Sunday, 20 December 2009

Barack Obama's Ambulance Wagon

In an attempt to defend the limited scope of the National Insurance scheme that he was closely associated with, David Lloyd George famously compared to the programme to an ambulance wagon - in other words on the one hand an emergency measure, offering services that, while limited, were life saving, and on the other as an implied promise for something grander and more comprehensive in the future*.

I mention this because the general situation seems oddly close to the highly limited healthcare reforms that, at the time I write this, appear likely to be passed in the United States. So instead of 'Lloyd George's Ambulance Wagon', make that 'Barack Obama's Ambulance Wagon'. Or perhaps not. Because, and this is both astonishing and sickening, the healthcare reform that looks set to become law in America is actually even more limited than the National Insurance system designed by Lloyd George in 1911. I'm not going to embark on a detailed, point-by-point comparative analysis of the two (in part because radically different societies make for radically different political discourse and social policy details, in part because the healthcare bill is so long), and I acknowledge that in some respects the reverse is true (NI only covered the working population, for example). But one of the main themes in the history of social policy is precedent (whether intentional or not), and as such one reason to look on NI as a positive development is that, although administered by private insurance companies, it represented a massive increase in the role of the state in some of the most critical areas of social policy. Yes, it was a conservative measure, but also a far sighted one (even if most of its supporters in the Liberal Party did not see so far ahead and would presumably not have supported it had they done so). Alas, the same cannot be said of legislation that (essentially) forces people to buy private sector insurance**. I think that the Ambulance Wagon imagery is still useful, but only if a little detail is added. An axel is broken and the horses are tired.

*Those that have seen in this evidence of plans by the wider Liberal Party to create a comprehensive welfare state are sadly mistaken. While Lloyd George's advocacy of social reform was genuine enough, the same can't really be said of the rest of his party. Serving the needs of capitalism and the 'British race' was one thing... a comprehensive welfare state would have been, well, Socialism.

**Just stripping it down to the essentials. It is, of course, far more complicated than that.

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