Devastating

William Oddie writes:

Before the American primary season proceeds much further, I need fairly soon to say something more about Rick Santorum. I would normally leave it for a week or two before returning to a subject like this, but we can’t be sure that Mr Santorum will necessarily still be around as a subject for comment by then. A blog like this one is either topical or it’s dead, and everyone seems unanimous in saying that though Santorum is doing well now, he will disappear from the radar at some point, possibly quite soon, since everyone knows that he couldn’t actually win against Obama even were he to be nominated.

I need to add something to my previous remarks from a perspective which not only those on the left in Britain but also most British conservatives – who would, if they had votes in American elections, be more likely to vote Republican than Democrat – probably share. Even those in the UK more temperamentally likely to lean to the American right than the American left would nevertheless have some doubts about most Republican candidates, and certainly about Santorum. I too have my doubts about Santorum, despite the fact that, as Conrad Black put it in this week’s Spectator, he is an “estimable turbo-Catholic”. This is, incidentally, something I would also say about many conservative American Catholics, like George Weigel, who really do seem to believe that orthodox Catholicism inevitably involves hardline economic neo-liberalism, even a full-on neocon stance, a view which seems to me not entirely orthodox (Mr Weigels’s hero, JPII, certainly thought so).

Nowhere is this doctrinaire neoconnery more evident than over the British National Health service, about which (like most American conservatives) Santorum has views which most English conservatives know, however critical they may be of the way in which the NHS is actually conducted, are not only ill-informed but almost deranged.

Santorum actually believes, it seems, that the NHS has “devastated” the UK and that its economic effect was partly responsible for the collapse of the British Empire (actually, the process of dismantling the Empire began in 1947 with the independence of India; the NHS was founded only in 1948 – but let that pass). Asked about this alleged economic devastation, Santorum said that Margaret Thatcher was on record as saying (where, I would like to know? I suspect that this supposed obiter dictum is a neocon urban myth) that if only she hadn’t had the NHS around her neck, she would have been able to do for Britain what Reagan did for America. Santorum seems unaware that it is fairly clear to most people here (whether you are pro- or anti-Thatcher) that her achievements were in fact considerably more radical within the British political system than Reagan’s within the American.

And if Santorum really thinks that British spending on the NHS “devastated” the British economy (incidentally, what does he think his hero George Bush did to the American economy? ), what must American health expenditure have done? The US spends 7.4 per cent of GDP on public healthcare (to which very few are entitled). We spend 7.2 per cent of GDP on the NHS for a system to which everyone in the population has an absolute right, and which most of those (I am one) who actually have any real experience of it, consider pretty effective.

Of course we are all aware that improvements need to be made. The bureaucracy is getting worse, not better. The Oxford hospital system has just installed a new fully computerised appointments system. I have to visit the (admirable) diabetic foot clinic at the Churchill hospital every two weeks. I now keep on getting letters from a computer situated in the John Radcliffe hospital, some miles away. The appointments it gives me are simply crazy. I have just had two letters: the first one gave me an appointment three weeks away: too long. The second I received on Friday, just after I had returned from the Churchill after an appointment which had taken place at 9.30 that morning. The letter was delivered at 12.30pm: it told me that I had an appointment that same day at 12.00pm.

I asked the clinic what I should do about these mad letters: just ignore them, they said; carry on making appointments here, when you come in. We expect the system to collapse; in the meantime, it’s a nuisance we just have to put up with. So, overall, the NHS as a system is still a work in progress. It’s reformable; and bit by bit it will be reformed. And the care (despite the exceptions we all know about) is mostly beyond praise.

Just one last killer fact about the dubious American healthcare system (to which the Obama reforms will in practice make little difference). According to a reputable study published in the American Journal of Medicine, 61% of bankruptcies in the US are caused by the costs of healthcare. I repeat: 61 per cent: it is simply insane. And these people have the infernal gall to equate our system with Soviet Communism (which incidentally had no public healthcare system at all). The abstract of the study is as follows:

BACKGROUND: Our 2001 study in 5 states found that medical problems contributed to at least 46.2% of all bankruptcies. Since then, health costs and the numbers of un- and underinsured have increased, and bankruptcy laws have tightened.

METHODS: We surveyed a random national sample of 2,314 bankruptcy filers in 2007, abstracted their court records, and interviewed 1,032 of them. We designated bankruptcies as “medical” based on debtors’ stated reasons for filing, income loss due to illness, and the magnitude of their medical debts.

RESULTS: Using a conservative definition, 62.1% of all bankruptcies in 2007 were medical; 92% of these medical debtors had medical debts over $5,000, or 10% of pretax family income. The rest met criteria for medical bankruptcy because they had lost significant income due to illness or mortgaged a home to pay medical bills. Most medical debtors were well educated, owned homes, and had middle-class occupations. Three quarters had health insurance. Using identical definitions in 2001 and 2007, the share of bankruptcies attributable to medical problems rose by 49.6%. In logistic regression analysis controlling for demographic factors, the odds that a bankruptcy had a medical cause was 2.38-fold higher in 2007 than in 2001.

CONCLUSIONS: Illness and medical bills contribute to a large and increasing share of US bankruptcies.

I have personal reasons to feel strongly about the NHS. It’s quite simple: due to complications deriving from the fact that I am a type two diabetic, I need an appointment with specialist podiatrists every two weeks, and I am on six different kinds of medication. These keep my condition under control but they would be beyond my means. In America I would by now be bankrupt, very ill or dead. Sorry Mr Santorum: you’re just wrong about the NHS. Your system is more expensive than ours and it just doesn’t work for a large proportion of the US population. If I were an American, I might well still vote for you (my ideal American candidate probably doesn’t exist). But the more I look at the American political system, the more profoundly grateful I am to be a British subject.

Santorum embodies the tendency of a significant section of the Italian-American community to become Republicans because they found their local Democratic parties already run by the Irish; his battle against the Caseys in Pennsylvania encapsulates this old, old feud.

They thus participated in, and were influenced by, the developments within the Republican Party. At best, they have become more or less paleoconservative, which in turn brings them within the orbit of critiques, not least Catholic critiques, of capitalism. At worst, they have become Rick Santorum.

Rather mirroring the battle for the Republican Party itself this year. Once and for all, is it the Party of God, or is it the Party of Mammon? The slow motion coronation of the candidate of big business in all its social liberalism and global military adventurism should settle that. To the surprise of nobody who has ever been paying attention.