The members of the United States Congress have gone home without approving Barack Obama's healthcare plan. The president has given the issue so much salience, and the case for reform is so urgent, that it is likely that some more or less satisfactory healthcare reforms will be passed between September 2009 (when Congress reconvenes) and the end of the year. But even if this happens, it is now plain that the result will fall far short of what Obama promised as a presidential candidate and what so many hoped for; it will be rather an intricate complex of compromises, cobbled together to meet the conflicting political and financial needs of dozens of special interests.
The exact lines of that package of reforms is not yet clear. But already it has offered a highly instructive look at three matters of great importance:
* Obama's growing political difficulties
* The current mood of American politics
* How very different American politics are from the style and substance of politics in other developed democracies.
The magnified madness
The inherently ridiculous affair of the professor, the policeman and the president revealed that, contrary to the "bliss-was-it-in-that-dawn" mood at the time of President Obama's election in November 2008, the United States is still very far from being a "post-racial" nation.
On 16 July 2009, A (white) neighbour observed what seemed to her to be two black men breaking into a house. The two turned out to be the best known African-American scholar in the country, the Harvard University professor Henry Louis Gates Jr, and his driver; they had gone round the back of Gates's home because the front-door was jammed.
Sergeant James Crowley of the Cambridge, Massachusetts police, was sent to investigate and arrested Gates, who - understandably, since he was in his own house - used some unprofessorial language. When asked about the episode at a press conference, President Obama, a personal friend of Gates, said that the local police had acted "stupidly". This is a president who, like most non-white people in America, has personal experience of being "racially profiled", the euphemism for discriminatory harassment by police (see Darryl Pinckney, "Henry Louis Gates Jr: Every black man's nightmare", Independent, 4 August 2009).
With some grace and political style, Obama invited both the tactless policeman and the touchy professor to the White House to have a beer with him in the rose garden.
So much for a silly-season story. What is of lasting significance is the storm of blogs, tweets and other responses the affair provoked, and what they reveal about the political mood. The great majority were furious, not with the policeman, but with the president. The incident has even given new life to the truly mad minority who insist that Barack Obama, a devoted Christian, is a Muslim; or that he is disqualified by foreign birth from the presidency, though he was born in Hawaii; and even that he is a "Manchurian candidate", sneaked into the United States by some Muslim conspiracy to undermine its constitutional-liberties system and Christian faith.
The public illness
What, it may be asked, does this have to do with healthcare reform?
No one, I think, who has read both the bloggers' response to the Gates affair and the chorus of incoherent rage about healthcare could fail to struck by the similarity of their stridency and irrationality.
True, there is one significant difference. On Gates, the great majority were hostile to the president: it looked very much as though only African-Americans and a thin sprinkling of liberals spoke up for Obama. On healthcare, the spluttering rage and wild indifference to the facts have come from both the president's assailants and his defenders.
There is now some evidence that support for both Obama's healthcare policy and his personal popularity are falling. Obama's own standing has (according to a Quinnipiac University poll) fallen from 66% to 50% between early July and early August 2009 (and by a similar margin, albeit to a higher total, in a CNN survey.
Obama's political circle fear that time is against him, and they may be right. They pushed to get Congress to pass a healthcare-reform proposal before Congress adjourned, and failed. The health-insurance industry and the Republicans will used the congressional vacation to bombard vulnerable politicians with even more fear-inducing material. Already the heaviest advertising spending has been in the districts of key members of relevant committees. The closer the 2010 mid-term elections approach, the more congressmen will be reluctant to expose themselves to this barrage.
The political mood in the United States is nervous, edgy, uncertain. In foreign policy, a number of events - the re-election (albeit dubious) of Mahmoud Ahmadinejad in Iran, the return to power of Binyamin Netanyahu in Israel, the continued frustrations in Afghanistan and Pakistan - have shown that Obama has less power to change the world than he, or at least those who voted for him, imagined.
In the domestic arena, against the background of a deep economic recession there is a strange political situation as the president seeks to push healthcare policy forward. A substantial majority of Americans still say they want serious change in this area. But on this as on other issues, Obama's wish to "reach across the aisle" and overcome the sharp political dichotomy (as well as to convince elements of his own side) has not worked; Republican politicians still caricature healthcare reform as "socialised medicine", even if as yet they have derived little political benefit from this stance.
The media story, however, is more sharply defined than the political one. Conservative publicists and pundits, especially on radio and on Fox TV, have recovered their confidence. They shamelessly travesty Democratic policies, and a surprising number of their readers and listeners seem to agree. Senator Charles Grassley, the senior Republican on the finance committee and a relatively responsible figure in the healthcare debate, asserted that Senator Ted Kennedy - the veteran champion of healthcare reform, who has had surgery for a brain tumour - would have died by now if he had lived in Canada or Britain.
The interest effect
The United States is a democracy. Its citizens have the right if they wish to spend twice what any other countries spend on healthcare, and receive in return an overall inferior service. But it is worth asking why - since Lyndon B Johnson's introduction in 1965 of Medicaid (for the poor) and Medicare (for the elderly) - the clearer failures in the delivery of healthcare have been so hard to remedy.
An important factor is undoubtedly the extraordinary influence of special interests at several points in the political system. "Interests" - in this case health insurance, pharmaceuticals and private hospitals on one side, and trial lawyers and trade unions on the other - are able to exert three kinds of pressure (see Joe Klein, "Will Special Interests Stymie Health-Care Reform?", Time, 3 August 2009).
First, they target politicians directly with massive campaigns of televised political advertising of a kind that would not be permitted by law (on account that it skews public debate) in most other developed countries.
Second, they lean on politicians by contributing large sums to their re-election campaigns, or to those of their opponents. The fact that elections for the House of Representatives are held every two years increases the temptation and vulnerability of congressmen.
Third, the interests can support a vast network of advocacy-groups, foundations, lobbies and public-relations operations which all strive to frame the debate. This includes the often explicit aim of influencing media reporting. The success here is most blatant in the resulting distortion of Americans' perception of how healthcare works in other countries (for example, the canard that people in Britain or Canada are not allowed to choose their own doctor).
The federal lesson
Most Americans believe that their system is more "democratic" than others, especially than parliamentary systems. There is some truth in this. It is certainly true that "interests" in the United States - special or routine, benign or selfish - have greater opportunities to stall or avert change, even when there is evidence that large majorities desire such change. Many Americans (and others) also believe that the spread of new media in America has introduced an enviable online "people's democracy". The quality of much online debate in the US makes this questionable.
Because the United States has a federal system, there is a wider range of geographical variation. In other respects, too, the American constitutional system makes quick and effective action by central governments more difficult. The weakness of the two parties means that a new coalition has to be negotiated for each major legislation.
The constitution enshrined two principles:
* the balance of powers between the three branches of government (the executive, the legislative and the judicial)
* the distribution of "checks and balances" between them, and between the federal government and the states, in a manner that was intended to defend against a tyranny of the majority. This it has done effectively.
The American constitution has worked well on the whole, and - even if William Ewart Gladstone's description of it as the "noblest work ever struck at one time from the mind of man" may be hyberbolic - it is respected to the verge of veneration in its homeland. Like any human creation, however, it has imperfections. A serious failing is that the constitution makes it harder to reach consensus on the need for change, or on the precise form that change could take, than do the (equally imperfect) political institutions of other nations. When in addition the political atmosphere in the United States has become so febrile and partisan, the result is that the fate of Barack Obama's flagship policy is in the balance.
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