A POINT OF VIEW

The most unlikely sources helped Barack Obama make history with the American health care bill, says Simon Schama.

Let me tell you about Natoma Canfield, for she has just helped make history.

She is a middle-aged cleaning lady living in Medina, Ohio. Medina itself is a small, pretty town lying on the ragged boundary between farmland and the broken industrial landscape of its big neighbour Cleveland - a city that has taken a beating from the recession.

That Ohio is a place of abandoned factories, boarded up houses, dark brick, squat churches, and dim pool halls. But it's the America I cherish for its never-say-die toughness. And no-one is tougher than the women of Ohio.

The high schools have roller derby girls who will mow you down as soon as look at you from beneath their killer mascara.

Tough girls finish first: roller derby demonstrates Ohio's mettle

Its urban heartbeat, Akron, has produced the black poet laureate of the United States, Rita Dove, and Chrissie Hynde of the Pretenders - whose deep tonsils alone are an invitation to lie down cheerfully on a bed of broken glass.

Natoma Canfield is built in that mould and on her story - as well as the tenacious labours of other women warriors in and out of Washington - the fate of health care reform, the Obama presidency, and the entire direction of American politics has, astoundingly, turned.

On the grounds of her "pre-existing condition" - a battle with breast cancer that she survived - Ms Canfield's health insurance costs doubled to the point where they exceeded her entire income. She had no option but to drop her plan, even though she has been recently diagnosed with leukaemia.

'Moral enormity'

Up until last Tuesday, insurance companies were able to turn a victory over death into a disqualification for future care. This moral enormity, along with the shocking figure of 30 million uninsured Americans, are part of what the health care act is meant to correct.

President Obama has often argued that case, but lessons in principled exhortation seldom work when they are faceless. Natoma Canfield gave the president the face he needed to make the argument about the plight of working people caught in a sickness trap.

Her letter to the president seems to have rekindled anger as well as compassion, and gave him a document he could use to embarrass opponents of the measure - some who thought it was too radical, some who thought it not radical enough.

People with pre-existing conditions had difficulty getting insurance

Lying on her sickbed, Natoma Canfield may have brought the Obama presidency back from the tomb into which a mere two months ago, a chorus of pundits had consigned it.

Let's re-spool the film to the frozen days of January when the Massachusetts Senate seat held by the most untiring champion of health care reform, Edward Kennedy, had - to general amazement - been won in a special election by the anti-liberal Republican Scott Brown.

Brown bragged that his would be the vote in the Senate that would kill the bill, notwithstanding that in 2006 he had voted for a Massachusetts version very like it. Brown channelled popular anger directed against a presidency that seemed remote from the economic pain of regular folks.

Obama's ratings did a swan-dive as he seemed to have lost the gift of connection with ordinary people.

Smell of fear

Suddenly, there were calls for the president to throw in the towel. And lo, the smell of fear was on the majority party and the sound was heard of a patter of furry-footed creatures running for the lifeboats: Democrats deciding they couldn't run for re-election.

Pursuing them were the baying hounds of right-wing talk radio and television, prophesying the coming of the Obama Soviet, should health care get any traction.

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Never mind the fact that Republicans like Theodore Roosevelt and Richard Nixon had been champions of universal health coverage, the end of America as the founding fathers had meant it to be was on hand.

Before the Democrats were buried under the same kind of debacle that had afflicted the first Clinton administration in 1993-4, when it too tackled health care, cries went up: "Change the subject! Get on with the job-creation programmes that the country really wants."

But something mysterious had happened to Obama in the aftershock of Massachusetts. Popeye had got to the spinach.

Even as he complained about the incivility of those demonizing him as alien to the American tradition, President Nice-Guy was slipping on his knuckledusters. Now it was time to use that raw thing called power.

The nuclear option

Instead of reaching out, he reached for what his foes called - scornfully - the nuclear option.

A moderate version of the bill - one that had done away with a publicly-run insurance programme that was meant to compete with the private industry and so drive costs down - had already passed in the Senate.

If he could induce the House of Representatives to vote on it, then enact their own amendments and send the law back to the Senate for a "reconciliation", the amended bill would need just a simple majority to become law.

The bill had its fair share of detractors

"No, no!" shrieked the alarmists. Polls were showing the American people were against the reform and would punish the Democrats for playing Congressional hardball. But Obama's people may have known that a significant part of that opposition came from Americans who thought the reform didn't go far enough. And that the poll numbers were moving.

But it was the president himself, who after convening a seven-hour televised bi-partisan debate on the issue, decided to gamble his entire authority on getting health care done. No sooner then he had gone gutsy, history handed him Natoma Canfield's letter. Then it got better.

The same insurance company - Anthem Blue Shield - that had doubled Ms Canfield's premiums summarily hiked premiums for its 800,000 California customers by a cool 39%. The reason, explained their public relations people - obviously a crackerjack team - was that the economy was in a downturn, people were shedding their unaffordable insurance, the revenue pool was smaller and so someone had to make up the difference.

"Ah, I see," Californians stuck with the tab said. "You mean we poor slobs who can't be without health care - say, for our small children - are stuck with a brutal bill, when your parent company, the amusingly named Wellpoint, clocked a profit of 2.7 billion dollars in the last quarter of 2009."

Women's regiment

Then the glorious regiment of women girded their loins for the fight, notwithstanding the fact that the price of enactment was a ban on using federal funding for abortions, thus depriving many poor women of reproductive counselling and help.

A phalanx of angry nuns - and believe me you don't want to mess with them - defied their bishops to come out in impassioned appeals to pass the reform as consistent with the sanctity of human life.

And, most critically of all perhaps, the Speaker of the House of Representatives, Nancy Pelosi (also a Catholic), took all these weapons and turned them into serious firepower.

There may be no-one, other than Barack Obama himself, who sets the teeth of the right on edge more than Nancy Pelosi. On her has been heaped truckloads of contempt, derision and abuse. But don't expect this to abate any time soon, for banging heads together as and when needed, Nancy Pelosi got the job done.

Fellow democrats including Joe Biden and Nancy Pelosi applauded the bill

On Sunday night, millions of Americans watched on television as the vote tally approached the magic number of 216 that pushed the act through.

What they also saw was a parade of almost entirely white Republicans come to the front of the House and damn the measure as the beginning of the end of freedom in America, the federally-funded massacre of multitudes of the unborn, and a fiscal apocalypse - notwithstanding that the bi-partisan Congressional Budget Office had scored the act as reducing the deficit by 140 billion dollars in its first decade and 1.2 trillion in the second.

Not all the criticisms are histrionic. Tax credits provided for small businesses to offer insurance for their employees, and subsidies to individuals unable to afford the insurance they are now required to buy, won't help the fiscal arithmetic.

And that Massachusetts programme - introduced by a Republican governor - is in dire financial straits after just a few years of operation.

But none of those concerns, nor the requirement for a re-run of the votes because of technicalities, nor the serious prospect of states filing law suits against the bill, could dampen the jubilation of the signing ceremony at the White House last Tuesday.

For once the sense of achievement did not seem like vain self-congratulation for something solid had been accomplished. In attendance were Nancy Pelosi and Natoma Canfield's sister, for she herself was too ill to appear.

But also, perhaps the ghosts of presidents past - Harry Truman and Lyndon Johnson - who, in LBJ's words in 1965 as he signed the act creating Medicare, wanted to bring a measure of "serenity to the fearful". There are worse things to aim for.

Below is a selection of your comments

I'm British so do not have an opinion either way on their voting, but Schama's writing is more like hagiography than real journalism.
Jonathan R, London, UK

All very true, without question an undoubted worthwhile triumph. Make, no mistake however, the Federal Budget will soar into the stratosphere. It was, after all the USA itself that first noted "There is no such thing as a free lunch". It may never be regretted, but it will always be doubted.
Peter Bolt

Has the cost of healthcare ever gone down? Now is not the time, and this is most certainly not the bill. If you really believe this will save the US taxpayer money, there is an island off the coast of Bangladesh/India you might want to buy for a holiday home. Like many properties in America it too is under water, so you should get a good price. As we know information provided by 'independent' government agencies, like how this bill will save money, is always correct and non-partisan. A good example was all the Weapons of Mass Destruction we found in Iraq, based on information from an 'independent' government agency. I am strongly considering learning Chinese so I might be able to get a job when the USA goes bankrupt.
Stan, Spokane, WA USA

60+ years back we got a National Health Service, the medics were appalled and many declined to join. It has its faults but overall it is good, but we are in danger of finding the price too high because too many things and too many people abuse the system, the US must go forward slowly.
Dudley Parker, near Southampton, England

As an American who has lived in Europe for 28 years, I view the health care victory as a small step back from the abyss for the USA. Mr Obama has a long way to go to teach Americans how to care about each other, but this is a start. Every year when I visit my relatives in the state of Oregon, I saw how the invidious effects of the health care mess had a deeply negative effect on all their lives. Now there is hope for a better life for them, and for that I am extremely thankful. The British do not know how fortunate they are to have the NHS, even with all its problems.
Warren, Bury St Edmunds, UK

There's only one solution to the health care insanity in the United States: A single-payer, national health care system, just like the ones Britain and Canada have. This new joke of a bill just reminds everyone how grossly incompetent the intelligence-challenged U.S. government is. I openly encourage everyone in Britain and Canada to overdose from laughing at the woefully inept embarrassment that is the U.S. Congress.
Jesse, Largo, Florida, USA

"Epic stuff"... I hope these bold measures, inspire and receive the ongoing visionary direction, good management and grass roots support they ultimately need to succeed. There is a minefield to negotiate with any public private initiative - health or otherwise. An unhealthy balance of double delegated responsibility, and misplaced financial incentive provide initial and short term comforts for all parties involved, but so often fail to deliver. A new model is needed.
Simon Henson, NORFOLK

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