Usborne in the USA: The best healthcare delivery system in the world? Are you off your rocker?

The Republicans are on a hot streak thanks to Obamacare's false start

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Sometimes I think Barack Obama just doesn’t get his own people. On the domestic front, his agenda is one mostly founded on the notion of building for the common good versus honouring the primacy of the individual.

That’s what he preaches and it’s at the core of his quest for better gun controls  and, of course, for moving the country towards some form of universal healthcare.

You may have noticed that on both counts, he has been walking in treacle. However frequent and ghastly the mass shootings, the land of the free – an apt moniker, to be sure – just isn’t willing to give up wearing a holster to Starbucks.

In 2010, he barely rammed the Affordable Care Act through Congress, but trying to implement it now is pushing him – and the rest of us – to the brink of a nervous breakdown. That the country remains resistant was crystal clear in a Washington Post-ABC poll released on Tuesday. It found that 57 per cent of Americans dislike the president’s proudest legislative achievement. That’s higher than ever.

As for the law’s most essential component – that every American must buy health insurance or face a fine – it is opposed  today by a margin of two-to-one.

Partly this has to do with the behaviour of politicians in Washington and I don’t know who to blame first, Mr Obama  himself for his blithering incompetence  or the Republicans for their shameless acts of sabotage. It beggars belief that three years after getting his baby passed Mr Obama has managed so comprehensively to fluff its roll-out. First off there were was the website that was meant to offer a seamless shopping experience for new policies. Right, like changing terminals at Heathrow is seamless.

Then, there was the promise he made over and over that everyone who had policies that they liked would be able to keep them. That has turned out to be nonsense. Was he lying or did he just not know his own law? Talk about dropping the drawbridge to the barbarians.

After their suicidal attempt last month to shut down the government, the Republicans were meant to be on the defensive.

Instead, they are on a tear thanks to the delinquency of the White House and they won’t stop until Obamacare is in shreds.

Listening to John Boehner, the speaker of the House, makes me want to burst. The strategy, he told members last week, is “targeted legislative strikes aimed at shattering the legislative coalition the president has used to force his law on the nation,” which, he went on, “is going to destroy the best healthcare delivery system in the world”. What was that last part? Are you completely off your trolley?

They may not be all you’d like – and  their execution so far is not – but Mr Obama’s reforms are America’s chance to right its greatest social sin. Among its industrial peers, it has the worst delivery system, bar none. Yes, if you are making money, all is hunky-dory at the Mayo Clinic or whatever your local equivalent.

But what if you are one of the tens of millions without insurance and you cough up blood one morning?

How is it possible to be proud of a status quo where a 10-block ambulance ride (mine recently) costs $900? Where the average cost of a preventative, 20 minute colonoscopy (had one of those too) in New York is $8,577? (In Switzerland it’s $655.)

What virtue in a system that puts volume and profit before care?

So why is this so tough a sell for Mr Obama and why are Mr Boehner and his Tea Party hoard gaining ground? The reason, I think, can be found in a study published earlier this year by three Stanford University professors in Psychological Science under the title, ‘In the Land of the Free, Interdependent Action Undermines Motivation’. Its conclusion: If you try to convince Americans (Anglo-Saxon white Americans especially) of a policy’s benefits in terms of the greater good it will fail. Tell them it’s about sanctifying individual rights – where it’s about the ‘you’ versus society as  a whole – then you’ll have a winner.

“US culture stresses independence,” says MarYam Hamedani, a co-author. “People often like the idea of working together and certainly care about social issues. Our findings show that thinking about and caring about others doesn’t always translate into effective action.”

This week, the president said his only hope is to rebrand Obamacare. He is right. He has to make the case that rather than it foisting big government on regular folk, as the Republicans claim, it will free them from the hegemony of industrial medical complex and, through the website (assuming it ever works) they will be liberated and gain freedom of choice over their healthcare options.

Then they will like it, but only then.

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