Barack Obama’s one year report card

One out of every five!

Obama made several promises during his campaign days, but precious few seem to have been realised. Will America and the world cherish his presidency the same way they had welcomed it? For that to happen, Obama will have to live up to expectations that could be well beyond his reach.

It is quite normal for elected candidates to bear the burden of expectations. What makes Obama peculiar is the scale and magnitude of expectations that he carries. That has in part to do with the symbolism of his election. But that’s a small part, as a majority has to do with all the promises of change he made. Contrary to the expectations of 75,000 supporters and 365 electoral votes, the P.O.T.U.S [President of the United States] Barack Obama has not delivered the change that they could believe in.

Ironically, a person whose campaign was all about “Yes, we can,” hasn’t accomplished much of what he promised. His stimulus package creditably prevented a probable catastrophic financial crash. Yes, it hasn’t nudged the unemployment figures by much, something Obama accepts now. Obama’s flagship agenda of the health care bill is still awaiting its time in the sun. The same goes for his much hyped climate change bill. In his recent State-of-the-Union speech on 27 January, 2010, Obama promised something that is quite the opposite of what he had stood for in his campaign days. Instead of talking about green jobs and climate change policy, he discussed his plans on nuclear power, oil, gas, coal and bio-fuels! That’s change indeed!

The major blows for his supporters so far has been his failure in closing the Guantanamo Bay prison and also in providing relief for illegal immigrants, which he promised and initiated in the initial period of his presidency. Even after a year, Gitmo is active and no concrete policy has been designed for illegal migrants. What is most surprising is that his promises of closing Gitmo and solving other human rights issues were part of the parcel that won him the coveted Nobel Peace Prize. The leading entity PolitiFact found that Obama has kept around 91 of his promises... out of 500!

But Obama’s fall from grace is perfectly well in line with his predecessors. History bears testimony to the fact that not one President of the United States has been able to meet any kind of unrealistic deadlines or unrealistic promises. Quoting from one of our previous surveys, take for instance Woodrow Wilson who promised to keep the US out of World War I and ended up pushing the US into the same war. Then came Herbert Hoover in 1928, who, in his presidency speech, pledged to end poverty and promised “a chicken in every pot and two cars in every garage”– but eventually gifted the US ‘The Great Depression’ and gave many chickens a new lease of life! By the end of 1932, the unemployment figure touched the 24.9% mark with around 5,000 banks failing. Following the trend, Franklin D. Roosevelt graciously ‘un’met his 1932 pledge to maintain balanced budgets and to keep the US out of World War II. He bombed Japan and his government’s spending increased from 8.0% of GNP to 10.2%. The national debt, in turn, doubled from 16% to 33.6%. Richard Nixon promised resolutely in 1968 to ‘quickly’ resolve the Vietnam War. He didn’t! George H.W. Bush Senior promised in 1988, “Read my lips: No new taxes!” For records, he increased taxes and strangely parted with exclusions for high-income taxpayers. It seems that Obama, is on his way to keeping the spirit of freedom alive and kicking.

Nothing can indicate this more than Obama’s southward moving rating graph. His approval rating has dropped from 67% in 2009 to 50% today, the lowest ever rating at the end of a president’s first year term. Jimmy Carter and Bill Clinton were the only other presidents polled who, like Obama, started their second years as president in the 50s (percentage wise), earning 55% and 54%, respectively. Then there’s more. A YouGov Polimetrix poll for The Economist found that 51% people think Obama says what people want to hear and not what he believes in. The same poll further reveals that a huge percentage disapproves the way Barack Obama is handling the Iraq issue (43% disapproval), the economy (47%), immigration (47%), terrorism (42%), health care (45%), social security (43%) and the Afghan war (49%).

Obama’s sycophantic speeches haven’t helped his cause post election so far. And beyond any apprehension, the second year will be even tougher. With Obama losing support (and majority) at the Senate, passing health care bills, moving his immigration policy further and ensuring more green jobs will become harder. But then as his campaign showed, Obama is known to be at his best with his back to the wall, at least when it comes to giving off his spiel against countries like India and China and the business threats they pose to the future of America. Irrespective of his spiel, there would be five simian issues that Obama would find hard to get off his back in the coming year. The IIPM Think Tank provides its analysis of the list.  

Obama promise: healthcare

Every time he promised to negotiate healthcare reforms in public during his two year long campaign, Obama won applause all around. His campaign rhetoric went thus, “We’ll have doctors and nurses and hospital administrators. Insurance companies, drug companies – they’ll get a seat at the table, they just won’t be able to buy every chair... That approach, I think, is what is going to allow people to stay involved in this process.”

Studies by the Department of Health and Human Services estimate that health spending will grow an average of 6.2% a year in the coming decade, to $4.4 trillion in 2018, which makes the whole issue about healthcare insurance more pertinent. The healthcare bill, if passed, would have required all US citizens’ to have a health insurance and would subsidise premiums for many. This would enable families to cut their medical costs by around $2,500 a year. But the bill has faced many hurdles, especially from lawmakers & an already burdened Treasury.

The malaise in health insurance currently is too deep and malignant, and it all is expounded in the face of some clearly nonchalant insurance plans. For example, in some private plans, women are charged up to 48% more than men for exactly the same medical service. Even a Caesarean section is considered a pre-existing condition. In fact, some plans even consider a victim of domestic abuse as having a pre-existing condition (and thus deny insurance). As per a few studies, lack of health insurance is responsible for more than 48,000 deaths every year in the US. Critics say that the whole industry is now like an organised mafia. If one plays to the hooters gallery, then it’s easy to see that while the private insurance industry is more concerned about (ensuring?) healthcare denial, the CEOs in this sector were pretty well looked after – CEO packages of ten large insurance companies averaged around $11 million in 2008.

So it’s not only about providing American’s with better medical service but also about breaking the existing mafia by private insurance companies. And Obama is clearly fighting a losing battle. 

US & Canada: healthcare dissimilarities

Rich dad, poor dad

Barack just needs to look to his neighbours to understand health policies

That America has not done as well in supporting health issues over the years is a given fact. But how bad is ‘not done as well’? The answer is pretty bad. Not many would know that in the US, the incidence of cancer among males and females is 562.3 and 417.3 per 1,00,000 respectively (American Cancer Society, Surveillance and Health Policy Research, 2009), life expectancy is 77.8 years, infant mortality rate is 6.9 deaths per 1,000
live births (CNN once reported that the US has the second worst newborn death  rate in the modern world), mortality rate under the age of five years for males and females is 9 and 7 per 1,000 live births respectively, only 2.7 acute care beds per 1,000 people are available (5th worst amongst all OECD nations), 2.8 physicians per 1,000 and ranks 72nd by overall level of health on WHO parameters!

Perhaps today, the biggest issue in the US is the failure of its healthcare system, especially given the debate on Obama’s policy decisions. Though Obama is not labelled a failure, yet when it comes to healthcare reforms, it might not take too long for his 300+ million supporters to ‘change’ their point-of-view. One need not travel miles to prove what ails the States. Their next door neighbour – Canada – is a case in point, or rather, against the point. Canada has a healthcare model that is better; because it works!

Even after having a US-like healthcare model, Canada has successfully achieved better results in its healthcare report card. Healthcare spending in Canada is around $160 billion or 10.1% of its GDP in 2007, which is one percentage point higher than the average spending by OECD countries. But very interestingly, it is far lower than the US allocation, which is 16% of GDP. Canada also spends lesser on a per capita basis compared to the US. Canada’s total healthcare per capita spending was around $3,895, which is lower than the $7,290 per capita spending of the US. The critical reason why the system, despite spending less, works better in Canada is that while the public sector is the main source of funding for Canadian healthcare, the US system is dependent on private source funding.

In the year 2007, 70% of healthcare spending in Canada was through public sources (which, though, has decreased from 74.5% in 1990), while in the US, the same was 45% (the lowest among all OECD countries). Unbelievably, this happens despite the fact that the Canadian government spends a lesser amount (16.7% of its revenue) on its citizens’ health than the US government (which spent 18.5% of its revenues last year). Surprisingly, in spite of such gigantic healthcare spending in the US, a whopping 40% of the US citizens lack adequate accessibility to the country’s healthcare system (24% of the US population remained under-insured, according to the Consumer Reports Study, 2007), while with relatively lower investments, only 5% of Canadians are outside the system.

It is also astounding to observe that simply having more doctors, physicians and nurses doesn’t ensure a high quality of health service. Canada has fewer physicians per capita than in most other OECD countries (In 2007, it had just 2.2 practicing physicians per 1,000 people, lesser than the 2.8 physicians per 1,000 population in the US). Canada has 9 nurses per 1,000 people, while the US has 10.6 nurses per 1,000. Canada also ranks as worse as the US in the number of acute care beds per 1000 people (2.7). Look at where that has brought Canada. Canadians have an average life expectancy of 80.4 years according to the Canadian Institute of Health Information (US: 77.8). Infant mortality rate also has come down drastically to 5 deaths per 1,000 live births (US: 6.9). Adult smokers consuming tobacco products has gone down from 34% in 1980 to 18% in 2007 through an effective public awareness campaign, advertising ban and taxation moves. In Canada, 15% of its population is obese, far below the US, which has 34.3% of its population afflicted by obesity (OECD health data). Experts comment that patented drug prices are 35% to 45% lower in Canada than in the US. Some US citizens now even purchase prescription drugs from Canada (many using online transactions) than from their home country – this cross-border purchasing has been estimated at $1 billion.

Where’s the learning in all this? A key concept that the US government could start with is that the Canadian government centrally sets the guidelines for healthcare and ensures they are uniform throughout the country. Moreover, the government ensures that the system is non-discriminatory, both qualitatively – in terms of treatment – and quantitatively – in terms of pricing. According to a recent news analysis by Financial Times, a heart bypass operation that would cost some $1,30,000 in the US costs $24,600 at Bumrungrad at Bangkok – and even when airfares and a two-week holiday/recuperation period are factored in, it is still almost 80% cheaper.

Barack Obama might do well to read a relatively newer study published in The American Journal of Medicine, which says that medical debt is the principal cause of personal bankruptcy in the US, and its impact on weakening the whole economy should not come as a surprise.

The Presidential Tracking Poll published by The Rasmussen Reports shows how now, “the number who Strongly Approve [of Obama] has fallen from 43% in January to 30% in August. During that same time frame, the number who Strongly Disapprove has grown from 20% to 39%. Those numbers translate to a Presidential Approval Index that has declined from +23 in January to -9 in August 2009.” That’s the lowest ever recorded for Barack Obama, once considered and talked of in the same breath as Lincoln and Roosevelt. But those ratings are still better than Bush’s, who – in the final month of his job – had only 13% saying they ‘Strongly Approved’ of him, and 43% saying they ‘Strongly Disapproved’ (Bush ended up getting a negative Presidential rating of -30).

This is not to say his health policy commentaries are wrong, but to say that clearly, Barack Obama does have an incredible lot of distance to cover on healthcare. Some mention the distance is 498 miles... from Washington to Ottawa.