The state of the economy and the issue of healthcare have dominated the evening news in America for the last several months. No one seems to know whether the slump can be ended and the economy turned around.

The issue of healthcare is not quite as problematic. It was a high priority item on Barack Obama’s agenda during his election campaign. He says he has a plan for improving the present healthcare system, and he has been addressing town hall meetings across the country to explain and advertise it.

Long before the beginning of his campaign, Senator Edward (Ted) Kennedy from Massachusetts had been advocating access for all Americans to healthcare. President Obama is alive and well, working away in the White House. Senator Kennedy passed away after a protracted illness last month. Before we move on to examine the issue of healthcare, a word about the senator should be in order.

Mr Kennedy, a liberal democrat, was a man of warm and humane impulses. He had been a member of the United States Senate for nearly 50 years. He was a star of that house, the envy of politicians and a great legislator. Not a bill designed to make life easier for Americans — especially the poor and disadvantaged — passed Congress that he had not sponsored or co-sponsored.

Optimistic and cheerful, with a fine sense of humour, he befriended not only fellow Democrats but also Republicans. He believed in the efficacy of personal relations and cultivated them on both sides of the aisle. Knowing that politics is the art of the possible, and that it has no place for absolutes, he was willing to engage in give-and-take and make compromises in order to get the work done.

A generous and giving person, he stood by not only the members of his own clan and his constituents in Massachusetts but all Americans who might be in trouble. He was intensely dedicated to the public interest and worked extremely hard to protect and advance it. He was widely liked and respected. It is generally agreed that one like him had never before appeared in the Senate.

Returning to the issue of healthcare in the United States, let us first say that it consists of three elements: access, coverage and cost. In most cases the employer provides some kind of health insurance for regular employees and pays the larger part of its cost. Retired persons can go to other providers. Those who are 65 years of age and over and had worked and paid social security taxes for a minimum of 10 years have access to a government-managed system called Medicare.

Medicare benefits come in four parts. Part A covers hospitalisation, hospital outpatient services and skilled nursing care. All of these are free. Part B relates to medically necessary visits with one’s primary physician and specialists, laboratory tests, X-rays and preventive treatment. There is usually a small ‘co-payment’ ($10-20) that the Medicare subscriber has to make. Parts C and D relate to the provision of prescription drugs. They are prescribed under their generic, not brand, names.

The operation of these parts is handled by private companies that have contracts with Medicare.

The noteworthy fact regarding access is that according to one estimate more than 30 million Americans do not have any kind of health insurance. This number has probably increased during the last couple of years of economic recession. Many workers have been laid off as a result of which they no longer have an employer and therefore no provider of health insurance. They are still liable to fall sick and if they do, they have to pay the doctor’s bills, cost of prescription drugs and hospital charges out of their own funds of which, needless to say, they don’t have any to speak of. These costs can run into thousands of dollars. The persons concerned, unemployed and probably destitute, have no way of paying these costs. No bank will lend them money. They will default and declare bankruptcy.

One’s health insurance pays the larger part (in some cases as much as 80 per cent) of one’s healthcare costs. The insured person has to pay the rest. For the poor and the needy even that can be burdensome. Many insurance companies will not cover ‘pre-existing’ ailments, meaning those which the person concerned had developed before the commencing date of his or her present insurance.

The cost of health insurance is almost prohibitive for those who must pay it out of their own resources. Several government agencies and many private employers have begun to hire persons on contract basis, under which they are not obligated to give them retirement and healthcare benefits.

Not all of the states in the union subscribe to the federal social security system. They do not deduct social security taxes from their employees’ salaries. Their retirees, therefore, do not become eligible for Medicare benefits. Notable among them is the Commonwealth of Massachusetts, which operates its own healthcare system for both current and retired employees. They pay a small fraction of the cost but the commonwealth pays the rest of it. I understand that this arrangement is working very well.

President Obama’s plan contemplates a government agency that will offer health insurance not only to those who do not have any but also to all others who may wish to enrol, presumably at a cost lower than the going market rate.

It will thus take care of the issue of access and its competitive operation will induce private health insurance companies to reduce their prices. Predictably, opposition to the plan has surfaced. It is engineered mainly by the private health insurance providers. Drug manufacturers and sellers and associations of physicians have joined the opposition’s ranks.

There is much misunderstanding about the president’s plan. Conservatives in Congress and outside suspect that he wants to nationalise the healthcare industry and introduce socialism in America. The great majority of the people who do have health insurance do not know how the plan will affect them and why they should support it. But the Democratic Party, which is also the president’s party, does have a majority in both houses of Congress. The likelihood, therefore, is that in spite of scepticism on the part of some Republicans and southern Democrats, the plan will pass and become law.

The writer is professor emeritus at the University of Massachusetts.
anwarsyed@cox.net