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Last Updated: Friday, 7 November, 2003, 13:18 GMT
US diary: Giving birth in America
BBC Washington correspondent Matt Frei
By Matt Frei
BBC Washington correspondent

In the third of a series of regular columns, Matt Frei gives his own perspective on America's health system and people's attitudes to events in Iraq.

Statue of Liberty
Born in America, baby Alice Frei could run for president
The last time I travelled into the US I made a terrible mistake. I wrote on the immigration form that I was "a resident".

The officer shook his head, sucked his teeth and then corrected me: "You are NOT a resident. You are an Alien."

"But I have a five year visa. I own a house here. I pay American taxes."

"Fill in another form," he demanded, keeping his sense of humour well concealed.

Well, the Freis may remain aliens in the land of the free and the home of the brave but one of us can now run for president.

Admittedly, so far, Alice Olivia Frei has not expressed any such ambitions.

She is 16 days old. But she was born on US soil and thus has the right to become an American citizen and, yes, run for office. We will be proffering her at the next immigration counter.

Efficient birth

We have now had four children in three countries. The first two were born in Hong Kong in a charming little hospital on the Peak overlooking the South China Sea.

Here my wife was allowed to languish for days while our son was eased into his infant routine of eating, crying and sleeping, in that order.

"Can we stay another night?" "Sure. That'll be a thousand bucks! You'd be better off staying at the Ritz!" Indeed.
Ancient Chinese tea ladies in blue pyjamas shuffled around the corridors pouring cups of Oolong tea.

In Singapore we went to a teaching hospital. My wife underwent a "C" section and 20 students from all over Asia peered diligently into her innards as a purple Charlotte was extracted feet first, like a rabbit out of a magician's hat.

There was polite applause all round and Penny was allowed to stay in hospital for a week.

In America things are more efficient.

Alice was born on a Sunday evening and the obstetrician was clearly impatient to get back home.

"Let's deliver this baby FAST", she exclaimed as she breezed into our room wearing stilettos.

Litigious

I spent the first hour signing insurance forms, disclaimers and disclosures. Once my litigious instincts had been neutralised the business of birth got rapidly under way.

Brad, the anaesthetist, was better looking than George Clooney. But he was a bit stingy with the epidural drugs.

Moreover, while my wife was still writhing in pain I was virtually passing out. Not in sympathy, nor in fright - honest!- but because I had swallowed almost half a pint of nocturnal cough mixture, which turned me into a zombie. I came round just in time for the finale.

An estimated 45 million Americans have no insurance - private or state. Many of them simply cannot afford to get ill
When my wife had finally reached a "level of pain that she was comfortable with", Alice was born.

As soon as I had signed the birth certificate with a weary hand, Betsy, the "lactation consultant" - a complicated word for midwife, I think - knocked on the door with a range of "nipple products" - no euphemisms here, strangely.

Thirty hours later we were sent home. "Can we stay another night?" I asked.

"Sure you can!" the head nurse replied. "That'll be a thousand bucks! You'd be better off staying at the Ritz!" Indeed.

Costly business

Despite its speed, the experience was safe and reassuring. Healthcare in America is wonderful if you have private insurance. If you don't, and if you are not poor enough to qualify for Medicaid, being ill is a prohibitively costly business.

Before we were signed up to an insurance plan we had to pay for bills up front.

The forms politely refer to this category as "self pay". Doctors and their assistants look at you with a mixture of pity and dismay when you fall into this category.

A three-day course of antibiotics for my one-year-old daughter cost $120. A 10 minute session with a GP was about the same.

Private health insurance lowers the cost by 90%. An estimated 45 million Americans have no insurance - private or state.

Many of them simply cannot afford to get ill.


The guerrilla war in Iraq grinds on. Yesterday I went back to Arlington National Cemetery to witness another funeral.

US soldiers stop a man wanting to enter Uja in Iraq
Bush may be re-elected, despite concerns about the war
Since my last visit in July, a whole new row of headstones from Operation Iraqi Freedom has been added.

Private First Class John Hart, a gunner from Massachusetts, was killed in late October in Kirkuk. He was 20 years old.

Massachusetts democrat Senator Ted Kennedy turned up to pay his respects.

I had not noticed politicians at any previous funerals in Arlington. Perhaps this signifies how politicised the war has become.

At another funeral, 10 minutes earlier, I spotted Senator John Warner, a Republican from Virginia.

Democratic 'choir'

I am still not sure whether the agony of Iraq could bring down the president.

The Democrats, many of whom voted for the war, are now using the war to hammer the administration, especially since the economy is starting to look up.

For the first time, a slim majority of Americans believe Mr Bush is mishandling Iraq.

According to one poll, 53% of Americans believe the Iraqi dictator was involved [in 9/11]
But the nine Democratic candidates still look like a choir during their televised debates, which in my view have become far too frequent.

The danger is that the public is getting tired of them without even being able to pin point one potential winner.

To offset the traumas of Iraq, President Bush keeps linking the war against the remnants of the Baathist regime to the war against terror.

Considering the number of "foreign mujahideen", who are slipping across the border into Iraq to fight the Americans, this appears to be a self-fulfilling prophecy.

'Make a difference'

But by lumping everything under the all-embracing label of the war against terror, it also allows the president to continue using 11 September 2001 as the justification of his foreign policy.

Officially, of course, the administration has denied that Saddam Hussein had anything to do with the hijackings.

But two years of consistent implication have paid off. According to one poll, an astonishing 53% of Americans believe that the Iraqi dictator was involved.

As long as the White House can uphold this connection, the guerrilla war in Iraq has meaning.

It would of course also help if they found Saddam or a stash of his weapons of mass destruction or at least came up with an exit strategy.

After the Arlington funeral I spoke to John's father, Brian. An affluent businessman, he spoke quietly with the intensity of profound grief.

"John joined up after 9/11", he told me, his voice barely rising above a whisper.

"He wanted to make a difference and I believe that he did. America is a different country today and I would like to thank the British people for all their support in Iraq. You are perhaps the only true friends we have!"

It was the wrong time to remind Brian Hart that this war and his support for President Bush were perhaps the most unpopular things Mr Blair had ever done.

But if Brian's attitude towards the war in Iraq prevails in a year's time, when America goes to the polls, I believe President Bush will get re-elected.

Then the phrase will be: "It's national security, stupid!"



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