We all know why Barack Obama postponed his trip to Indonesia. Again. It was the hotly contested US health bill.
I can’t say I blame him for putting us on hold. If it were me, I’d hang around at home too.
After all, improving access to medical care in the United States would be truly historic: since Teddy Roosevelt first called for health reform in 1912, seven presidents – Democrats and Republicans alike – have taken up the cause, and none succeeded.
And the bill isn’t just about the health of the 32 million Americans not covered by health insurance. It’s also about the health of Obama’s presidency. In fact, if he fails, the political consequences would be dire. His administration might become terminal.
So I heaved a big sigh of relief on Monday morning when I went online and read that the bill had been passed by a hair’s breadth – just 7 votes: 219 to 212! Yes, I’m on Obama’s side on this one. I believe that universal healthcare is a basic human right, and no one should be denied good health services.
That’s why it’s amazing to me that the US – the world’s richest country – is the only industrialized country that doesn’t provide universal healthcare. In fact, it ranks only 37 in a WHO ranking of world health systems, just above Slovenia (http://www.photius.com/rankings/healthranks.html).
Of course the political dimensions of universal healthcare are not limited to Obama’s presidency. The idea of universal, affordable healthcare, like social welfare, is anathema to the ideology that underpins the laissez-faire capitalism that most Americans strongly support.
Fair enough, but isn’t this position hard to sustain with an aging population worldwide, and the US reeling from the financial crisis? Increasing numbers of elderly and jobless means more and more who can’t afford to pay for healthcare, and hordes of sick people make for a sick nation.
Seems obvious, huh? That’s why I just don’t understand why those Republican Reds have fought so hard against a medical safety net for so long. In 1960, Ronald Reagan even went so far as to say that universal healthcare was dangerous because “it could lead to Communism”!
I suppose that’s what made me think about our own new 2009 Health Law passed in October 13 last year, after eight years of struggle to replace the outdated 1992 Health Law.
You see, a big challenge for a country with a huge poor population like Indonesia’s is providing any access to health services at all. In Soeharto’s New Order, community health centers (puskesmas) were set up around the country, with integrated health services (posyandu), family planning clinics and under-fives health centers.
Impressive, huh? Well, that’s one thing you can say in defense of authoritarian dictatorships: if they want something, it gets done, by hook or by crook.
And “crooks” there were aplenty, even in the national family planning program, the New Order’s pride and joy. It was based on a target system, and women were “persuaded” by village heads and religious figures to use contraception, and herded to the family planning clinics by the military. Ah well, at least the facilities were there, if you needed them. The issue of choice was another matter.
With decentralization in 1998, Soeharto’s health system disintegrated rapidly, a process aggravated by the Asian financial crisis. Things became pretty tough for the poor, and experts claim Indonesia has now lost at least one generation to malnutrition and general poor health. How do you make up for that?
So health reforms were obviously urgently needed here, but as in the United States, political and ideological interests got in the way. Democracy made people realize that health was a basic human right, but it also gave conservatives and hard-liners a voice, and they objected to the inclusion of “reproductive rights” in the bill (despite coming from wombs themselves!). Reproductive rights, they said, would lead to free sex and abortion, and “dangerous” liberal ideologies. (Hmm … maybe they were all Ronald Reagan fans? Or is it just an old man thing?)
In any case, in line with the opening up of democratic space and a think-for-yourself attitude, the new law now includes provisions for prevention, health promotion and education. Yes, doctors can be as authoritarian as ex-generals who become presidents, but the “right to know” now applies across the board, and in all sectors – politics as well as health!
And the right to vote also means a right to access health services. The new Health Law states, for example, that hospitals are not allowed to reject patients for lack of funds … in theory, anyway. Like many, I have first-hand experience of hospitals focusing on moneymaking rather than patient needs.
When I helped out Santi, the woman who was hideously burnt by her husband (see my column http://www.thejakartapost.com/news/2009/12/30/money-burn.html), I collected funds for her five operations, but the hospital where she was operated on insisted on an 80 percent down payment, otherwise “the computer says no”. Santi almost missed out.
And what about women? Well, the new Health Law finally recognized they exist – just not as autonomous entities! That’s right, reproductive health services often cannot be delivered without the permission of the husband. A bit tricky for single women, huh?
As in the US, abortion is an arena for ideological and political struggle. In real terms, Islamic parties are losing their ground, but in terms of loud-mouthed persistence, they win. It’s a matter of who can shout the loudest and drown out the rest of us. Who loses? Women, mainly … as usual.
Oh well, politics and laws go together, like the health industry and profit making. But doesn’t this make the term “Health Law” somewhat of an oxymoron? Our bill has been passed, but it looks to me like our health system is still on life support. Let’s hope Obama has more luck with his one!
Julia Suryakusuma
(www.juliasuryakusuma.com) is the author of Julia’s Jihad.
