Why America's health care debate matters for the Middle East

Gordon's column from Wednesday's Gulf News:

One might think the health care debate is a purely domestic issue - holding no importance for the Middle East. Nothing could be further from the truth.

US Debate Resonates
By Gordon Robison, Special to Gulf News

Viewed from the Middle East, America's loud, increasingly angry debate over healthcare may look like a purely domestic matter - yet another Washington argument that seems terribly important to the people involved, but holds little interest for the wider world.

This, however, is not the case.

Healthcare is shaping up as perhaps the defining battle of Barack Obama's presidency. Its outcome, for better or worse, will affect the president's political strength in every other area of policy. That, in turn, means it ought to matter to observers in the Middle East.

If Obama loses this fight - either because Congress fails to deliver a health bill that he can sign, or because the bill that does get signed is widely seen as watered-down to the point of being meaningless - the consequences for the rest of the world will be significant.

Traditionally, August is the quiet season for American politics. Members of Congress return to their home districts and spend most of the month meeting with constituents. They take the local pulse regarding the issues of the day and offer assistance to those needing help dealing with the federal government's bureaucracy.

During these weeks back home members routinely hold 'town hall meetings' - open forums where any interested citizen can come hear a presentation from the congressman, ask questions and raise issues of concern.

That, however, is rather different from what has been happening over the last two weeks.

Congressmen returning home this month have found themselves hung in effigy, portrayed on posters as the devil and routinely shouted down by protesters opposed to the health bills making their way through congress. With anti-reform protesters becoming increasingly vocal, pro-reform activists have stepped up to confront them.

In a few cases the resulting arguments have degenerated into violence - an almost unheard-of development in American political culture. The recriminations on both sides have served only to deepen the partisan divide over this and many other issues.

Obama's supporters charge that the protesters are a mix of partisan activists and gullible 'real folks' taken in by lies circulated by insurance and drug companies, right-wing talk-radio and the Republican Party (including the ridiculous, yet widely believed, claim that the health bill would mandate euthanasia).

Republicans tend to look at the same crowds and see concerned citizens worried by the seemingly inexorable growth of government and fearful of European-style 'socialised medicine'.

And that, in a nutshell, is the problem.

For too many people - Republicans mainly, but some Democrats as well - the healthcare debate no longer has anything to do with policy or philosophy (let alone helping sick people). It is simply about winning.

Because healthcare has emerged as the signature issue of Obama's first year, the Republicans want to defeat him not because they are against health reform - though many are - but because they believe such a defeat will cripple his presidency.

If health reform dies the GOP strategy of opposing anything Obama suggests will be validated. Having succeeded on this issue, Republicans will redouble their efforts, again with little or no thought regarding the merits of the actual policies they will line up to oppose.

That would include efforts to reach out to the Muslim World, open a dialogue with Iran, thaw relations with Syria and get the Israelis and the Palestinians to deal seriously with each other.

So if you care about the myriad issues on Washington's Middle East agenda and hope a new administration can bring genuine change to this part of the world, pay close attention to America's seemingly arcane debate over health reform. Because if Obama fails in his effort to bring fundamental change to how America cares for its sick, he has little chance of winning the domestic backing he will need to shift debate in and about the Middle East.

Gordon Robison is a writer and commentator based in Burlington, Vermont. He has lived in and reported on the Middle East for two decades.