Greetings Kossacks. I'm an Australian expatriate residing in New York City, and it is a great pleasure and privilege to witness the amazing transformation now taking place in your country.
The purpose of this diary is two-fold:
One is to give you a little window into the way people from other parts of the world will come to regard the USA following an Obama victory.
The other is to offer you a glimpse of the future from my country, Australia, where we've had low-cost universal public health care for over 25 years.
As I grew up on the other side of the Pacific Ocean, my impressions of life in America were formed largely by TV news. In 1992, in the wake of the Rodney King trial and the LA riots, I and billions of others could not have dared imagine that your country was only 16 years away from having an African-American Presidential candidate, and as it appears, very likely President.
But you see, that's part of the genius of your American spirit. That is why you hold the rest of the world spellbound so much of the time. As a collective group, you are capable of the most sublime, transcendent moments -- and the most appalling idiocies. Your Constitution is a document for the Ages, yet it has been used at times to justify hate-speech and the sale of semi-automatic weapons to teenagers. You gave the world MLK Jr., and took him away again. You put a man on the Moon, and then spawned an army of conspiracy theorists to say it never happened. You gave us Catcher In The Rye, and Who Wants To Marry A Millionaire.
For all these reasons, America amazes, surprises and sometimes appalls the rest of the world. So it is with this election.
Your Barack Obama seems to be channeling Lincoln, FDR (and a bit of Reagan showbiz!). Meanwhile, you offer us a Republican vice-Presidential candidate who's the butt of jokes on every evening talk show in the land.
In putting forward Barack Obama and Joe Biden as candidates, against the McCain-Palin ticket, you face a stark choice. If your country elects Obama-Biden, the world will add that victory to the list of your most stunning achievements, up there with the Moon landing and the defeat of Communism. If McCain-Palin are the victors, it will become another "Rodney King moment" for us international viewers. Another indictment that the "American Dream" remains just that.
So let me turn now to the other thread of these meditations: I have noted with interest Obama's announcements on healthcare. I have noted the great difficulty your country has with its "heaven and hell" healthcare system -- heaven for those with money and a steady job, hell for everybody else.
I have also noted the reservations of those who are concerned with what an expanded or universal healthcare system might mean. These concerns range from the deranged cries of Wingnutistan, who believe that government healthcare means the rise of Communism -- to the more reasonable reservations of those who are concerned about "big government" and whether universal healthcare will truly benefit the American people. It is to the latter, more reasonable group, that I wish to address my remarks.
First, although it grates with me, I'm afraid to say that "big government" is an inescapable fact of life in the developed world, and getting moreso with each decade. At the start of the 19th century, even the world's largest nations had tiny governments that did little more than maintain an army and conduct foreign affairs. They employed barely a few hundred public servants. Their economies were also a lot simpler. People lived on average less than 50 years, and there wasn't anything like the demands of a modern economy for infrastructure, education, health, transport and finance.
As our nations have developed, as our world has grown in complexity and become more prosperous, our governments have swelled to a size that our ancestors would have thought frankly grotesque, and about which many of us today also have reservations.
But look at our modern developed economies, at the pressures they face from globalised markets, energy demands, growing and aging populations -- do you really think a government the size of what we had during the 19th century could have managed in such a world?
I'm afraid "big government" is with us to stay. The question is how to find that spoonful of sugar to make the medicine of paying our taxes easier to stomach.
When it comes to "big government", Australia lies about half-way between the USA and Europe. Public-sector activity accounts for just under one-third of Australia's economic activity. That's half the level of some of the Nordic countries, but rather more than the size of government here in America.
Australia is a Federation of States like the USA, but our government spending is different in one important respect -- it's our Federal government that does most of the spending. Of the 33% of our economy that is represented by government, about 2 Federal dollars are spent for every 1 State dollar.
So, how much does Australia's universal health system cost the taxpayer, and what do we get for our money? I'll answer the last question first: an Australian citizen can go to any government-approved doctor and obtain a diagnosis and prescription for zero dollars out-of-pocket. If they wish to choose their own doctor, they might pay between $30-$70 for a consultation.
What about the medicine? An uninsured Australian will pay on average about 25% of the true cost of their medicine, and the taxpayer will foot the bill for the rest. For pensioners, veterans and the disabled, they will pay only $5 per prescription, regardless of the actual cost of the medicine. For families whose out-of-pocket medical expenses exceed $2000 per year, the government provides a tax rebate for every extra dollar that family has to spend.
For involuntary (ie. emergency) hospitalization in a public hospital, a patient will pay nothing except for the $200-$500 ambulance cost, and even this can be waived or insured for. For "elective" surgery (ie. necessary but non-emergency, like a knee-replacement) in a public hospital, usually the patient will pay nothing, but they might have to go onto a waiting list that could be from 3 weeks to as long as 2 years. If they have private health insurance, they can pretty much choose their own doctor and surgery times, and pay thousands of dollars accordingly.
About one-third of Australians choose to pay for their own private health insurance, as they prefer to use a particular hospital in a private room, with their choice of surgeon at their chosen time. About two-thirds of Australians rely on the public system exclusively, and keep thousands of dollars in their pockets instead.
What does this system cost us? The Australian Federal government pays for the doctors' visits and the prescription medicines, and it amounts to about 2% of our annual GDP. The State governments pay to run our hospitals, which cost about 1% of our annual GDP. That's it. 3% of our total annual economic activity is what it takes to keep our entire population covered by a viable, universal, public health system.
In America, 3% of your GDP would be about $413 billion per year. It's a lot of money to find every single year, but consider also that it's just over half the Wall St. bailout package, a bit less than this year's budget deficit, and much less than half the cost of the Iraq war.
And as a nation, you would also save many billions of dollars by improving the health of your population, with more people able to work for a living, look after themselves and pay taxes instead of languishing in their sick beds unable to afford medicine. And you'd get universal, low-cost healthcare, while preserving private healthcare for those who want it and can afford it.
I've seen reports that suggest your current healthcare industry, with insurance, accounts for something like 10% of your GDP. The rest of the world looks at America and wonders how you manage to get so little healthcare for so much money, and still leave over 40 million people without cover.
For just 3% of your GDP, you Americans could have what Australians (and many Europeans) take for granted -- every American able to access medical care to manage acute and chronic illnesses, without facing bankruptcy for the misfortune of falling ill.
I think a little "big government" is a price worth paying for such a benefit. Don't you?