In the midst of a financial and economic crisis, the US electoral campaign has highlighted the difficulties facing ordinary middle class Americans.
But some social issues have been pushed into the background, not least healthcare where reform not revolution is being proposed.
“No one of the two, not Senator Obama, not Senator McCain, is in favour of introducing a public health care system like we have in Europe today,” said US political expert Herman Mathys.
“On the other side, if we take the budget of the United States, the federal budget, 2008,
already 47 to 48 percent of the outlays are going to Social Security programmes.”
While the US system is the most expensive in the world, with healthcare spending rising rapidly, around 45 million people have no health insurance. The inequalities and distress that can result were highlighted in Michael Moore’s documentary film “Sicko.”
The US has two state-funded health programmes: Medicare for the over-65s and Medicaid for the poor. Everyone else has to rely on health insurance, if they can afford it. Two thirds of workers get insurance benefits in a scheme through their employers, but if they lose their jobs, the coverage goes with it.
As health services become increasingly expensive, Republican John McCain is focussing on keeping costs under control, with competition in the health insurance market. Barack Obama is pushing for universal coverage, although health insurance would be mandatory only for children. Subsidies would help bring insurance into more people’s reach.
Education is another subject largely ignored in the campaign. Both candidates agree on the need to increase the amount of state aid enabling students to go to university.
As for more delicate subjects, the positions are radically opposed. On abortion, Obama is pro-choice. His rival is not. And, while McCain has said he is not opposed to same-sex couples entering legal agreements for insurance and other benefits, he has not backed Obama’s support for civil unions.