Jane McCredie: Broccoli and health reform

WHAT does broccoli have to do with the principle of universal access to health care?

Well, if you’ve been following the legal arguments over US President Barack Obama’s proposed health care reforms, apparently quite a lot.

In a country where an estimated 50 million citizens have no health insurance, the reforms are designed to provide universal cover by requiring most Americans to purchase insurance or face a financial penalty.

As part of the package, insurers would be prohibited from rejecting or imposing higher premiums on those with pre-existing conditions.

From an Australian perspective, it all sounds kind of … sensible. But nothing illuminates the differences between our two nations more clearly than a debate over the role of government in people’s lives.

And that’s where the broccoli comes in.

The “Obamacare” reforms are facing a constitutional challenge by 26 states and the National Federation of Independent Business in the US Supreme Court, a case described in the New York Times as “a historic test of federal power versus individual liberty”.

The Americans are very keen on their individual liberty, even when that means the freedom to die for lack of access to medical treatment.

As one of the Supreme Court judges who will decide on the constitutionality of mandated health insurance, Justice Antonin Scalia, put it during the hearings: “If the government can do this, what else can it not do?”

The same arguments relied on in the health care case could, he said, be used to “make people buy broccoli”.

Well, maybe they could. But it’s hard to imagine a Congress foolish enough to try.

From this side of the Pacific, the tenor of the debate over the reforms can seem bewildering.

Sure, you can always tussle over the details of a complex package of reform but how, you might wonder, could ensuring all citizens have access to decent health care in itself be a bad thing?

The answer to that can be partially explained by the strange mix of libertarianism and religious faith that is so much a part of American political thought.

An innate suspicion of secular authority — that perhaps goes all the way back to the Pilgrim Fathers — combines in some quarters with a belief that trusting in government is in itself an affront to God.

Never mind the consequences for millions of people facing ill health or worse who cannot afford the care they need.

One of the most moving things I have read recently is an impassioned plea on behalf of the reforms by a woman called Susan Gardner, whose 22-year-old daughter faces an ongoing battle with congenital heart defects.

“It comes down to this”, Gardner writes. “We either let these children die at birth or we as a society agree to spread the cost among all of us. There really is no other way ... No one family and no one individual can possibly shoulder the medical cost of ‘miracle’ lives.”

And it’s not just the miracle lives. It’s also the middle-aged clerical worker who loses her job — and therefore her health insurance — just before receiving a cancer diagnosis.

For all the failings of our own health system, I wouldn’t want to exchange places with the Americans. Not even for a whole truckload of broccoli.

Jane McCredie is a Sydney-based science and medicine writer.

Posted 10 April 2012

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