o8 February 2018
by J.R. Thomas
Donald has really gone and done it now. Russian influence in your electoral campaign? Who cares… Misbehaviour with ladies at the golf club? Yes, indeed, but so what? Unfunded tax cuts? Hey, it worked OK for Ronnie, didn’t it? (Didn’t it?)
But insult the British NHS? Hey fella, cease and desist! Mr Trump’s latest outrage is his suggestion that the UK’s National Health Service is bankrupt. As most doctors, health service workers, and all opposition political parties have been saying that the NHS has run out of money and needs more, that particular Trumpism would seem to be relatively uncontroversial, at least on the left of the political spectrum. Mr Trump seems to have been inspired to his remarks by Nigel Farage, currently not leader of UKIP, who said that the NHS had insufficient doctors, not enough money, and too many patients – especially foreign ones, who come to the UK for free health treatment. And Mr Trump noticed from his television set that last Saturday a march organised by The People’s Assembly Against Austerity and Health Campaigns Together was parading through central London claiming that the NHS was in a (Tory) funding crisis.
So Mr Trump’s tweeting (“going broke and not working”) should be well received, you might think. The PAAA and HCT of course are probably even now been admitted to A&E somewhere with a nasty attack of the vapours, having found that Satan himself has taken up their cause. Simon Stevens, who has the unenviable job of being chief executive of NHS England, suggested that Mr Trump on his forthcoming visit to London should spend time in an NHS hospital and see how it delivers health care at “half the cost” of the US system. Should Mr Trump take up that invitation, he will could certainly learn something about healthcare in the NHS, though Mr Stevens may want to dictate the location and timing of the Presidential visit carefully. And Jeremy Hunt, the Health Secretary who fought so valiantly in the recent cabinet reshuffle to keep his job, was quick to attack the President for his remarks, leaping to the defence of his lovechild to say that he was proud to be from the country “that invented universal coverage – where all get care no matter the size of their bank balance”. Nobody, oddly enough, intervened to say that the NHS cannot go broke because it is a government body and thus has access to an unlimited purse, albeit one that the Chancellor of the Exchequer keeps hidden down the back of the sofa as much as he can.
Mr Trump has got healthcare on his mind at the moment; he is grappling with possible reforms to Obamacare, as the system reformed by the previous US President is called. Mr Trump would like to reform the reforms, and so would a lot of other Americans. The problem is that there are a lot of irreconcilable views as to what further reforms are needed. Many Democrats would like to continue with what Mr Obama started, to create a system of universal healthcare, one in which all persons, irrespective of income, would get access to healing and care. Some would like something akin to the British system (a smallish group, it should be said), whilst others would prefer universal health insurance – a system under which all get their choice of health cover for the costs of at least basic treatment, subsidised or paid by the federal government for those who cannot afford it privately or obtain it through their employer. This was the thrust of the Obama reforms, but Mr Trump has rather cut the legs off that (sorry, uninsured folk, unfortunate analogy) by removing parts of the incentives to procure the insurance cover.
You might think universal health care in some shape or form would be a sure vote winner, but not so; opinion polls suggest that a majority of Americans are actually against it, fearing the economic consequences. (We need hardly point out that those for universality are mostly those not covered – around 28 million says Mr Hunt and we won’t disbelieve him – and those against it are those well insured.) On the Republican side there is a wide divergence of opinion also – ranging from those who think people should make their own arrangements or rely on charitable hospitals to those who think that indeed there should be some system of universal insurance. Not many Republicans think that the government should replicate the British system and run the whole healthcare system itself, fearing that this would soon bring government to its financial knees. This was indeed the point Mr Trump was tweeting; “going broke and not working”. The problem though is, of course, that any system where the government is going to underwrite costs for something with effectively free universal access is going to turn out to be very expensive. Most western governments are grappling with this problem and there is no easy answer as to how to fund it. The Americans have a long way to go to find a solution; and the British Chancellor of the Exchequer as he peruses the bill for the NHS – which, remember, is suffering not from cuts, but from funding not going up as quickly as expenditure – may think that he also ought to be looking for one.
At least Mr Hammond though does not have to worry about building a wall along national boundaries. Not a physical one; not yet, anyway. Mr Trump has self-inflicted that problem and continues to tie the fate of the Dreamers (the illegal immigrants who arrived as children) to the Wall; that has become even more complicated with the inability of the various executive branches of Washington government to pass an agreed budget to keep the federal government operating. The previous shut down in December was swiftly averted by a temporary fix, which expires this Thursday; best guess is that once again this will go to and under (or possibly over) the wire as Donald keeps adding strands – one of them now being a link to at least some funding for the Wall. This no doubt sounds very alarming to a European readership – government workers not been paid; quelle horreur! Not something that could happen in Brussels, mon dieu. But in fact it is not that unusual in Washington where failures to agree budgets often end up with at least a couple of days with the National Parks closed and the Congressional lifts switched off.
In the meantime, never mind funding the government. This is the month of the leaked memos. Last week the Republican Congressman Devin Nunes leaked a Republican memo suggesting that the FBI had covered up the fact that their investigation of the so-called Steele affair – the allegations by ex-British agent Christopher Steele about links between Donald and the Russians that so enlivened the 2016 election campaign – revealed that the Democrat National Committee had funded Mr Steele and his investigation. The FBI is widely said to be (ie has leaked that it is) outraged at this breach of operational intelligence. They haven’t denied it though. Now Adam Schiff, who is senior Democrat on the House Intelligence Committee (not, alas, a committee that promotes intelligence, but which oversees the FBI and CIA), is threating to release a Democrat memo which suggests the Republicans are wrong, and the FBI are saintly and beyond reproach.
As readers who have been to see the film “The Post” will know, there was a time when politicians did not leak their own correspondence, but left the key role of leakage in a democracy to journalists who, if this continues, will all be out of work and unable to pay their health insurance.