Barack Obama, America’s 44th President, ran on a centrist platform and has been forced to deal with a party divided ideologically even though, like Laurier’s Liberals, the Democrats have majorities in the United States House of Representatives and the Senate while holding the White House. Where Laurier is remembered for his “Naval Compromise” and “Reciprocity” President Obama is wagering his legacy on the success of the Health Insurance Reform bill that passed the Senate 60 – 40 (a strict party-line vote) on Christmas Eve.
The United States is #1 in percentage of GDP spent on health care (approximately 15%) though they remain far from first place when ranked in terms of quality of care. A 2009 estimate puts the number of uninsured in the United States at 47 million. Since Franklin D. Roosevelt, American Presidents have spent time and political on reforming the United States’ Health Care system. In the 1960s Lyndon B. Johnson failed because of lobbying by the health insurance industry and Blue Dogs (Southern Democrats) blocking reform, Bill Clinton failed because of a Republican Congress and accusations that his administration was too secretive in its attempts. Health reform in the United States is the equivalent of fighting a land war in Russia for Presidential administrations.
So what does the population of the United States, and President Obama, get from the Senate Bill? H.R. 3590, Patient Protection and Affordable Care Act does not contain a “public option” but does have an insurance exchange program which would allow those with insurance to keep a similar program when switching careers. The Senate Bill will increase the Medicare payroll tax from 1.45% to 2.35% on incomes over $200,000 for individuals and $250,000 for families. The bill finally makes it illegal for insurances companies to deny coverage. All of this, if the Senate bill was signed into law today, would come into effect on December 26, 2011.
Lester B. Pearson, another Liberal PM forced to compromise by presiding over a minority government, passed the Medicare Act in 1966. In 1984 under Brian Mulroney, the Canada Health Act was passed, which prohibited user fees and extra billing by doctors.
From a Canadian perspective the Senate bill, which is still a ways away from being signed into law, seems weak by comparison. Those in favour of more comprehensive health reform in the United States decry obstructionist Republicans and conservative Democrats.
The reason that H.R. 3590 doesn’t include a public option and the United States’ health care system is nowhere close to “socialized medicine” (a term popularized by President Reagan) is their system of government. If the Prime Minister of Canada isn’t passing bills quickly, efficiently and without checks and balances then it isn’t working right. Though Prime Minster Harper doesn’t have a majority, the Conservative Government has operated that way (with no real opposition to prevent them.) John A. Macdonald and the Father’s of Confederation designed our government to give majority governments as much power as possible. The American founding fathers designed the United States’ government to have three equal branches (legislative, judicial and executive) with as many institutional veto points as possible.
President Obama is quick to point out that this isn’t “Obamacare”, it is the US Congress’ health care bill. This isn’t an attempt to distance himself from a bill that doesn’t go far enough for his liking but a pragmatic admission of his own institutional limitations. Perhaps President Obama will be America’s Great Conciliator.