Garrett on US health reform and global health

Health Reform Vote: Global Impressions
Author:
Laurie A. Garrett, Senior Fellow for Global Health
March 23, 2010
People all over the world have followed the political rollercoaster surrounding healthcare reform in the United States, and millions witnessed Sunday's debate and countdown to midnight in the House of Representatives. The chaos that we call a "health system" in the United States--featuring some 47 million Americans with no insurance and millions more who are under-insured and face bankruptcy with catastrophic illness--stuns people overseas, especially in Western Europe.
Many view passage of healthcare reform as a test of President Barack Obama's mettle, and an unfortunate distraction for the White House from pressing issues such as the global economy, Iranian nuclear capacity, the wars in Iraq and Afghanistan, and trade negotiations. The president's decision to postpone until June his planned swing through Indonesia and Australia in order to be in Washington for the House vote appeared to validate overseas concerns that the U.S. domestic situation was overwhelming the White House.
It's hard not to wonder how international audiences responded to the image of a pro-life, conservative Democrat (Representative Bart Stupak of Michigan) apparently being decried as a "baby killer" by Texas Republican Randy Neugebauer during the weekend's final debate, and whether it reinforced concerns about the deep, often uncivil divisions in the American body politic.
For Americans engaged in global health efforts, the sorry status of the U.S. healthcare system--its nearly $9,000 per person annual costs and its lowest-in-the-industrial-world achievements in health outcomes--has been a source of considerable embarrassment. Even as the United States funds the largest efforts in the world to provide antiretroviral drugs to people with AIDS in Africa, several U.S. states now have waiting lists for access to the same drugs, for American citizens. As the United States puts increasing pressure on poor and emerging-market countries to develop their healthcare infrastructures and meet the medical needs of their people, millions of Americans have lost health coverage amid layoffs in the financial crisis.
Many overseas friends of America have been befuddled by the anger healthcare reform has evoked inside the United States--cries that reform equals socialism, the entire Tea Party movement, and the general concept that bringing more people into the medical system is, somehow, a bad thing. Foreign observers cannot be blamed for their confusion: Americans, too, are perplexed by the anger and emotions the debate has engendered. It is painful.
On Monday, Neugebauer explained his outcry this way: "Last night was the climax of weeks and months of debate on a support. In the heat and emotion of the debate, I exclaimed the phrase, 'It's a baby killer' in reference to the agreement reached by the Democratic leadership. While I remain heartbroken over the passage of this bill and the tragic consequences it will have for the unborn, I deeply regret that my actions were mistakenly interpreted as a direct reference to Congressman Stupak himself."
For Americans engaged in global health efforts, the sorry status of the U.S. healthcare system--its nearly $9,000 per person annual costs, and its lowest-in-the-industrial-world achievements in health outcomes--has been a source of considerable embarrassment.
Some Democrats retorted that a bill that allows millions more families access to healthcare should save babies, and pregnant future moms, from a range of health problems, including ones that, left untreated, are fatal to babies.
In this week's issue of the liberal New York Review of Books, Michael Tomasky argues that some of the heat in the U.S. healthcare debate stems from the record amounts of lobbying money spent by key interest groups to influence the language of the bill and the final vote.
In total, Tomasky says, lobbyists spent a record $3.47 billion in Washington in 2009, with the proportion of that directed at healthcare reform soaring a whopping 12 percent over the previous year. More than half that lobbying money came from the pharmaceutical industry. In the final quarter of 2009, as the healthcare reform bill language was hammered out, lobbyists spent $955 million and employed hundreds of professional button-holers to roam the halls of House and Senate office buildings, pushing to weaken regulation and price controls on their respective industries. At that point, more than 3,300 healthcare lobbyists were registered in Washington--more than six for every elected political official.
According to the National Journal, a conservative publication, another big spender was the U.S. Chamber of Commerce, which opposed employer mandates to provide insurance coverage for their workers. Other big spenders included doctors' groups, hospitals, the insurance industry, labor unions, patients' organizations and senior citizens' groups.
The health reform debate has distracted Health and Human Services Secretary Kathleen Sebelius and most of the senior leadership of HHS for months. Global health affairs other than the H1N1 flu pandemic have, by necessity, taken a back seat since the day Sebelius was sworn in at HHS. Perhaps now, with the imminent swearing-in of Dr. Nils Daulaire as director of the HHS Office of Global Health Affairs, the agency can look to such issues as the world HIV pandemic, rising incidence of drug-resistant tuberculosis, counterfeit medicinal drugs, and the World Health Organization's capacity to lead world health efforts.
Even if HHS is able to redirect its attention, the White House itself might not be able to do so. Although there are plenty of international issues begging for attention, the administration will have to keep an eye focused on healthcare reform. The midterm elections will see Republicans--who unanimously voted against healthcare reform--using the bill's passage as a bludgeon with which to hammer political opponents. President Obama and much of his White House staff will likely spend the next eight months campaigning to convince American voters that Democrats have passed a bill that is in their interests.
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