Lyndon Johnson fam-ously favoured the von Bismarck quote that "laws are like sausages, it is better not to watch them being made".
That pretty much sums up the final crucial days of deal making the President of the United States had to endure to establish what Malta has known and enjoyed for many generations: that the provision of medical care is a basic human right. Earlier this week, by a vote of 219 - 212, the US Congress extended health care to some 32 million Americans who, because of poverty, unemployment or pre-existing or chronic illness had been literally priced out or excluded.
Lesser men, certainly public figures concerned about their own political fortunes, would have either not taken up the topic or given up in the face of orchestrated opposition. President Barack Obama did neither. Instead, he invited his opponents to discuss their opposition and offer alternatives. Most every opponent who had a constructive suggestion, such as those addressing the avoidance of fraud and keeping federal money from being misdirected in support of abortion, found the President amenable to making a responsive change. Unfortunately, some in the opposition were chiefly interested in labeling the President a socialist. These obstructionists persist in their unhelpful ways, as evidenced by over a dozen lawsuits challenging the new law.
Many readers know that my prior life was teaching and practising Constitutional law for prior presidents and private clients. I can say without fear of contradiction that these cases should be easily dismissed as frivolous. Because they lack all reasonable prospect for success, they also merit no preliminary relief interfering with the extension of benefits.
As this is written, the opposition is engaged in yet another effort which would make even Machiavelli blanch. The new law still requires a final Senate vote reconciling differences between the House and Senate. As part of that process, the opposition offered up a Trojan horse: an amendment for a public option as a competitive check on the market. The opposition finds the public option distasteful but is making this effort to draw off progressive votes and unravel the overall reform. This should fail.
Returning to President Obama's transformative achievement: What are the law's main benefits? Primarily, again, this is legislation that extends health insurance; it does not create a government-run health programme, cancel the existing insurance policies many upper income Americans enjoy through their employments or dictate that one change doctors.
In the immediate, the new law extends insurance to children with pre-existing conditions, allows parents to keep their older children up to age 26 on their health plan and offers a tax credit of up to 35 per cent to small businesses to insure their ranks, a responsibility that will be made more affordable by purchasing pools that spread risk.
Senior citizens will begin to have access to prescriptions at a deep discount reaching 50 per cent in 2011.
All Americans will benefit from the more uniform and responsible regulation of the insurance industry, including an accountable appeals mechanism to challenge treatment denials, an explicit requirement that 80-85 per cent of premium dollars be spent on medical service, not corporate bonuses, and the provision of monies to increase the numbers of primary care physicians, nurses and medical assistants. There is also funding for doubling the capacity of community health clinics over five years.
Healthcare is never "free" and the cost of the new law is borne largely by those making in excess of $200,000 per year, with the bulk of assistance directed at individuals earning less than $88,000. The high-end tax increase phases in gradually, beginning in 2013, with the so-called Medicare tax going from 1.45 per cent to 2.35 per cent. Once the funds are on hand for the needed subsidies, the requirement that all Americans have insurance or face a fine begins in 2014.
Will Americans appreciate the significance of using the government for this act of health care solidarity? Yes, Fox television notwithstanding. This American, in particular, shall always be grateful to have carried to the White House and to our home town of Los Angeles, through some thought ful writing by my wife Carol, the healthcare lessons from this island of "uncommon kindness". As one doctor articulated in the health forum our embassy held at Mater Dei Hospital earlier this month: "You know, Mr Ambassador, in Malta we train for medicine because it is a unique way to be needed, to be of service and, in that service, we are fulfilled."
Well said and, by the vote this week, a lesson learned.
The author is the US Ambassador to Malta.
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