The fractured U.S. healthcare debate, replete with wild distortions of Canada's medicare, must seem incomprehensible to many north of our border.
News images of fabricated "death panels" or traumatized seniors on U.S. Medicare -- a government-funded program -- urging legislators to keep the government's hands "off my Medicare" must seem especially hard to fathom.
Equally puzzling, no doubt, has been the reaction of the administration and many of its allies in Congress whose response to the attacks is to move further away from comprehensive reform.
Entering the year with a Democratic president and strong majorities in both houses of Congress, and a clear public mandate to end our long health-care nightmare, President Barack Obama and Congressional leaders decided to compromise from the outset, and not pursue the most effective reform, Medicare for all.
Gambling they could bring along conservative opponents, the administration and Congressional leaders instead advanced a more limited plan that preserves the role of the insurance industry. Prospects of broader reform were further undermined by some liberal and progressive groups and labour unions, who chose to merely endorse the proposals of the administration and top Congressional Democrats, rather than fighting for a national system like single-payer, which many of them have long endorsed.
Overnight, the left flank was effectively gutted from the beginning of the fight. Most of the pressure has thus come from the right and those who embrace the status quo -- leading to further compromises by both Obama and the leading Democrats.
This retreat was clearly articulated by the former president, Bill Clinton, who chastised a conference of worried netroots activists Aug. 13, saying "I want us to be mindful we may need to take less than a full loaf."
But mobilizing activists for a half loaf has proven to be a challenge, as the White House and Congress have learned to their dismay in recent weeks as they struggle to counter those denouncing them from the right.
Even the grassroots network built by candidate Obama that set new standards for campaign activism last year has, the New York Times noted Aug. 15, failed to produce much enthusiasm for the current health plan, and most liberal constituency groups have not fared much better.
What's left is a proposal that will force the uninsured to buy private insurance with subsidies for low-income earners and only limited constraints on industry price gouging and care denials that characterize the collapsing insurance-based system.
In sum, it looks like another massive corporate bailout, following the earlier version for the banks, this time for an equally unpopular insurance industry, which will fuel even more public cynicism of the reform process and political system.
To residents of all other industrialized countries, terrors over a government role in promoting and protecting the health and safety of its citizenry, and the reluctance of political leaders to effectively respond to these attacks must be especially confounding. Among major nations, only in the U.S. is health care not a fundamental right, but bartered for profit by a maze of health-care corporations. The result is that the U.S. continues to fall far behind other industrial nations in a variety of measurements, from access to care to equality in treatment, and even in the much discussed issue of waiting times for medical care.
While the U.S. spends twice as much as every other nation on per capita health care, there remain more than 45 million Americans with no health coverage and tens of millions more with insurance who are routinely denied medical care because their insurer doesn't want to pay for it.
Medical bills account for 62 per cent of personal bankruptcies. Half of all Americans skip doctor visits or immunizations for their children because of high out-of-pocket costs, troubling news indeed with the U.S. already leading the globe in swine flu infections and deaths.
The nation's registered nurses and many doctors continue to press for real change, a national or single-payer system that would look familiar to Canadians and the rest of the industrial world. It is still possible to achieve stronger reform, but time is running out.