14 August 2009

So, where were we? (Yes, I had a lovely break, thanks for asking … walking in Scotland, and the sun shone every day.)

Well, before I hung up my microphone two weeks ago, President Obama was trying to make progress with his healthcare reform proposals. Two weeks on, guess what? President Obama is still trying to make progress with his healthcare reform proposals.

What’s new is that the British National Health Service is now playing a central role in the US debate. “Socialised medicine” – in other words, health care provided by the State – is anathema to American conservatives, and they’re using the NHS as a warning of what they say Mr Obama is trying to introduce.

It’s not often that political debate in America is influenced by what happens in the UK. (I don’t think I’d claim the same was true vice versa.) But the current debate in the US does have some echoes of the debate Britain went through in the 1940s when the medical establishment here fought tooth and nail to prevent the establishment of the NHS.

Incidentally, British Conservatives (with the exception of the occasional maverick like MEP Daniel Hannan, who has been popping up on US TV networks) insist that unlike their American equivalents, they are devoted supporters of the NHS.

Just last night, the party leader, David Cameron, sent out an email to supporters saying: “Millions of people are grateful for the care they have received from the NHS - including my own family. One of the wonderful things about living in this country is that the moment you're injured or fall ill - no matter who you are, where you are from, or how much money you've got - you know that the NHS will look after you.”

But President Obama undoubtedly is finding his ideas tough to sell. And it could be that one reason is that he has not yet put together a detailed package, which means there are still many unanswered questions about cost and the small print.

Robert Reich, who was a key figure in President Clinton’s first administration, wrote this week: “The White House is waiting to see what emerges from the House and Senate before insisting on what it wants … But that's the problem: It's always easier to stir up fear and anger against something that's amorphous than to stir up enthusiasm for it.”

No American needs reminding that Hillary Clinton tried – and failed – to introduce healthcare reform in 1993. The Obama team say they have learned from the mistakes made then … that they are working with Congress and health care professionals rather than against them to come up with a package that will be politically acceptable.

The stakes are certainly high, not least for the 46 million Americans (that’s about 15 per cent of the population) who have no health insurance. President Obama has invested huge amounts of personal political credibility in getting a deal through … and his administration will be seriously damaged if he fails.

How important is it? Look at it this way: according to the political news website Politico.com, which says it has analysed just about every word the President has uttered in public since his inauguration, he has used the word “health” more often than “Iraq”, “Iran”, “Afghanistan”, and “terrorism” combined.

That’s how important it is.