No serious reading today. No time today. Only I do spot one article on the BBC that is of interest: David Runciman explaining why people vote against their own self-interests. As I have noted before on this blog, at least British politics make some degree of sense. The working class, mainly concentrated in the formerly industrialised northern regions of England, tend to vote Labour, for the party that stands (or used to) for the redistribution of wealth. The rich south, especially in the financial districts of London, votes for the free-market Conservatives. When this pattern is not followed, it is logically enough because the Conservatives have managed to appeal to other core issues that concern working class voters, such as immigration, or because Labour have moved to the centre to appease middle-class concerns, such as healthcare and education.

In the US, though, the whole scheme seems awry. It is almost as if the poorer you are, the more likely you are to vote Republican, against your own interests in receiving free healthcare, for example. In his article, Runciman does a good job of explaining this inconsistency. It is all to do with the patronising effect that comes about when liberals try to help the disenfranchised:

The Republicans have learnt how to stoke up resentment against the patronising liberal elite, all those do-gooders who assume they know what poor people ought to be thinking.

Right-wing politics has become a vehicle for channelling this popular anger against intellectual snobs. The result is that many of America's poorest citizens have a deep emotional attachment to a party that serves the interests of its richest.

This still does not seem to me to be quite enough to explain how deeply-rooted suspicion of Democratic government is in the US, such that even its positive actions - or what would appear to be so from a European vantage point - are seen as negative and oppressive by those they seek to help. But it's a good start.

Labels: Barack Obama, Daily Diary, Republicanism

Sometimes, from my seat in the United Kingdom, it is hard not to laugh at politics in the United States. Take the fierce war about healthcare reform currently being fought in town halls throughout the country. Waking up bleary-eared to the radio news this morning, my ears pricked alert when I heard one woman berating a Democratic senator: "this is about the systematic dismantling of this country...I don't want this country turning into Russia. I don't want this country turning into a socialised country." What Cold War time warp is she stuck in?

But my laughter died and my blood got hot when I turned to this morning's Guardian. This reports that America's right wing is using the National Health Service to exemplify the terrible consequence of state controlled health care.

In television commercials and press releases from the American right wing, misinformation abounds. They report that the NHS puts "an Orwellian financial cap" on the value of human life. An email widely circulated among US voters claims that anyone over 59 in Britain is ineligible for treatment for heart disease. Republican Chuck Grassley says that:

I don't know for sure, but I've heard several senators say that Ted Kennedy with a brain tumour, being 77 years old as opposed to being 37 years old, if he were in England, would not be treated for his disease, because end of life – when you get to be 77, your life is considered less valuable under those systems.

A television advert from the conservative Club for Growth intones a figure of $22,750 whilst, with the backdrop of a Union Jack, a voiceover says: "In England, government health officials have decided that's how much six months of life is worth. If a medical treatment costs more, you're out of luck."

The group Conservatives for Patients' Rights has pages explaining healthcare systems in other, mainly European, countries. In its entry for Great Britain, it claims that in the NHS:

Waiting lists are a huge problem...Some examples: 750,000 are on waiting lists for hospital admission; 40% of cancer patients are never able to see an oncologist; there is explicit rationing for services such as kidney dialysis, open heart surgery and care for the terminally ill.

All of the above claims are at best misinformed, and at worst utter drivel.

There may be large waiting lists in NHS, but the simple number is irrelevant. What matters is waiting times, and as of 2009, no patient has to wait more than 18 weeks between being referred by their doctor and starting their hospital treatment. Most patients will actually start their treatments within 8 weeks. It is also utterly false that patients above a certain age, such as Senator Kennedy, would be denied any treatment.

The statement that 40% of cancer patients never get to see an oncologist is based on a study 15 years old (ironically, when the NHS was chronically underfunded by a conservative, right-wing government), and is no longer accurate. Naturally, though, some cancer patients may never get to see an oncologist, because advanced-stage but recently diagnosed cancers may kill before treatment.

The idea bandied both in the Club for Growth television advertisement, and also by Steven Pollard on the Conservatives for Patients' Rights site, that there is an "Orwellian financial cap on the value of human life" needs qualifying. The claims stem from the fact that when deciding whether to spend NHS money on new drugs, the National Institute for Clinical Excellence applies a cost-utility analysis. If a drug costs more than £30 000 to potentially extend the quality life of a patient by a year, NICE may deny funding for that drug. This is, of course, entirely sensible. Given a limited pot of money - and, yes, even US private health insurance schemes work with these - it would be unethical for one patient to receive an expensive drug to extend their life by one year, thereby meaning that other, cheaper drugs which might extend the lives for more patients for longer are restricted. NICE also offers a barrier against the salesmanship so prevalent in US healthcare, whereby doctors are pressed by the pharmaceuticals to prescribe the latest expensive drug. In the UK, with the health service working with more or less the same suite of drugs under NICE's recommendations, what amounts to bribery of individual doctors can have less of an impact.

One could go on all day exposing the lies behind the US claims, but The Guardian has already done a good job of collating decisive rebuttals on this page.

The bottom line, though, is this. In the UK, according to the World Health Organisation, healthcare spending per capita is around $2000. In the US, it is around $6000 per head. Yet in the UK (again using WHO figures), life expectancy is 79, whereas in the US it is 78. It is not surprising that the WHO ranks Britain's healthcare as 18th in the world, while the US is in 37th place.

But forget the figures for a moment, for healthcare is about humans. Healthcare is perhaps the most complex system any government administers. There can never be a perfect system which satisfies the needs of every patient every time; neither private health insurance nor a national health service are necessarily bad ways of paying for the service. Things do go wrong with the NHS. People get left waiting to see a nurse in a cold hospital corridor. Waiting lists always have room to come down. A patient is lucky if they can find an NHS dentist. Some cancer patients do get denied the most expensive drugs that might prolong their lives - if not cure the cancer - for a few months. Healthcare professionals are invariably overworked.

But the National Health Service has looked after numerous members of my family, providing cancer care, and long term care of chronically ill or disabled relatives, who would not have been able to afford to pay in the American model. If I want to see a doctor because I am worried about a tiny lump on my throat, I could see one this afternoon, and not put off the appointment until next year when I have saved enough. If I am in a car crash, I will receive trauma care that is second to none, and not be turned away at the doors of the nearest casualty department, or of the best department to treat my particular injuries, because my insurance is inadequate. If I have a child who suffers from learning difficulties, he or she will be seen and treated by an occupational therapist (someone like my mother, a paediatric OT), so that they can be integrated into mainstream education where possible. If my grandmother needs things such as grab rails installing in her home, she will be means-tested to see if on her income she qualifies for a grant to help her make the required changes, which allow her to live at home for longer. If I need a prescription, I pay just £7.20 per item, no matter how great the cost to the government. Or if I need a repeat prescription, I can take a prepayment certificate for £104.00 per year. And, for all these benefits, I pay less as a taxpayer than my US counterpart.

The National Health Service is a source of national pride, and I have to say I felt patriotically offended when I read the Guardian this morning. If the Labour government have done one thing well since 1997, it has been to fund the NHS sufficiently such that no future government could ever dream of removing it. It is our institution, and it is here to stay, robust against any abuse and slanders levelled at it from across the Atlantic.

Update Following the post above from this morning, I am delighted to see that I am not the only one who feels positively about the NHS. With thousands of people posting their personal, positive accounts of healthcare in the UK, Twitter posts using #welovetheNHS made it to the top of its trending topics this afternoon. Even the Prime Minister got in on the act.

Labels: healthcare reform, National Health Service, Politics, Republicanism

I have noticed quite a few US-based commenters on various message boards (see here, here, and here) lamenting the way in which the European media have been biased in their coverage of the US election; in particular, they criticise the BBC for leering across the Atlantic with a typical leftist lean. Now I suspect that over the course of the election it has probably been true that Obama has received more coverage than his Republican rival (though a Google News search for stories containing Obama and McCain shows the latter outweighing the former by 181 to 824 occurrences over the last month). What I object to is the way in which the word "bias" is used here in a pejorative sense, as if we should expect the European media to offer impartial coverage of an election in a foreign country. I am not at all sure that the onus should be placed on them to do this; indeed, the reasons for any bias seem to me to be so comprehensible that it is hard to imagine what a more "objective" European media would look like. Further, I would argue that where any bias does exist, it is not so much the fault of European-based broadcasters as the failure of the American right to make itself understood to the world.

The term "bias" raises that old fallacy that objective and impartial reporting means giving fifty percent of the coverage to each side in any bipartisan contest or debate. But we would not expect the BBC to dedicate half of its coverage of climate change to those 5% of scientists who disagreed with the anthropocentric global warming hypothesis in the IPCC report, even though this too is essentially a binary position (either global warming is happening, or it is not).

In practice, in and between UK elections the BBC's public service remit generally does lead it to fairly represent to the two major parties, with proportional representation of the views of minority parties on appropriate issues (the Green Party in relation to environmental politics) and at pertinent times (during the Liberal Democrat convention, for example). But even here, the coverage is not quantitatively divided. Naturally, the incumbent party will receive more airtime than the opposition, and naturally at certain times - during terrorist crises, for example - the broad rallying of the opposition behind the government means that it is pointless to repeat the same opinions simply because they are voiced by the other side. The aim here is not so much that the BBC represents every single voice in a noisy democracy, but rather that the BBC avoids swaying UK voters, allowing them to make up their own minds based on the evidence of the manifestos and personalities in the political arena as a whole over an extended period.

With the US election, the aim of an organisation like the BBC is surely different. Whilst undoubtedly the outcome of the US election will have huge foreign and economic policy implications, because UK voters do not have any direct say in the result, the need to report stories that will be of interest to the public becomes more significant than the need to report stories that may be intrinsically dull (NHS waiting lists, for example) but that are still a significant factor in deciding who to vote for.

In the case of the US election, it is personalities, not politics or manifestos, which are of dominant interest. And which personality is the more interesting? The folksy "ordinary" white guy who waves his arms around a lot (I mean McCain, not Bush), or the charismatic candidate who might well become the first coloured President of any major Western power, let alone a United States in which half a century before he would have been ineligible even to vote? Quite clearly, the public interest in historical terms lies in covering the American election through the prism of Obama.

Secondly - and the most significant contributing factor to any Democratic bias in the European media - is that it has become increasingly evident since the first election of George Bush that there is simply no political bloc or ideological grouping in Europe that compares to American Republicanism. It is very difficult for the European mind to conceptualise the dynamic relationships of evangelism, subscription to the myth of the self-made American, and geography, that ensures that the poor Southern white voter is most likely to cast in favour of the pro-life and low-tax Republicans even though that party is the least likely to improve their socio-economic status.

The Republican party have claimed that Obama will bring with him a "European-style Socialism," as if this politics ranks there with Islamic fundamentalism and Cold War Communism as an alien to be kept out of American life. With this statement, it becomes clear that the low voter turnout in Europe as compared to America does not indicate in any strong sense the failure of democracy, but the broad convergence of politics to a centre-left position such that neither side has much to say that is different from another. Though it is clear with the credit crunch that liberal Blairite economics is by no means the best way of macromanaging an economy, France, Germany and Italy all share New Labour's (failed) ambition that although the state should allow business to run itself it needs also to ensure that welfare support is provided at the very base of society. The state is responsible for ensuring both that wealth is allowed to accumulate at the top, but also that it is redistributed to the bottom.

It is, for example, inconceivable that any future Conservative government would abolish the National Health Service, whereas for a time during the 1980s and early 1990s that establishment seemed to be destined to fade into privatisation. Today, the only significant difference between New Labour and Cameron's Conservatives is where they decide to draw the bottom line: New Labour drew it through the lower-middle classes who provided their supporter base, whilst the Conservatives would suggest support should be provided only for the very severely underprivileged, and would appeal to that class by being strong on issues such as immigration. In America, by contrast, the lower it digs through the social strata the more Republicanism finds voter-rich seams of support. And it is difficult for the secular, European political mind to comprehend what drives this bloc. What commingling of ideology, religion and history leads Republican voters to believe not only that business and corporations at the top should not be pulled down by the state, but that they themselves should not be helped up?

In spite of the valiant efforts of the BBC's bloggers and correspondents (such as Justin Webb) to get among the trailer parks and into the minds of this community, they remain ideological others, taking over from the coloured minority who previously assumed that role in American culture. And so, I would contend, it is not any deliberate strategy but the sheer incomprehensibility of the Republicans that leads organisations like the BBC to any bias in their coverage. I am not suggesting this is a good thing. If Bush's foreign policy has been immoral because he has refused to attempt to understand the very sincere beliefs that drive terrorists to commit atrocities, at a time of global financial crisis it is vital that we try to understand what motivates Republicans genuinely to feel they are doing the right thing even if that seems so different to European politics. Simply castigating them as Others will not help. But I would argue that when right-wing commenters condemn the BBC for its bias, these Republican complainants ought to be a little more self-reflexive. The real problem is that they need to make themselves known and understood to the world. A world which, until that time, will continue to cast an overwhelming preference for the Democratic model, even without the obvious anti-Republican catalysts of the Iraq war and the Wall Street credit crunch.

Labels: BBC bias, Politics, Republicanism