People all over the world have followed the political rollercoaster surrounding healthcare reform in the United States, and millions witnessed Sunday's debate and countdown to midnight in the House of Representatives. The chaos that we call a "health system" in the United States--featuring some 47 million Americans with no insurance and millions more who are under-insured and face bankruptcy with catastrophic illness--stuns people overseas, especially in Western Europe.
Many view passage of healthcare reform as a test of President Barack Obama's mettle, and an unfortunate distraction for the White House from pressing issues such as the global economy, Iranian nuclear capacity, the wars in Iraq and Afghanistan, and trade negotiations. The president's decision to postpone until June his planned swing through Indonesia and Australia in order to be in Washington for the House vote appeared to validate overseas concerns that the U.S. domestic situation was overwhelming the White House.
It's hard not to wonder how international audiences responded to the image of a pro-life, conservative Democrat (Representative Bart Stupak of Michigan) apparently being decried as a "baby killer" by Texas Republican Randy Neugebauer during the weekend's final debate, and whether it reinforced concerns about the deep, often uncivil divisions in the American body politic.
For Americans engaged in global health efforts, the sorry status of the U.S. healthcare system--its nearly $9,000 per person annual costs and its lowest-in-the-industrial-world achievements in health outcomes--has been a source of considerable embarrassment. Even as the United States funds the largest efforts in the world to provide antiretroviral drugs to people with AIDS in Africa, several U.S. states now have waiting lists for access to the same drugs, for American citizens. As the United States puts increasing pressure on poor and emerging-market countries to develop their healthcare infrastructures and meet the medical needs of their people, millions of Americans have lost health coverage amid layoffs in the financial crisis.
Many overseas friends of America have been befuddled by the anger healthcare reform has evoked inside the United States--cries that reform equals socialism, the entire Tea Party movement, and the general concept that bringing more people into the medical system is, somehow, a bad thing. Foreign observers cannot be blamed for their confusion: Americans, too, are perplexed by the anger and emotions the debate has engendered. It is painful.
