Prof Pauline Rosenau, of the University of Texas, speaking
in Dunedin yesterday. Photo by Gerard O'Brien.
Lingering resentment in the South over the American Civil
War hinders important national initiatives, such as healthcare
reform, in the United States, political scientist Prof Pauline
Rosenau, of the University of Texas, told an audience in
She said divisions wrought by the 19th-century war were ably
demonstrated by the map of states voting Democrat or
Republican in this week's election.
Values and beliefs varied hugely from state to state, which
made national health reform difficult because it aimed to
standardise certain entitlements.
"We are not one country, we are many little countries."
President Barack Obama's re-election ensured a crucial
element of the reforms, a requirement on people to have
health insurance, should go ahead in 2014.
The reforms have been implemented in stages since Mr Obama's
healthcare law was enacted in 2010.
Had challenger Mitt Romney been elected, she did not believe
he would have made good on a promise to repeal the law, but
he could have granted states waivers from its provisions.
Even when fully implemented, the reforms would leave millions
of people without health cover, because of exemptions in who
had to buy cover.
The law faced a major challenge in the Supreme Court this
year, which confirmed the federal Government's right to make
people buy insurance. This is critical because if people were
not required to buy insurance, companies could not be made to
cover such things as pre-existing conditions.
Prof Rosenau said she was often asked by her students whether
she had been afraid when she lived in Canada to visit the
"socialist" doctors there.
The healthcare reforms were opposed by 40% to 70% of the US
public, depending how questions were phrased. However, the
overwhelming majority agreed with individual components, such
as forcing insurance companies to spell out their plans in
plain English without confusing small print.
"We do not have a sophisticated population," she said.
Even the people with the most to gain from reforms opposed
them, displaying a tendency to put ideology before their
self-interest, she said.
The insurance reform brought the industry into the 21st
century, she said.
Prof Rosenau is visiting the University of Otago as a William
Evans Fellow. Her talk was organised by the Dunedin School of
Medicine's Centre for Health Systems.