My decision in 2005 to leave the USA had many motives. But whenever I’ve contemplated returning permanently, the single strongest reason not to has been the nation’s barbaric, anti-competitive, and stupendously inefficient approach to health care.
The plight of the uninsured and underinsured was bad enough; more than one relative has told me that the great thing about turning 65 in America is that you can finally go to the doctor. I couldn’t contemplate living in a place where I could be trapped in a toxic job for fear of losing my health care, or where the appalling burden the system places on employers would prevent me from starting a small business, should I want to do that. I have always been amazed that Americans tell themselves they value entrepreneurship. Taking on your first employees is a much easier decision in Canada or Australia, where you’re not taking on their health care needs as well.
I have few illusions about health care in Australia, where I live now. Here, the central government is considering seizing control of public hospitals from the states, in order to address long-term problems of underfunding and incompetence that have made years of lurid news. Health care is an emotional issue everywhere, an issue that has us all by the throat, much like the issue of “home” that lies at the heart of NIMBYism. People will never be entirely rational about health care, any more than they are about “home.”
I also have few illusions about the complex and compromised bill that President Obama is about to sign, but I do know this is about more than health care. Apart from the election day of 2008, no other day in recent history has made me feel as hopeful about the US’s ability to reform despite its toxic politics and archaic systems of governance. If a reform of this magnitude can survive all the fear-mongering and confusion and somehow get to the president’s desk, reforming transportation policy may not be such a crazy dream. When I’m feeling really dreamy, I can almost imagine a world where California could put together a constitutional convention to fix its dysfunctional budget system, so that it wouldn’t have to continue wrecking its great universities, or its magnificent and diverse experiments in urbanism.
I hope, wherever you live and whatever your views on the issue, that you too feel a sense of a release and opportunity, in the fact that reform on this scale can still get done.