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A few days ago the United States Congress approved initial moves to repeal the Affordable Care Act – otherwise known as Obamacare. 

For most of us in the UK the exact nature of the ACA remains muddled. Possibly because in terms of our own socialised healthcare system it is rather confusing.  It’s certainly no NHS but it did address the issue of millions of Americans being left outside any form of access to medical care.  Essentially it was the best system Obama could get past the Republicans who fought him every step of the way. 

Among other things, it forced many employers to provide their workforce with health insurance (something many smaller firms didn’t do) and it allowed young people under the age of 26 to remain on their parents policies.  Most importantly, it prevented health insurance companies from excluding pre-existing conditions and applying caps to cover on long term conditions, including cancer.  Overall it was designed fill the gap between those already covered by occupational policies and those well off enough to afford private insurance and those who would be covered by Medicare – a service that provides basic care to the very poor and the elderly. Probably the closest thing the US has to our NHS. 

It’s easy to see why it wasn’t liked by small businesses and those already covered by personal insurance.  Not only did it mean more costs for business owners, it also increased general premiums as medical cover companies sought to offset the additional costs being imposed on them.  It was also hated by many on ideological grounds.  It smacked of socialism and a reduction of free market choice. It wasn’t the American way.  Forcing people to sell their house to fund cancer care was much more in tune with the star spangled banner. 

But the real mystery is why it was so unpopular with people in poorer areas, in fact exactly the same areas that were vehement supporters of Trump, a man who was so forthright in revealing his plans to abolish the ACA if he were to be elected.  

The answer may be in the nomenclature chosen by most of the country for the scheme itself.  The popular name ‘Obamacare’ became synonymous with a bad idea, mostly promulgated by the right wing press and of course that great defender of the rights of the poor – The Donald himself – someone with a pathological hatred of anything tagged with the Obama brand. 

Sine the election there have been reports coming out of Trump stronghold areas of his supporters celebrating the imminent demise of Obamacare, apparently safe in the knowledge that they had health cover through the ACA.  It’s painfully apparent that most of them don’t actually realise they are one and the same thing.  Time will tell how much of a shock it’s going to be to when they finally discover the horrible truth.   

With 20 million Americans left without any form of healthcare it’s likely that there’s going to be a fair bit of wailing and rending of garments.  But will they equate their own actions with the consequences that are about to rain down upon them?  A recent poll here in the UK suggests they may not be easily be shaken from their delusions. 

It’s long amazed me that people who claim to be terrified of the demise of the NHS still vote Tory in general elections.  During the 2015 campaign it was obvious that another 5 years of Conservative rule would likely see the end of it in any form that we’d recognise, and so far we haven’t been disappointed. 

Yet as doctors groups such as the BMA and the Royal College of General Practitioners join the throng of criticism of government inaction and underfunding, along with patient support organisations and even the Red Cross, condemning Theresa May’s criminally dissociated administration, a Comres poll reports that The Tories are still more trusted on the NHS than Labour. 

Nearly half of respondents to the poll supported the Red Cross assessment that we were seeing an humanitarian crisis in the NHS, but they still gave Theresa May a 12% lead on Jeremy Corbyn when asked who was more trusted with the future of our healthcare service.  Perhaps it’s simply a greater distrust of Corbyn rather than a vote of confidence in May, but amidst probably the greatest crisis ever faced in the health service, it still beggars belief that, given the chance, the electorate still wouldn’t kick the Conservatives back under their rock.  

With 222 serious alerts in 6 days, four out of ten hospitals in England having declared a major alert in the first week of 2017, and announcements that even cancer operations were now being suspended due to lack of beds, one has to wonder just what May and her gang have to do before the country wakes up and smells the chloroform.  Perhaps the public flogging of junior doctors or the bulldozing of a few local hospitals might get the message across.  And one of those alternatives is not half as flippant as it sounds. 

Indeed another recent report has highlighted a increasingly rationed NHS.  The BBC today published a warning from the BMA over the overzealous reliance on “crude, expensive” referral management centres causing “dangerous” treatment delays due to a 10-fold increase in their use since 2005.  These are privately run centres, originally setup by the last Labour government in 2003 in order to save money by limiting the number of unnecessary referrals.   But they now appear to operate in a similar way to the DWP in deciding the validity of a GP’s requests for patients to be seen by specialists and surgeons for further treatment.  Just like other notorious private assessment organisations such as ATOS, there’s speculation that they are paid on results, with an obvious bias towards rejecting requests. 

Many of the rejections appear to be made on administrative grounds, with referrals being refused or delayed due to paperwork not being correctly filled out.  This potentially leads to life saving treatment being dependent on a busy GP ticking the right boxes.  Reports suggest that some decisions being made by these agencies are not just cynical but positively dangerous, with cases such as a referral to a skin specialist being disallowed leading to a missed diagnosis of cancer.  This is a regime of selectivity that represents a further dissolution of the chain of concern in the NHS.  If we can’t rely on the opinion of primary care services being acted upon, access to more advanced treatments becomes little more than a lottery.  

Maybe when we approach something like the system that millions of US citizens will be facing in a few months we might finally realise that all the promises and spin, the reorganisations and reviews amount to the same process that Congress began this week.  The erosion of any kind of socialised healthcare system and the denial of access to all but the well off or the very poor.  An NHS that will merely patch you up and send you packing, or even worse, totally refuse treatment if it doesn’t meet with strict criteria. 

If the ACA is repealed without the promised replacement system being enacted (as seems likely) the result could easily be described as premeditated genocide, or a simple cull of the poor and ‘undeserving’.  It will remain to be seen if this politically toxic move goes unchallenged when those who have facilitated the likes of Trump finally realise their mistake in backing him. 

The question uppermost in my mind though is will the penny ever drop here?  Or will we continue to support a party who year after year chips away at the NHS and yet still apparently retains our trust. 

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