Sunday, October 04, 2009
Sat in a comfy chair at home musing on our experiences in America. Result: lovely country but I'm glad I don't have to live there. It really is survival of the fittest in the Land of the Free. All through the trip I watched the health care row take form on tv and the web. I struggled to get into the complexities, and will stand correcting, but it appears to be based on the concept of insurers commissioning care from the health system on behalf of clients. Naturally this only works if you have the resources to get the insurance. If you have insufficient resources you don't have a policy - unless you have none at all in which case the state can step in - or if you're over 65 in which case you get 'medicare' benefits (which it has to be said seem very good).
The majority of young people take the risk, don't buy a policy, and hope they won't become ill. So a large proportion of the population pays nothing at all into the health system. If they do get ill that's a problem because you can't get insurance if you have a pre existing condition. The cost of health care has in any case ballooned in the US, as it has in all industrialised countries, but in the US to a really radical degree. It now accounts for 16% of the country's GDP, up from just 8% in 1980. At some point a bill will emerge 'from the hill'. For what it's worth, and I'm no expert, I reckon it'll be Obama's defining moment in this term.
It was exciting to be in a country that can faces up to this problem with heated debate and a proper democratic process, albeit swayed by the lobbyists. And as we travelled I got a real sense of ordinary Americans wanting something sorted out; I think back to Georgia when I met a man at breakfast who faced a bill of over $1000 when his daughter picked up a minor sports injury; only a proportion of the bill which was largely borne by his employers policy .
The country as a whole feels as if it's weathering a difficult period. Two wars. The health care problem. The economy still very much in a trough, with more unemployed this month than even the analysts were expecting. But I got the sense, speaking to people, of a country with a great sense of pride in itself, and a sense of purpose that I rather wish we had over here.