime I wanted to point you to this nice email I received from blog fan Simon Kimber:

I stumbled across one of the rallies (the one on Millenium Bridge) and i'm a massive fan of Obama so I took a bunch of photos. Then I heard about your last rally in Parliament Square through some friends, so I went along to take some more pictures and I never thought much more about it.

Well anyway I recently put together a slideshow of the pictures to show to a few friends and when I came across your blog I thought you might be interested in seeing it as well. It's available here.

Thanks Simon - lovely pics.

Inaugural Flight

This is just a quick note to say that I have arrived in Washington DC safe and sound. In just a moment I'll be heading out the door to meet some friends for Brunch and to attend the inaugural kickoff concert at the Lincoln Memorial.

For now, I just wanted to share with you that my favorite moment so far was arriving at my gate at Heathrow to find 150 people gathered around the telly, riveted, to watch Obama speaking from Philadelphia. Young asian men, elderly English couples, an older African American man and his 20 something daughter - everybody watched with smiles. There was a small spontaneous applause at the end.

This is going to be a great four years. And an even better four days.

Stay tuned for updates. Love to all!

Karin