Why is this even an issue?
Published in Gulf News, 9 September 2009
By Gordon Robison, Special to Gulf News
Tonight in Washington, President Barack Obama will address a joint session of Congress in an effort to get his ambitious health reform agenda back on track. Make no mistake, this is a big deal. The annual ritual of the State of the Union message aside, presidents rarely invoke the gravitas and high ceremony of a joint session. Ronald Reagan, George W. Bush and Bill Clinton each served eight years as president and each did it precisely once. Even Franklin Delano Roosevelt (FDR), the sole president to serve for 12 years, only made a single such speech.
FDR addressed a joint session to ask for a Declaration of War after the Japanese attack on Pearl Harbour. Reagan reported on his first meeting with Soviet leader Mikhail Gorbachev. Bush's speech came 10 days after 9/11.
Clearly such speeches are reserved for great and grave occasions. Clinton, 16 years ago this month used his to call on Congress to pass health insurance reform, an effort in which he famously failed.
In the United States the question of the moment is whether Obama, unlike Clinton, can succeed. Viewed from abroad the question has to be why we Americans are even having this conversation.
In every other rich country on earth - and not a few poor ones as well - health care is viewed as a basic human right. Different countries deal with the issue in different ways, but most start from the premise that everyone is entitled to the treatment they need. Why is America so different?
A big reason, of course, is money. The American political system floats on a sea of money, and the health industry (doctors, insurance companies, drug manufacturers, etc) is among the biggest and most powerful players in this culture of influence.
Philosophy, however, also plays a significant part. A regular viewer of the 2008 American presidential campaign debates - especially the early debates, back in 2007 when both parties still had six or eight contenders apiece - would have noticed a severe disconnect. Democrats and Republicans seemed not only to be addressing different audiences in their respective gatherings, but to be looking out on different countries.
Health care was the single best measure of this. It was a central theme of virtually every Democrat debate, yet rarely mentioned at Republicans gatherings. On the few occasions when it did come up GOP candidates tended to praise the existing system. The US has the best health care system in the world, they would say; to even imply that it might require fixing was not only wrong, but unpatriotic.
Put simply, many Republicans are philosophically opposed to any suggestion that the government ought to fix health care (or much of anything else, though that is a separate debate). At a very basic level they view health care as a personal responsibility, something with which the government ought to have little or no involvement.
This is why the dominant Republican narrative throughout the summer's health care debate has been about the need to keep the government away from issues of personal choice, such as what doctor you will see and what sort of coverage you will be able to purchase. The Republicans' appeal has been to people afraid of losing what they have.
In contrast, Democratic arguments this summer have alternated between the moral (health care is a human right. Period.), and the practical (sure, you may have insurance now, but what if you lose it?).
For Obama the coming weeks are a test of both his political and his policy skills. As a matter of politics he must win this fight. His poll numbers have been slipping in recent weeks, health care has long been touted as the centrepiece of his domestic agenda and the Republicans have made little secret of their hope that beating him on this issue will be their ticket back to control of the Congress when voters go to the polls next year.
As a policy matter the question is whether he can pass and sign a bill that offers meaningful change at a moment of fiscal austerity.
Doing so, however, will require convincing a significant number of Americans who are more-or-less happy with their current health care arrangements that nothing the president proposes represents a threat to them. This, in the end, may prove to be Obama's greatest challenge. Because for every person in America who thinks health reform is a pressing concern there is someone else who believes the current system - despite all its inadequacies, inequities and horror stories - works just fine. Those are the people the US President needs to reach when he stands before Congress tonight.
Gordon Robison, a writer and commentator who has lived in and reported on the Middle East for two decades, teaches political science at the University of Vermont.