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Obama's health care reform

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Matt Smith:

Welcome to the La Trobe University podcast. I will be your host, Matt Smith, and I’m here today with my guest, Dr. Tim Minchin from the history program. Thanks for joining me, Tim.

Tim Minchin:

Thank you.

Matt Smith:

You’re here today to talk to me about the presidency of Barack Obama from your own unique perspective. Where would you like to start?

Tim Minchin:

I think obviously at the moment in November. We’ve just had the anniversary for one year for Obama’s presidency. So I think it’s a good time to try and reflect on where we stand on the moment, and what he’s achieved after one year, and to try and, you know, project a little bit into the future. And you know, sort of anticipate where he’s going, and obviously the health care debate is very much in the news of the moment. I feel a lot of his presidency will turn on that issue, and when he’s judged in the future, I think that this will be a big part of how he’s judged and the labels that are placed on him, and some will ride a lot on this reform that he’s trying to push through at the moment.

Matt Smith:

So he’s had a really challenging first year. Do you think that he’s lived up to the expectations that everybody has had for him?

Tim Minchin:

Not really. I think it’s inevitable that there was always going to be a sort of deflation after a president is elected particularly for the first term obviously - particularly in the case of Obama, the hope that he’s aroused was so great, and the narrative that he told of change and, “Yes we can,” gave people a feel-good effect. But at the same time, his approval ratings are still, I think, are now in the '50s, around 53%, 55% which is similar to the percentage of the vote that he won a year ago.

So in that sense I think where he is now is probably an accurate reflection of the support that he holds where, of course the initial ratings of over 70%, were in that sense exaggerated. So there’s always going to be that drop, I think. It’s in the nature of the situation.

Matt Smith:

You mentioned before his health care. Is there any particular reason why he’s targeted that as one of the big things that he wanted to do in his first year?

Tim Minchin:

Well I think giving it some historical perspective, I think every democratic president, going back to Franklin Roosevelt, has tried to reform health care. And some republican presidents have also tried to reform it. So there’s been a historical precedent of that issue being tackled as a crucial reform issue. But of course, we haven’t seen a bill passed since Lyndon Johnson in the 1960's.

So I think already of Obama’s not struck a significant achievement in getting his bill through the House. If we cast our minds a few months back, he’ll look like he wouldn’t get that far. So I think he’s shown a political skill in getting it passed and, you know, just bringing that about is itself an achievement no matter what happens from now on.

Matt Smith:

What is the situation with the health care at the moment in the U.S.? How did that get to be the way that it is? You hear horror stories about people not being able to get their fingers reattached simply because they couldn’t afford it when, I think, that that would be a basic health need of health care. How did a country like America manage to get in that situation?

Tim Minchin:

The origins of the health system, well, a lot of it was put in place in the 1930’s by Franklin Roosevelt, and his idea was that this would be the first step in the foundation of a state system. But in actual fact it has never been built on very much in the way that Franklin Roosevelt anticipated largely because of opposition, conservative opposition largely. And that opposition is still there. It’s what Obama is confronting now. I think the health care situation offers a window into America as a whole particularly as we look at it from outside as foreign observers.

America has some of the best health care in the world, at the top end if you can afford it. I think there’s no doubt that they’ve got some of the best health care in the world for those that can afford it. But at the same time, as you say, for a significant number of people, they’ve got some of the terrible situation where you got 46 million people without any health care. You got another chunk of the population is underinsured that’s missing treatments or not getting treated for things because their insurance doesn’t cover it.

So it’s kind of a, it offers you a window as they say, in a way, that America is a country of extremes, I always think, in the polarization of living standards. Just as you can see one from neighbourhoods with beautiful houses and two miles away, you can see people living in third world conditions in trailers and, you know, falling down houses. It’s that disparity that always strikes, visitors from Europe or from Australia, I think, and the health care situation gives you the same sort of insight into that disparity as well of the best of worlds and the worst of worlds coexisting very close together.

Matt Smith:

How is Obama trying to make a difference with their health care?

Tim Minchin:

Yeah, his plan is very complex certainly. He is stopping insurance companies from refusing to cover pre-existing conditions. Another is expanding the Medicaid program. They are crucial part, as well as, what we call the public auction, which is, you know, the government sort of setting up insurance resolve, insurance schemes, or exchanges as they call them. But it’s a complex package. The version that’s going to be debated in the Senate is going to be somewhat different than what was passed in the House.

Matt Smith:

It’s going to be watered down a bit, isn’t it?

Tim Minchin:

It probably looks that way, yeah. He needs 60 votes to get it through the Senate and you’ve only got 58 democrats. There are two independents. One of those independents, Joseph Lieberman, has already said that he won’t vote for a bill that includes this public option, which is a crucial part of the package. So that will tell us that if it does get through, it’s going to be watered down as you say.

Matt Smith:

So what are your thoughts in Obama’s effort to get the health care plan and coming with those promises and images that he’s trying to set out about himself? Do you that this was a good move to dealing with health care in the first year?

Tim Minchin:

It’s undeniable that there is a strong desire for change on this issue within the American population. It is a symbolic issue as a reforming president with a reforming agenda. It made a lot of sense to prioritize this issue. Of course, he couldn’t do it straight away in the first few months of his presidency we're dealing with the financial crisis. But I think it does make sense, as he needs to try and satisfy that demand for change that is there. I mean, the opinion polls show us that there is a strong demand for change on this issue. But there is also a very powerful and significant opposition which is now mobilizing, and is unifying because it’s got Obama’s package to focus on.

The role of conservative media, which is very powerful, I think that they are being very clever in their slogan. What they’re using is, “Does Obama care for his health care package?” Well he’s personalizing the issue. It’s focusing on Obama. And most of these people dislike Obama, and a lot of them don’t accept his legitimacy as the president. So using that label, you know, taps into that hatred or dislike of him, they’re using that very effectively.

Matt Smith:

Why is Obama somebody that polarizes people so much? There’s either an intense love for Obama or a great admiration for him, or people that are against him are like they've been against no other president. Is it simply just down on the basic racial scar that that’s happening?

Tim Minchin:

I think race is certainly present. Yes. If you look at this Tea Party Movement, the people that are involved there are overwhelmingly white. If you look at the opposition that he is producing generally is overwhelmingly white.

And you should look at the people marching against his reforms and so on are overwhelmingly white, probably the vast majority. Those people don’t really accept his legitimacy as a president. They haven’t, you know, really adjusted to his election. And so I think, I think the racial side of it is present. But at the same time, I think there’s an inherent conservatism in America, in popular culture, which of course, he’s also running into as somebody that’s trying to reform.

In the psyche of Americans, there’s this opposition to strong central government which doesn’t exist in the same way in Europe or in Australia, and which he’s now confronting because his opponents are accusing him of forcing them to buy health care. So that’s what they’re saying about it. “The government’s forcing us to buy health care.”

And on some of the talk radio and so on, they’re even comparing him to Hitler and to the Nazis saying that, “This is fascism essentially. The government’s forcing us to buy health care.” And that’s tapping into this American psyche of opposition to a strong central government, which I think is why this issue is so polarizing. And I think any president that tried to do this would run into that. But I think the racial element adds some momentum to it maybe as well.

Matt Smith:

There was another president that have a very similar plan to the one that Barack Obama’s trying to get through.

Tim Minchin:

Bill Clinton was the last president that really tackled this issue. Yes. In his first term, a similar story, to some extent in it, he tried to carry out a significant reform of the health care system early in his first term, and it failed.

Matt Smith:

Did he experience as much opposition as Barack Obama has?

Tim Minchin:

Yes. I mean maybe not quite as much, but really he didn’t get as far as Obama. And he didn’t get his bill passed in the House.

And one of the differences is that Obama has been able to bring segments of the insurance industry and the medical profession on board, and employers - the business community as well, largely because there’s this recognition that the current system needs reform. The cost of health care are spiralling out of control. Employers, a lot of the employers are worried about that. And Obama has been quite successful in tapping into that and bringing some of his constituencies on board so support him.

Of course, they want a lot of amendments. They want, you know, changes that favour them, but at the same time, he has mobilized more support from potential opponents than Clinton did.

Matt Smith:

Do his detractors have a case? Is Obama proposing that people are forced to buy health care?

Tim Minchin:

The details of it vary, I think, and a lot of it is interpretation. Nancy Pelosi was asked, “Are you going to jail people that don’t buy health care?” and she evaded the question. And Rush Limbaugh, the conservative radio commentator, seized on this to say that this was an admission that people are going to be jailed. Whether they’ve got a case I suppose it depends a lot on your personal opinion whether you think that that’s a valid argument. I think probably viewing it from our perspective of a country that has a government health care system, and that system is broadly supported even by, you know, by both major parties.

We find this somewhat puzzling that the government providing the insurance would be so vehemently opposed. As to say, it’s getting into that very different psyche in America that this strong opposition to a central government.

Matt Smith:

By the same logic that our government could be seen as fascist, I suppose, because we’re forced to vote. We don’t have an option to vote. We’ve got to do it, or we get fined.

Tim Minchin:

Yeah. When I’ve been to the U.S., that’s not very well known I find, that Australia has a compulsory voting that when I’ve talked to people about that, you do run into this attitude that, “That’s wrong.” You know, part of democracy is that you should be free not to vote. But at the same time when I talked to my students here in La Trobe, I find that most of them are supportive of it, and they see it as part of the citizen’s duty is to vote.

And so, again, it’s a very different culture that you’re coming across. The Australians, you know, see that as a civic duty, and they cloak it in that language, whereas in America, you see the language of individual rights coming through much more strongly.

Matt Smith:

For Obama, the health care reform isn’t entirely a win-win situation. It’s going to go through in some form but it’s not necessarily going to benefit him. Once it goes through, it could still impact negatively on him if Americans as a whole don’t like the outcome from it. So what do you think is going to be the result about it? Do you think it will work in his favour?

Tim Minchin:

I’m doubtful really about whether it will work in his favour because looking at the situation, I don’t think it is a done deal that he’ll get it through the Senate. I think it’s, you know, they say he needs the 60 votes, and there are only 58 democrats. There are also conservative democrats that might not vote for it, just so there are 39 democrats in the House that voted against it. So in the Senate you’re going to come across the same problem. There are quite a lot of conservative democrats, and they vote primarily on local interests in response to local pressures.

If you’re in an area where your margin of victory is small or you’re in a conservative state or region, you know, you’re vulnerable on this sort of issue as a democrat. So it’s certainly not a win-win reform, and I think it’s a risky issue. And you know, you could argue that his presidency is in a lot of trouble because of this issue, really.

Matt Smith:

Is there something that you think he should have turn his attention to instead?

Tim Minchin:

I very much believe personally that the health care issue needs to be reformed. And I admire him for attacking that and trying to do it. I think the economic issue is also very important. I think the, you know, the American economy is still very vulnerable. In Australia we might not appreciate that as much. The downturn or the recession has not been as severe here. But officially the unemployment rate in the U.S. is sitting around 10%.

Real unemployment is estimated to be about 17% or 18%, and it’s going to keep going up for the foreseeable future because it’s what they call a lagging indicator. So even if there are signs of recovery, unemployment will keep rising. So Obama is going to have to go back to that economic issue before too long, which is why he’s pushing to get the health care issue resolved as quickly as he can, and he'd like to have it wrapped up before the Christmas recess which would certainly involve a lot of momentum if he doesn’t do that.

Matt Smith:

Dr. Tim Minchin, thank you for your time.

Tim Minchin:

Thank you.