Monday, 18 April 2016

Medical Reform - one of the hardest fought battles of the Obama Presidency

In his election campaign Barack  Obama had made promises to change the USA and by definition the World. 

One of the mainstays of that campaign message  had been Affordable, Accessible, Healthcare  for All. In the BBC Documentary, “Inside Obama’s Whitehouse” Obama describes himself as being Temperamentally optimistic. He was willing to give this all his efforts to improve the situation for millions of Americans.

As I describe in the previous two Blogs of this April  White House Blog Series; The Financial Crisis that hit in the first weeks  of the presidency, had put all bold reform on hold. 

Obama had an advantage unusual in US politics, for the first time in Fifteen years , there was a democratic congress Majority. If the party was ever going to reform Healthcare, the time was now. 
Advisors were telling him the extent of Financial Reform required to prevent another Depression was a significant legacy on it’s own. Telling him that  Healthcare was too thorny an issue to tackle after the rigours of collapsing economies. To put the enormity of his  task into context, Seven Democratic Presidents had  tried and failed.  Some saw this particular area of reform as Political Suicide. 

Obama felt it was Critical to at least try, the moral costs to the millions failing to receive adequate care  were too high not to.

One of the loudest and most respected voices in the Democrat Party, Ted Kennedy had been pushing for reforms in the Healthcare system since  the Seventies. He argued that Democrats had brought about National Insurance in the1930s, in the  1960’s  Medicare had come to bear and that finally , with Barack Obama at the helm they could  “break the old gridlock, that healthcare could be a fundamental right for all, not just an expensive privilege for the few.” 

Knowing his health was deteriorating, he passed the baton onto the younger man to bring his political life’s work to fruition and when a Kennedy puts you to work you rarely refuse!

Government  Provision  already  covered the veterans, the old and the very poor. The existing system  was not a comprehensive protection even for them. However  One in Six Americans had no private health insurance at all. One of the closest Advisors  to Mr Obama, David Axelrod had first hand experience of how damaging the current system was. His daughter had for  19 years, been suffering  seizures .In the early days of his career, the  cost of treatments and medications as  $10,000 a year from  pocket from a  30,000 salary. He had no facility to change providers or policies as her Malady was classed as a Pre -existing condition ( she had been afflicted from birth.)

A British style NHS would be untenable within the US system so Obama sought to fix the Insurance System. Reforms to fill the gaping holes in provision were to be put in place.

One  of the big ones was that of Gender,Women paid 48% more for Health Insurance than men, and ridiculous things were counting as  pre existing conditions included caesarean,pregnancy and injury from  violence against women(which I am presuming is a euphemism for Rape and sexual assault). 

When Obama took office  45,000 people were dying a year because they were Uninsured or not covered sufficiently to adequately cover their care. Obama was convinced the only way to proceed was to get the Drugs and insurance companies onboard from  the launch and so made sure that they were well represented at the Press Conference launching this very ambitious plan.

The Republican Party  were seeking any way  to prevent the bill from passing, they were convinced it was against all the core principles of the Republican Party, that individual choices and Liberty was going to be infringed.

 A chance comment from a Republican voter at a Republican  voters focus group meeting gave  was gave Frank Luntz, the Republican Pollster an idea that  provided them with the sound bite that might have brought the whole thing crashing down before it had even begun. The lady  had said she thought it was not  so much the case that it was just  more Government Control over Healthcare, but a “Government take over” 

This became the phrase of choice, in every argument against the plan and the Tea Party used it as a cornerstone of their argument against What they termed “Socialism”.

They accused Obama of Socialism for his attempts to Control education,firearms,Healthcare despite the fact that all he was trying to do was even the playing field a little for people who were being failed by the present system.

The Republicans and Conservative Democrats often point at the British system as being close to Socialism, so for clarity, I thought I would briefly describe for my US readers the way the British system works.

Every person born in the UK has access to free medicine. if Donald Trump, little Orphan Oliver  of Dickens Fame and I  all got hit by a bus, (predisposing that we were all in the same times and registered as a Citizen) we would all be treated  by the same doctors, Paramedics and aftercare staff. The trip to the Hospital is free, all the medicine administered in the Hospital and the care of the doctors are all free.

Once we are released, our painkillers would cost £7 or about $9.99 unless generic brands at the same dosage are available which are probably cheaper in our local supermarket. 

For other conditions a flat rate of £7 per prescription is charged  to those who pay fees (anyone not on benefits or under 16 and over 65) a monthly certificate is available for repeat prescriptions with several components which works out even cheaper.

Dentistry is charged at the following rates for every who is not already exempt as above

There are three NHS charge bands:

Band 1: £19.70 or about $28  covers an examination, diagnosis and advice. If necessary, it also includes X-rays, a scale and polish and planning for further treatment. 

Band 2: £53.90 covers all treatment covered by Band 1, plus additional treatment, such as fillings, root canal treatment and removing teeth (extractions). 

Band 3: £233.70 or $332 covers all treatment covered by Bands 1 and 2, plus more complex procedures, such as crowns, dentures and bridges.

We can also take out medical insurance to reduce the costs of things like dental treatment or glasses and contact lenses. Something I take advantage of  as the average pair of glasses for my prescription with thinned lenses to make the frames less heavy on my face is about £400, but I rely on the NHS for all of my day to day and emergent needs. 

This is all paid for out of Taxation and the budget for Healthcare and whilst the system is flawed and sometimes involves a wait for elective or non emergent treatment, I know on any given day that should disaster or calamity occur that My Family and I will always be given hospital care which will not stop because my premium does not cover the cost.

Returning to the Programme.

One woman described socialism as  a bid to 

“Take my money and give it to people who do not deserve it because they never worked for it”

Larry Pratt describes a “Cultural war”,  where the Socialists seek  over control over education, the economy, and  firearms by people who seek Govt as the  solutions  to problems, whereas we still see government  is a “problem to solve”

True pure socialism ( not held in Marxist theory , which is quite different) actually allies itself to the idea that would align itself to the Republican ideas of Pratt.

"a political and economic theory of social organization which advocates that the means of production, distribution, and exchange should be owned or regulated by the community as a whole"

Paul Ryan called the reforms “Fiscal Frankenstein, a Government Takeover" 

As this message started to be pushed as hard as possible by the Republicans,Town Hall meetings became violent  and argumentative with people being  kicked and  spat upon, people were getting totally out of control and the only solution were  5-6 hour meetings to ensure everyone felt heard. 

Dozens of people would be queueing  for the microphone.

“Promise me you will keep Government out of your  Medicare” the Irony being that Medicare is a , 100%  government funded programme  and a single payer programme. 

The Republicans were playing on the fact that many Americans had a total  lack of understanding for the provision that they already had under the current system. It is not hard to see why, the system even today is quite complex.

For Brits who are confused -

Medicaid is a joint federal and state program that helps with medical costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, like nursing home care and personal care services 

Medicare is a federal program that provides health coverage if you are 65 or older or have a severe disability, no matter your income.

The President was worried about this  failure to communicate the true scope and expectation of the plan, but  quitting not an option. Did he have doubt that this might be just too big of a challenge and many advisors were pushing a  smaller approach. He persevered.

He took himself to address a Joint session of Congress. He spoke to nervousness generally in the opposition  about reform. He called out the Republicans who had made erroneous and Bogus claim. He refuted The claim that federal dollars would be used  to  fund abortions he spoke against the claims of a government takeover. 

Almost unheard of, a US president was heckled on National televised Congress session a shout of “You Lie”  can be heard  audibly on the video. Coping with the interruption and resulting gasps of astonishment with aplomb, Obama demands that the   bickering be over, games in the past, and a, season for action must begin.

The last time the White House had tried to impose a bill on congress, it  failed so Obama was advised against it, bills developed in separated chambers and then amalgamated into one workable bill was the only option.

Obama used case studies to argue his case. A woman with Breast cancer had her insurance cancelled because she had not declared a case of acne and by the time the insurance was reinstated, her cancer had progressed to the point that it was double in size. He called this  heartbreaking, wrong and declared  no US Citizen  should be treated that way.

Mainstream Reps had been wary of tea party but as the vote approached, they began to court them to ensure blockage of the bill. John Boehner  asked them to join him to oppose all of Obama’s reform measures.  

The Passed in the House of Representatives.

Then it was the Senates turn to pass their bill. Senate Democrats were squabbling amongst themselves over the subject of the Public Option. A government run insurance that would compete with the private  insurance companies. The Right Wing  of the party were concerned that a this might  be the First step to National Health Service which they were wholly against.   Joe Lieberman, one of those Conservative senators was to be the sixtieth of the Sixty votes needed to end debate on the bill, some claimed he was holding the President to Ransom. Lieberman’s threat to vote against effectively removed public option from the vote that was taken in the Senate on Christmas Eve.

The Republicans were still hopeful for a defeat but expressed it in (in my opinion) the most horrible of manners. A Blizzard had severely impacted the transport network around Capitol Hill and if one Senator had failed to turn up Harry Reid  knew the Bill would fail. The Republican Senator from Oklahoma said that Senator Byrd was very old and he hoped he would die overnight. Thankfully tough old Bird, Senator Byrd at age 92  arrived chipper in his wheelchair and voted a resounding Aye in the name of his friend Ted Kennedy. In a strange slip of the tongue,Harry  Reid voted No by accident but corrected his mistake before calamity!

Now the House Democrats and Senate Democrats had to find a way to amalgamate both bills into one workable document and the main stumbling block as ever was about money.Senators wanted to cut costs and the Hose opposed this. Obama had been sitting in on debates in the Cabinet room hearing all the arguments and they were getting nowhere fast, ultimately it was decided that Rahm Emanuel as Chief of Staff would announce that the President had made a decision and however they resolved it, there would be no presidential signature if it was not done. So they had to agree something to get a law given the Presidential seal. The different elements were hashed out and they finally came to a mutually agreeable bill.

Next time, how a throw away comment almost brought the  Health Bill to it’s Demise, the work expended almost moot, despite the blood sweat and tears of all involved. There was going to be a very Frosty reception in Washington.


  1. Wow! A vivid and well researched article on Healthcare Reform. What I find about these articles that I enjoy so much are the accompanying illustrations which brings the information to life. These articles are a fast read and I always find myself learning so much. Thank you again for another outstanding article in this series. I eagerly look forward to the next!

    1. Thank you! You did not have long to wait... Next one is up Right Now!!

  2. Very well written and tells all about the fight for the AFCA. We have been waiting for this forever! Obama deserves so much credit for pushing it through.