Americans' ailments persist away from the ideological clash about medical care, writes CARL O'BRIENin Cleveland
IT MIGHT not sound like it, but Mike Mayle says he’s one of the lucky ones.
After losing his job at the car manufacturer Ford, he decided to look after his ailing mother on a full-time basis. He lost his health insurance, which was tied to his employer, and relied on social security payments to get by. Then, his hip gave out.
He’s one of an estimated 32 million Americans without health insurance in a country where healthcare is among the most expensive in the world.
Research shows lack of insurance is harmful to people’s health.
Because healthcare in the US is so expensive – up to three times that of many developed countries – the uninsured are more likely to suffer chronic ill-health or die prematurely. The uninsured can always go to a hospital emergency room – hospitals are legally obliged to provide care. But by the time they do, many are much sicker than they would have been had insurance given them access to routine and preventive care.
“From my point of view, I had no medical coverage and no way of paying for my medicine, or surgery,” says Mayle, now 63. “But, thankfully, I didn’t have to worry about that.”
Last year, he was able to avail of a “community benefit” programme run by the Cleveland Clinic, a massive non-profit medical centre in northeast Ohio which provides free or discounted medical care to those who can’t afford it.
“I’m lucky,” says Mayle, who uses specially adapted crutches to get around the city. “I have a lot to be thankful for.”
After the economy, no subject generates more debate among voters on this presidential election than healthcare.
Barack Obama and Mitt Romney have sharply divergent views.
The key issue in the spotlight is Obama’s Affordable Care Act, passed in the face of seething Republican opposition in 2010.
The law has come to symbolise everything that most Republicans believe is wrong with Obama’s presidency, including the cost of the legislation and the government’s role in the healthcare market.
It is the most far-reaching overhaul of the healthcare system in living history. In short, it will extend health insurance coverage to an additional 30 million people.
“We believe that in the richest nation on Earth, you shouldn’t go broke when you get sick,” Mr Obama said earlier this year. “And after a century of trying, and decision now from the highest court in the land, healthcare reform is here to stay.”
To implement all this involves obliging all Americans to obtain insurance or pay a tax penalty which is due to begin in 2014. Health insurers will be prevented from rejecting sick people with pre-existing conditions. In many respects, it’s not unlike what the Irish Government is pledging to do.
Ironically, the plan is based largely on a mandatory health insurance model introduced by Romney when he was governor of Massachusetts.
The legislation in his state cut in half the number of uninsured people – though the state is struggling to cope with the rising cost of healthcare.
Romney, however, has rejected these plans as inappropriate on a national level. He insists that states should be able to produce their own policies to deal with uninsured people, and cites his own state as what can be achieved. Handing over control to the federal government, he says, is too blunt a step.
“Obamacare is really exhibit number one of the president’s political philosophy, and that is that the government knows better than people how to run your lives,” Romney said recently. “It is a view that the government should stand between you and your doctor.”
The most vigorous applause at any Republican rally these days is at his pledge to repeal the president’s legislation.
Opinion polls show the country is split on the issue. One of the few healthcare issues both agree on is the need to bring down the cost of healthcare.
At the first television debate between the candidates, Obama cited the Cleveland Clinic as an organisation that was taking a “smart” approach to providing care at a cheaper-than-average cost.
Romney, too, said the clinic was a success, naming it as example of healthcare systems that do things “superbly well”.
The clinic, basking in the glow of such praise, took out full-page adverts in some newspapers with the headline: “No debate – both candidates agree.”
So what is the secret to what the Ohio-based clinic is doing? There are several reasons, says Dr David Longworth. One is that primary care teams and specialists work closely together, unlike the disjointed system that dominates in the US (and Ireland).
Another is that employees are paid set salaries, so there isn’t an incentive to do unnecessary and expensive tests that is common across the US health system.
“We’re committed to value,” he says. “The escalating healthcare costs in this country, and the average quality outcomes, are unsustainable as a trend.”
He says regardless of who is elected, reform is on the cards. Doing nothing is not an option.
“It’s uncertain how these things are going to happen. But I think there is an economic tsunami that will forces these changes to occur.”