…there are things about you I will never understand.
I mean it when I say that I love you, America. I love you because you are, more than any other country, the embodiment of Enlightenment values, because things like equality and justice and liberty are among the values that you honour most highly. (And never mind that the lived experience fell (and still falls) short of those ideals – the fact that you expressed them, and that a proportion of your population have always been working towards realising them more fully, are grounds enough for me to love you). I love the fact that you are a secular country, that secular values were at the heart of your founding, and are still central to what you do. I know you have struggled to maintain that separation of church and state – it was a terrible shame when ‘e pluribus unum’ became ‘in God we trust’. But you were still the first high-profile successful attempt to break the link between theism and authority, and that’s reason enough for me to love you.
I love you for your embracing of the idea that executive and legislative and judicial power are all derived from the authority of your citizenry, as opposed to deriving from god, or from an accident of birth, or by secret appointment. I know you have struggled with the fact that political power (like money) seems to have a kind of gravity. Just last year you came very close to having the list of successive presidents run Bush, Clinton, Bush, Clinton. I know that prominent families – the Kennedys, the Bushes – seem to have a near-permanent grip on high office, but they retain those positions because of an appeal to the electorate (albeit that making that appeal is made far easier as a result of their enormous personal wealth). The fact remains that they do not govern simply by ‘right’ of inheritance. You have no equivalent of our (outdated, anachronistic) royal family, and that is another reason I love you.
There is much to love about you, America, but mine is not a love that is blind to your faults. I do not love your attempts to turn yourself into the bully-boy of the world. I do not love the way you have attempted to impose your will upon nations less powerful than yourself. I do not love – in fact I despise – the way you have talked of exporting freedom and democracy to the world while secretly (and sometimes overtly) bringing down democratically elected governments that have failed to surrender to US interests. Like many of your admirers from the UK, part of the reason this pains me is that, for so many years, we were the country that did those things. We know that what you are trying to do is impossible, that it will end in failure, and that you will end up regretting the attempt. It is sad that you cannot learn from our mistakes.
But, even more than there are things you do that I do not approve of, America, there are things about you that I do not understand.
I don’t understand why you persist with the electoral college system for your presidential elections. This is the system that transformed President Obama’s modest 52.9% of the popular vote into a landslide two-thirds majority. This is the system that, in 2000, transformed Al Gore’s 0.5% victory in the popular vote into a 0.5% victory for President Bush in the electoral college (and that’s without getting into the argument about whether Florida’s votes were counted fairly). This is the system that routinely over-values the votes of Americans who live in states with a small population, and routinely under-values the votes of Americans from more populous states. (But, yes, I agree – the electoral college is a less serious distortion of true democracy than the first-past-the-post system used in the UK. At least you sometimes end up with the government you actually voted for, something that almost never happens in the UK.)
I don’t understand, given your commitment to democracy in the selection of minor officials such as sanitation commissioners, your willingness to accept that those occupying much higher office should be able to wield power without having to face election. Gerald Ford, the 38th President, was not elected to either the Presidency or the Vice Presidency. He was appointed as Vice President by Richard Nixon, and succeeded to the Presidency after Nixon resigned ahead of impeachment proceedings. There is a certain irony in the fact that the self-proclaimed ‘greatest democracy in the world’ couldn’t muster an elected president just 32 years ago.
But, more current than either of these things, I do not understand your opposition to healthcare reform. We are told that support for reform has slipped as low as 50%. I understand that there are powerful vested interests ranged against reform, and that these are conducting an expensive advertising campaign. I might, in fact, describe this as a campaign of deliberate misinformation, given that Americans have apparently been told that UK patients over the age of 59 can’t get treatment for heart problems. This is a lie – there is no upper or lower age limit for receiving treatment on the NHS, neither is treatment withheld because a person is terminally ill.
My own mother (who was 75, and terminally ill) received expensive treatment at the hands of dedicated and caring professionals right up to the moment of her death, and did not have to pay a penny for it (beyond the money she had paid in tax earlier in her life, of course). Ultimately she did die – there was no way back at any price from what eventually killed her, sadly – but she was never refused treatment. In fact, in the final months of her life she benefited from a treatment so new it was being reported in the current issue of the British Medical Journal at the time she received it. I wonder if a private health insurer would have paid out for a new treatment so rapidly?
Other lies and distortions are being peddled also. One of the more amusing was the (hastily retracted) claim that Stephen Hawking would not receive treatment on the NHS. The paper making this claim (and the many anonymous internet commenters who have repeated it) seem to be unaware of the fact that Professor Hawking is a UK resident, and has received all of his medical care free at the point of delivery on the NHS.
It is also interesting to note that, even amongst right-wing zealots in the UK, there is majority support for the NHS. It takes a lot, America, to unite The Daily Mail (the most rightwing of our mainstream newspapers) and The Guardian (the most leftwing), but the outrageous lies being peddled about the NHS by some in your country has achieved this improbable feat. The fact is, having once experienced cradle-to-grave universal medical care, we Britons love it. We don’t want to go back (and the NHS is only 61 years old, so pre-NHS times are still well within living memory) to the old system where poverty equalled death. Even those amongst us who despise big government, those who rail against the ‘nanny state’, don’t want to run the risk that, were they to lose their jobs, they would also lose their healthcare. They may argue for greater ‘market efficiency’ in the NHS, they may argue for it to be run at arm’s length from the government, but very few question the principle of free, universal healthcare provision, at least for established residents.
I hope you will correct me if I’m wrong, America, but this seems to be a point that many of you have not considered: you seem to think in terms of the ‘insured’ and the ‘uninsured’, but not to recognise that, when many of you receive your healthcare through your job, there is potential for you, yourselves, to become a member of the uninsured. If the current recession has reminded us of anything, it has reminded us that any company can fail, that no grade of job (such as a high-flying corporate lawyer at Lehman Brothers, for example), is immune from sudden redundancy. And it’s worth remembering that even if you found another job straight away, the shift to another health insurance scheme might leave you at risk of not having all your (or your dependents) pre-existing conditions covered.
This is a worry that we in the UK simply do not have. Even if we move abroad to live and work for a few years, and then return to a job in the UK, the NHS will offer us treatment for all that ails us, whether we had the condition when we returned to the country or not. Another thing we do not have to worry about is whether certain conditions are covered under our insurance. I routinely read blog posts from mentally ill people in the US who struggle to pay for medication because psychiatric meds are not covered under their insurance policy. No person treated by the NHS has to worry about this. It is true, there are parts of the NHS that are extremely poorly funded (MH is one such area), and that there may be a delay in receiving treatment (though the length of the waiting lists have been exaggerated by your media), but treatment will, ultimately, be available for all our citizens, irrespective of their wealth, or age, or employment status. This is not something that you can claim.
Much has been made in your country of the fact that not every drug licensed for prescription is made immediately available on the NHS. This is undeniably true – where a new medication is exceptionally expensive, and where it offers only limited benefit to the people taking it, a drug may have to be withheld on cost grounds. Where this happens, patents who have the money are able to pay for the drug themselves. This is far from being an acceptable situation, but before you rush to criticise our system, America, you might like to consider that many of your health insurance policies exclude certain treatments, and that it is then (as in the UK) down to the personal wealth of the individual whether or not they can pay for them. And you might like to further consider that a goodly proportion of your population receives no healthcare at all, beyond that which is provided charitably, and this is not the case for us.
The fact remains, America – I do not understand your widespread opposition to universal health coverage. I have watched footage of some of the town hall meetings that have been called to discuss the issue, and I have seen people – nice, ordinary, decent, non-ranting people – talk about universal healthcare as though it is one short step from there to Stalin’s gulags. These people are not extremists. In some cases they are themselves uninsured, or under-insured. But the fear of government is so great that they cannot see the great good that will come from universal healthcare provision, and can see only a shadowy, anonymous threat they call ‘Socialism’.
This fear of government is something that only seems to exist, or only exist to this extent, within your borders, America. And it blinds you to so much. It blinds you to the fact that, in the realm of healthcare, you pay more for a poorer service that produces worse outcomes. In the UK we pay, per person, only two-fifths what you pay, per person, for healthcare. Despite this we have, relative to the size of our population, almost as many doctors as you do, a third more nurses, more hospital beds, and average life expectancy at birth is two years longer in the UK than it is in the US. You have the most expensive healthcare system in the G8 group of nations, but have the second worst life expectancy amongst that group of nations – only Russia does less well than you. (The source of all this is here.)
Your blindness to all of this mystifies me, America, but that’s not really the heart of what I don’t understand. In most of the rest of the world we feel we have a duty to each other, to look out, not only for our own best interests, but also for what’s best for friends, and neighbours, and fellow-citizens. And sometimes it seems that you share that, America, and even exceed what the rest of us can achieve – stories of the friendliness and hospitality and offers of practical help experienced by new arrivals in US communities are justly famous around the world. So why is it that, on issues like these, you change from such wonderful, helpful, supportive folk into people who will instead stand quietly by while their compatriots suffer and die for a lack of insurance?
I say it again: America, I love you. But there are things about you I will never understand.