In India, a Bill with the same provisions as the US health-care reform Bill is unlikely to encounter opposition, except perhaps from some fringe parties. It would seem obvious that a country that spends a sixth of its GDP on health care, and still leaves one-sixth of its people beyond the pale of health insurance, has a health-delivery system that needs fixing — especially since US health statistics (like life expectancy) compare poorly with most European ones. Yet, the House of Representatives passed the reform Bill by just seven votes after nearly four months of hard lobbying and angry debate. This speaks volumes for the “anti-socialist” ethos that dominates American thinking, and the partisanship that now dictates US politics.
By guaranteeing near-universal coverage to its citizens (about 6 per cent may continue to be outside the pale), via state subsidies if necessary, and taxing rich people to part-finance the expanded costs, the Bill has “Big Government” written all over it. But the Bill’s defenders see it in the same line as Lyndon Johnson’s Great Society reforms of the 1960s, while liberal critics would argue that the Bill has made too many compromises with the vested interests, which is why total health-care spending will not come down, and most health insurance policy premiums will go up. The Bill could easily have failed had some fringe Democrats not been assured that there would be no federal funding for abortions.
Electoral opportunism also explains why so many lawmakers strongly oppose offering all American citizens a benefit that West European countries take for granted and most emerging economies want to give their citizens. The Republican Party, which is hoping to win back the swing states that it lost in the presidential elections last November, can ill-afford to alienate its traditional support base. This includes big insurance companies and rich baby boomers, the current beneficiaries of state-sponsored medical care, who will have to pay more.
Republicans have argued that the Bill will push up the US budget deficit to $1 trillion, though the independent Congress Budgetary Office says the legislation will cut the deficit by $138 billion. Even if the final picture on the deficit is unclear — financing the new insurance plan is dependent on imposing new taxes and spending cutbacks elsewhere — it is worth noting that similar concerns for fiscal prudence never arose when Congress approved two wars (Iraq and Afghanistan) and the bailouts of Wall Street investment banks.
A reconciliation Bill, synchronising House changes to the Bill, still requires to be passed through the Senate. Such a Bill can be passed by a simple majority, which the Democrats say they can count on in the Senate. Meanwhile, the Republicans have announced that they would move the Supreme Court against the legislation approved by Congress. “This Bill is terribly wrong for America”, the former Republican presidential candidate, John McCain, wrote and suggested that the Democrats could no longer count on Republican cooperation. So, President Obama may have won the battle for health-care reform, a feat that eluded Richard Nixon and Bill Clinton, but in doing so, he would have kissed goodbye to any return of bipartisan sentiment in the remainder of his tenure.