Not-So-Healthy Debate

We noted a couple of weeks ago that the Obama administration had run into the sand on one of its main campaign promises – to close the Guantanamo Bay detention centre. But next to the the liquidizer of political capital that is healthcare reform, the fate of the detainees in Cuba is small beer.

A David Brooks op-ed in the New York Times last week argues forcefully that, such is the endemic lack of trust in government in the USA, that a would-be reforming administration needs to move slowly and incrementally on a hugely contentious issue like healthcare to build the confidence of the electorate rather than attempting a 'big bang' approach. The Times now advocates a 'weak and feckless' strategy of retreat and regrouping, rather than a 'heedless and arrogant' drive to push the reforms through in the teeth of huge opposition.

Curiously, the assumption that trust in government is at rock bottom isn't borne out by our regular public attitudes tracking data. For ten years, we've been measuring the degree to which people across the world trust a range of institutions to act in the best interest of society, and recorded a twenty-two point jump in Americans' trust in government between late 2007 and late 2009. Certainly, 2007 represented the dog days of the Bush administration, and the shine has certainly come off Obama and his team since our poll was taken, but still. A net trust rating of +25 isn't the worst starting point for major reform.

What looks more likely is that Obama's problems getting healthcare reform through is less because Americans across the board don't trust their government, and more because the nation remains hopelessly, viciously, ruinously divided on a whole range of emotive issues. Despite a filibuster-proof majority in Congress, Obama in fact invested a lot of time and energy consulting on the shape of a reformed healthcare system, trying to forge a 'bi-partisan' plan with support from both Republicans and Democrats. It's far from clear that much common ground exists. The resulting fudge, as the Times correctly points out, hasn't satisfied anyone and the wrangling has in the meantime allowed the reforms to be painted – ludicrously - as something akin to a Communist takeover of the federal government. This is one instance where, ironically, a less inclusive approach might have proven less divisive in the longer term.

A Healthy Debate?

It's been clear for a while now that US President Barack Obama isn't going to have it all his own way. In particular, his attempts to reform the United States' healthcare system appear to be in intensive care, with his latest compromise proposals achieving the unenviable feat of irritating liberals while leaving his conservative critics unmoved.

While much of the concern centres around the potentially astronomical costs of extending coverage to the millions of Americans currently without health insurance, anything that smacks of 'socialising' the healthcare system seems guaranteed to raise the ire of a significant section of the American general public.

It's a reminder of how different the US mindset is in many respects from the rest of the developed world, whether we're talking about the role of religion in public life, its attitude towards climate change, or taxation. The furore caused in the UK last week by the American right's demonisation of the UK's publicly-funded health service illustrated that - bar the occasional heretic like MEP Daniel Hannan - Europeans are much more comfortable with the state playing a high-profile and overtly redistributive role in their lives. They may whinge about it, but belief in the NHS is a lot more fervent than belief in God in Britain these days.

But if Americans aren't sold on 'socialised medicine', they clearly perceive the need for reform of some kind. Every couple of years, GlobeScan asks the general public in over 20 countries to name the most important issue facing their nation. Our latest data, just out of field, shows that Americans are by some distance the most likely of any country surveyed to mention health care costs - in fact, it's the second most mentioned issue. So maybe Obama is right to persist.

What's the top issue preoccupying Americans then, you ask? With apologies to Bill Clinton, it's the economy, stupid. As it is everywhere else. Maybe Americans aren't so different from the rest of the world after all.