ObamaCare is not the answer

The first illusion to chase off the stage is that the great debate in the United States has much to with health. So far as public health is concerned, many of the biggest battles were fought and won a hundred years ago, at the end of the 19th century, with better nutrition, birth control, the change from wool to cotton clothing, the introduction of modern sanitation in the urban environment and - most important - clean water.

Between 1900 and 1973 American life expectancy went from 47 to 71 but most of this rise had taken place by 1949 when the average life span reached 68.  Much of the upward curve could be attributed to improved survival rates for infants and young people. Prohibition helped, since people drank less alchohol, ate more and hence TB rates dropped sharply, well before the introduction of sulfa drugs.

Health in America is class-based, naturally. The poor die sooner, starting with black men who tend to drop dead in their middle 60s, usually from stress and diseases consequent upon eating fried food. The better-off folk drink less than they did in the 1950s, take a bit more exercise and sometimes live longer. The poor get fatter and fatter. A real health plan would start with public executions of the top thousand CEOs and owners of the major food companies and fast food franchises.

A real health plan would start with public executions of the CEOs of the major food companies and fast food franchises

The plagues of America today are beyond the reach of the modern medical system, and that system is itself a peculiarly outrageous example of antisocial imperatives: high technology health care which serves fewer and fewer people. Part and parcel of this system are the drug companies, working in concert with the hospitals and insurance industry. Doctors have long since been shoved to the side as major players.

Shunned in all this are the major causes of modern disease which are environmental. Between 70 and 90 per cent of all cancer is environmental in origin. Heart disease and stroke - the largest killers today - are largely caused by hypertension and stress, which are derived from social conditions.

America is very efficient in promulgating Death Plans - tobacco, sugar additives, excessive salt, nitrous oxides out of power plant chimneys, nuclear testing in the 1950s, industrial accidents, speed-up at work and lengthening of the working day, rush hour traffic - launched in the hope of making a buck and protected fiercely until, very occasionally, the mountain of corpses gets too high to be occluded by even the most refined techniques of the PR industry and the most lavish contributions to politicians. Thus it was with tobacco.

Health reform in the 1930s, in the Roosevelt era, came mostly in the guise of the Wagner Act - a better deal for unions and workers - and Social Security. Old people got something to live on in their later years.  Health reform in the 1950s and 1960s came with better wages, a shorter working week, more leisure, plus Medicare - the federal health plan for older people - driven through Congress by the most consummately cunning and accomplished politician of the post-war era and maybe of the 20th century (unless you make the case for FDR), Lyndon Johnson, who really did care about poverty, having seen a lot of it up close in Texas.

Since then we've gone nowhere. Nixon declared war on cancer and founded the Environmental Protection Agency - but corporate pollution continued virtually unabated, courtesy of the energy industry and modern, chemical-based agriculture.

In 1977 the Senate Select Committee on Nutrition, chaired by George McGovern, issued a splendid special report on recommended dietary goals for the United States. It swiftly provoked the virulent hostility of the medical establishment and the food industry.

The former contested the idea that diet might have any particular bearing on health and hotly denounced this particular application of the notion of preventative medicine. The latter, for obvious reasons, saw no reason to welcome the committee's recommendation that Americans eat less meat. The injunction was axed from the report a year later.

The Clintons tried very moderate health reform in 1993 and the insurance industry and lobbyists ate them for breakfast. Typically, Democratic presidents like Clinton and now Barack Obama commit during their campaigns to some kind of 'reform', usually meaning some pledge that the 'disgrace' of 45m or so uninsured Americans will end.

The radical reformers argue for a national insurance scheme, like Canada's or the NHS, where the state can use its purchasing weight to drive down drug prices, set rates and clean up the system.

There is a strong eugenic thread to American progressivism

It's not going to happen, any more than Obama will nationalise the banks and tell householders to repudiate their mortgages. The insurance industry, the drugs industry, real estate and finance are the most powerful forces in the country. They own Congress. Men like former Democratic senate leader Tom Daschle spring to do their bidding.

So Obama finally produced a modest compromise whereby uninsured people would be herded under various health insurance umbrellas with "a public component". The insurance industry can swallow this like a python swallowing a field mouse.

Though Obama sometimes tries to argue that the public component of his plan is the springboard to full-bore single payer national health, this is transparent nonsense. In present political conditions, the publicly insured component would soon become a ghetto, offering minimal care to the indigent and gradually shriveled into some sort of punitive maintenance scheme.

Fear never fails. Americans burdened with the worst and most exploitative health system of any advanced country, are being expertly stampeded by the right's campaign that Obama's health plan means that state-licensed executioners will make the unilateral decision to give granny her final morphine shot whenever they think fit. The present system means that granny gets her final morphine shot once her money runs out.

The liberals are howling about the unfairness of the 'Death for Granny' attacks, now led by Sarah Palin revived by her 'death panel' talk and equipped with a dexterous new speech writer who is even adding footnotes to her press releases.

But what is a conservative meant to think? Since the major preoccupation of liberals for 30 years has been the right to kill embryos, why should they not be suspect in their intentions towards those gasping in the diminishing amniotic fluid of senility?  There is a strong eugenic thread to American progressivism, most horribly expressed in its very successful campaign across much of the 20th century to sterilise 'imbeciles'. 

Abortion is now widening in its function as a eugenic device - with increasingly refined testing to eliminate Downs Syndrome baby embryos. Women in their 40s take fertility drugs, then abort the inconvenient twins, triplets or quadruplets when they show up on the scan.

For 40 years every American president has deprecated the powers of government to improve the public weal. Why now should Americans believe that any government-backed 'health reform' will do them any good, as opposed to assigning them the appropriate lifespan, relative to their income and contributions to the corporate bottom line, which is what the present system amounts to? ·