GELFAND’S WORLD-Few Americans seem to know that three weeks from now, Scotland will have a referendum to decide whether or not it will be independent of England. For our purposes in this discussion, there is one issue that would really surprise many Americans: Both sides are trying to prove that they will do the best job of p rotecting what we Americans like to call "socialized medicine."
To the Scots and the English, it's called the National Health Service, or NHS for short. There is an interesting connection to what is happening on the American political scene.
Scotland's referendum is actually very simple. It's a ballot question that reads, "Should Scotland be an independent country? Yes/No." There are strong advocates on both sides. The pro-independence group is represented by Yes Scotland. The movement to preserve the United Kingdom is represented by Better Together. They do seem to agree on one point.
Here's what Better Together has to say:
The NHS is our most cherished public institution. There is no greater achievement than providing universal health coverage for all. However as medicine becomes more expensive and our population becomes older, our NHS faces challenges in the future. Only as part of a strong and secure UK can we ensure our NHS goes from strength to strength in the future.
Yes Scotland, argues its own virtues:
The process of becoming independent will not change the way you receive your health care. You’ll still be able to visit your GP and local hospital as now.
NHS Scotland already operates independently in Scotland. NHS Scotland has been the responsibility of the Scottish Parliament since devolution in 1999.
The Scottish Government’s vision for the NHS in Scotland is to maintain our publicly owned, publicly funded health service providing care free at the point of delivery.
I raise this issue of the Scottish vote because it's illustrative of a point I have been trying to make for the past year: As the Affordable Care Act, also referred to as Obamacare, begins to be used, and people learn in actual practice that they are being served by it, they will become its defenders.
By now, a few million Americans have gotten their Medicaid benefits through the new law, and numerous others have had the good fortune to be able to purchase insurance through the Obamacare exchanges even though they have some preexisting condition. Anecdotal evidence suggests that a lot of these people have become devoted to having insurance that they couldn't get before.
We refer to this process colloquially as developing a vested interest in the system. According to the most thorough calculations, probably eleven million Americans have come into the ranks of the insured through Obamacare after being on the outside of the system previously.
Back to Scotland for a moment. The NHS is, for Britain, what we in this country call a "third rail" in politics. That is, metaphorically speaking, the electrified rail in the subway tunnel that will burn you to a crisp if you dare get near it. Our third rails are Social Security and Medicare. My prediction is that just like the other two programs, the Affordable Care Act will eventually reach third rail status in American politics. All that's required is that enough people enjoy its advantages and wish to keep them.
The Scottish referendum reveals just how powerful a third rail the idea of national healthcare can be, once people get used to its benefits. We are not nearly so far down that road, but there is reason to believe we're moving in that direction.
The strongest evidence is that the Republicans are beginning to get the idea. Mitch McConnell, the Republican majority leader in the U.S. Senate, is running what looks to be a tight race with his Democratic opponent. He has been struggling to explain that his repeated calls for the abolition of Obamacare would not effect Kentucky's version of what is, after all, Obamacare. Hundreds of thousands of Kentucky residents have signed up, so Mitch has to pretend he is not going after their newly created benefits.
Down in Arkansas, the Democratic Senate incumbent is actually running ads bragging that he voted to protect the ability of that state's people to get insurance protection. This says that he knows his opponent can't come after him effectively on the issue.
What the political professionals have been noticing is that the Republican Party as a whole has backed way off of Obamacare as a target. Early on, they concentrated on the failed initial month of online access, but seem to have understood implicitly that if the system got going, they wouldn't be able to stop it, and that the people would like it. Republicans are now in a position of having to downplay the 54 votes they took in the House of Representatives to abolish the Affordable Care Act.
In this country, we're 4 years along in our grand experiment. It's been fought at the level of internet access, battling television commercials, and ponderous speeches. The obvious prediction is that if Obamacare can hold on for another couple of years, it will be an entrenched part of our political system, just as Social Security and the Farm Bill have become.
One digression. Since the voting age for the Scottish referendum goes down to 16, the news media have been interviewing potential voters in the 16-18 age group. What topic do they bring up? Many of them talk about maintaining governmental support for higher education. It's a blast from the past for us Californians, going back to the days when the University of California did not charge tuition, back before Governor Reagan decided to change all of that.
This referendum is historically weird
So far, it's all been so very civilized, considering that Scotland and the English kings were at each others' throats for half a millennium. They finally settled their differences more or less by accident when the reigning Scottish king inherited the English throne (without giving up his own) upon the death of Elizabeth I. This was shortly after 1600, before the Pilgrims settled in Plymouth in our own country. The two kingdoms, although technically separate, were ruled by a single monarch for the next century, until finally both Parliaments voted to unify under the banner of the United Kingdom in 1707.
I repeat, that's 1707, not 1907. Neither George Washington nor Paul Revere had been born yet. You'd think that three hundred years later, they would have hashed through their differences and would no longer be talking secession.
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But the Scots will have the chance to go back to something equivalent to the reign of Elizabeth I, at least in terms of independence from the English Parliament.
One other bit of weirdness. The official position of the Scottish ruling party is that an independent Scotland would retain the British monarch as chief of state, just as she is in Commonwealth countries such as Australia. Think of it as home rule with a twist. Others in the Yes Scotland coalition think otherwise, suggesting a non-monarchial republic. It's comforting to note that even if they can't agree on having a queen or not, at least they understand that universal availability of medical care is a major policy imperative.
(Bob Gelfand writes on culture and politics for CityWatch. He can be reached at [email protected])
-cw
CityWatch
Vol 12 Issue 69
Pub: Aug 26, 2014
