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Last Updated: Saturday, 27 January 2007, 12:03 GMT
Caring for America's health
By Justin Webb
BBC, Washington

Senator Barack Obama, an early frontrunner in the 2008 presidential race, advocates something the US has never had - universal health care, but just how bad a state is America's health care service really in?

Senator Barack Obama
Senator Barack Obama believes health care is a right for everyone

It was the summer of 1981.

Mrs Thatcher was only two years into her first term and Ronald Reagan only months into his.

I was starting out as well. Writing stories for the Beaver newspaper at the London School of Economics (LSE) about students throwing eggs at government ministers and the iniquities of low-cost coach travel to Greece.

I had arrived in London from a boarding school in the West Country and a black and white world had suddenly burst into colour.

My room mate in our hall of residence was a cheerful American with lively eyes and a vague resemblance to Bruce Springstein (a resemblance of which he was enormously proud).

Bo Nora was exotic. My friends at school had been called Patrick or Adrian, and mostly hailed from Somerset.

Bo came from Chicago and studied at the University of California. He was at the LSE for only a few months.

Parting company

Bo and I never felt the slightest bit mortal.

I remember us listening to a programme on the local London radio station where people with emotional problems would call in for counselling.

We laughed.

We had no problems.

I said goodbye to Bo on Great Portland Street tube station and we stayed in touch for a few years.

And then life took over and Bo Nora became a memory.

I moved to Northern Ireland, back to London, to Brussels and here to the US.

Insured but unwanted

A few months ago, 25 years after that central London goodbye, I tracked Bo down.

I found his e-mail address and sent him a message.

His reply talked of marriage and career and children and then came these words: "After several years of increasing physical difficulties, I saw a doctor in 1991 and was diagnosed with multiple sclerosis. I retired due to further disability and incapacity. Presently, I am spastic quadriplegic."

Bo is expensive and the insurers do not want him... and they make it obvious

I went to see Bo the other day in his home on the outskirts of Chicago.

We had supper.

Bo's eyes flashing with recognition as we talked about London and university and people we had known.

His wife fed him.

Bo is not a bitter person - funny how happiness is wired into some people whatever life brings - but one subject genuinely pained him.

Bo has health insurance, I presume provided by the law firm he worked for when he was diagnosed.

This is good news for Bo - bad news for the insurance company.

Bo is expensive and the insurers do not want him... and they make it obvious.

'Cut no slack'

Every year Bo gets a letter asking him if he is still ill.

President Bush (R) looks through a microscope at the US National Institute of Health
The story of American healthcare is one of huge expenditure for little obvious benefit

Someone has to fill in a form for him: "Yes, I am quadriplegic; no, no miracle appears to have happened."

He told me recently he had to have a minor procedure associated with the condition.

The bill was $78,000 (40,000).

In the end he paid only a small part of it himself but of the various entities that chipped in - the state, the insurer, the hospital - you can bet that no-one wanted to, and everyone would have got out of it if they could.

Americans who fall ill are cut no slack. A society which expects everyone to pay their way, expects it of them as well.

As a jolly man selling life insurance pointed out to me the other day, most personal bankruptcies in the US are the result of illness.

Endless letters

The story of American healthcare is one of huge expenditure for little obvious benefit.

By head of population America spends twice the amount Britain does on health.

But life expectancy here is lower and infant mortality is higher, way higher in some ethnic groups.

Most of the money seems to go on overheads and on profits for the many private companies providing care, the hospital groups, the drug manufacturers, and above all the insurance companies which write letters to Bo inquiring about his MS and write incessantly to all their other customers as well, endlessly negotiating, fussing, harassing.

As the costs spiral upwards and private employers ditch their health care schemes to stave off bankruptcy, increasing numbers of Americans have reduced their health insurance to the barest minimum, and when something goes wrong they are dependent on the back-up provided by the state.

So in a nation where socialised medicine is a phrase to be spat out contemptuously, Americans are on course by the year 2050 to spend every cent the government takes in tax, on health-related claims. Nothing left even for the tiniest war.

For the time being, Bo Nora will go on getting his annual letter but all of America is cottoning on to what Bo has known for years: there must be a better way of looking after sick Americans.

If Iraq is eventually resolved, the issue waiting next in line for the president, or more likely for his successors, is restoring health to American health care.

From Our Own Correspondent was broadcast on Saturday, 27 January, 2007 at 1130 GMT on BBC Radio 4. Please check the programme schedules for World Service transmission times.

SEE ALSO
US health care coverage shrinks
30 Sep 03 |  Business
Bush seeks health care shake-up
04 Mar 03 |  Americas

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