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When the old fear being ‘put down’

31 January 2014

Obama-care is alarming to those who would gain most from it, says Harriet Baber

MY FUTURE husband being British, I flew to the UK to be married, in Christ Church, Swindon.

We were poor students; so we flew on a charter flight that landed somewhere in Continental Europe, and then popped across the Channel to an airstrip in East Anglia. From there, a bus would take us to London, where we could get the train to the West.

I had fallen asleep on the plane in my hard contact lenses, and by the time the bus set off I knew I was in trouble. I had abraded corneas - painful, but harmless. My future husband told the bus driver, who veered off his designated route to find a hospital, cheered by the passengers.

We finally arrived at a hospital somewhere in east London, where they patched me up, and dispatched me to a ward of elderly ladies recovering from surgery. My room-mates wanted to know how health care worked in the US. I said that it was a matter of getting insurance. What happened if you were not insured, they asked - did you have to "do for yourself"? I didn't know. And I still don't.

As far as I can see, if you are uninsured, your options in the US are a patchwork of emergency-room visits, for which you are billed, and for which you can be in debt for the rest of your life; self-paid doctors' visits; and charity. They wanted to know why Americans put up with this system. I could not answer. I thought the NHS, as I had experienced it, was great.

Now, as we in the US are on the verge of getting a minimal, privatised national-health system, working-class Americans who stand to benefit from it are fighting to stop it.

Most Americans are convinced that we cannot afford a national health-care programme. Working-class Americans who are insured believe that the programme will send their insurance premiums sky-high, as they are forced to subsidise the improvident, uninsured underclass. (For underclass, read "black".) And older people who have Medicare, a programme for retirees, are convinced that it will privilege the young at their expense. They worry about "death panels", and pressure to forgo treatment.

Money has always been the best defence against evolutionary fitness. Once Eskimos got into a money economy, in which old men had economic power, they stopped putting their old men out on ice floes to die. We worry that, in a national health-care system, we will be put outon the ice floes. We have a sense that a private system, which we pay for, will give us control over our lives, and ensure that we will be able to get treatment, even if we are old - that we will not be bullied into having ourselves "put down".

But, in the US, health care is run by for-profit insurance firms, which employ cadres of clerical workers to screen claims, and do what they can to deny them, or to minimise payments. I am not crazy about government, but, if I have to trust anyone with my body and my fate, I would rather go with government than for-profit insurance companies, whose primary aim is to deny me treatment in order to promote their profitability.

Dear Jesus, give us the National Health!

Dr Harriet Baber is Professor of Philosophy at the University of San Diego, USA.

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