Daily Diary: Healthcare Reform

I read Jerome Groopman on the difficulty of assessing the best treatment or practice in healthcare, something that will become prominent in Obama's health reform proposals which will be led by "comparative effectiveness research." As usual, the NHS gets some stick, in this case for rationing expensive cancer treatments, which lead some cancer mortality rates to be among the worst in Europe. This seems to be a pop at the National Institute for Clinical Excellence, which determines drugs spending and best practice, but it fails to take into account that a large part of the problem seems to be a general lack of money. Cancer survival rates have improved markedly since 1997, since when Labour trebled the budget for cancer care, although there remains a large variance in success rates depending on where a patient lives, which implies that individual hospitals and social attitudes may have much to do with it, rather than anything systemically wrong with a government-run healthcare program.

Groopman's article, however, seems somewhat irrelevant, in the wake of Republican Scott's Brown's takeover of the safe Democratic seat of Massachusetts, meaning the Democrats no longer have the Senate majority required to push through healthcare reform. Being in the UK (or even continental Europe), it is hard not to see America's politics as socially and morally bankrupt, in the failure to provide some form of universal coverage. It is hard, too, not to be bemused by the fact that the lower-class groups which seemed to have fallen for Brown's everyman, pickup-driving image, are precisely those who would have most to gain from healthcare reform. It seems now that Obama's promises on the matter will firstly be bent by partisan negotiations in the Senate, and then ultimately broken once and for all.

I heard an interesting comment about the apparent Republican bounceback, though, which is that it shows that Obama was ironically not bold enough on healthcare. If only he had stuck with a truly radical, public option, he could have presented the Republicans as a dark force, in league with big insurers and pharmaceuticals. As it was, in an attempt to push a bipartisan bill through, Obama compromised so much that he neither sufficiently pleased those on the far left, nor sufficiently alienated those on the far right.

Interestingly enough, the news this morning seems to herald a change of tack in Obama's politics. Obama has just proposed stringent curbs on the power and activities of banks. The extreme nature of his proposals, which seem to go beyond anything suggested thus far in Europe, push the Republicans into a corner, as since they try to condemn the proposals, they may seem to fall in league with the bankers, who have been the prime target of public anger. The Republican's trick counterattack must be to try to attack the bankers, the personalities and leaders who instigated the proposals, but to defend the freedoms of the market in general. That, no doubt, will involve stabbing a few former friends in the back.

Labels: Daily Diary, healthcare reform

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