The pulse of the nation

Recently the US Supreme Court upheld most of what's come to be known as "Obamacare" - a huge raft of changes to the way health care is regulated here in the United States.  Though the legislation has many provisions, the most controversial aspect must be the individual mandate that forces all Americans (and foreign hangers-on, including yours truly) to have health insurance - while at the same time ensuring that those who can't afford to buy their own will receive assistance to do so.  Coming from a country where health care is taken for granted, I can only see positives in making sure that everyone can go to the hospital if they are sick and not worry about being turfed out into the street or (more likely) bankrupted by the cost.

Most Americans don't, in fact, buy their own health insurance.  Through a strange historical quirk most people receive insurance as a benefit from their employer - not just for themselves but for their families, too.

This all works fine in principle, but there are numerous cracks which people can fall down and end up without coverage.  Obviously if you don't work for someone else you either have to pay out of your own pocket or go without which is a very risky proposition.  There are also rather grey areas when people change jobs or when grown children leave the nest.  The majority of Americans are covered, one way or another, by a patchwork of insurance schemes but the patchwork is straining at the seams and people are dropping into the gaping holes that are opening up.

I should make it clear that the American people are not so heartless that they would see sick people dying in the street next to a hospital.  If you come to an emergency room gushing blood you will be treated.  But you still have to pay - and if you can't then someone has to make up the difference, generally the taxpayer.  The point of the individual mandate, as I understand it, is that everyone should have health insurance even if society has to pay for it - on the assumption that society would have to pay anyway somewhere down the line, when the unpaid medical bills start piling up.  In some ways its just a way of nudging costs from one line to another in the national budget.

Unfortunately many Americans do not see it that way.  After President Obama guided these changes into law early in his term, opponents challenged their legitimacy in the Supreme Court.  Now that the court has ruled in Obama's favour the only option is repeal, and as long as Obama is in the White House that isn't going to happen.  So healthcare reform is threatening to become a major theme of this year's election.  Not for any reason to do with the care of the sick; as with so many other apparently everyday things in the US this has become a kind of constitutional crisis.  But that's a theme for another day.