Obama’s health-care triumph? What a Pyrrhic victory

It’s too soon to celebrate the passing of the Democrats’ health-care reform bill.

Yes, President Barack Obama's 2010 health-care reform bill was a real watershed for the US, I enthusiastically told the lady from BBC Radio the day after the bill squeaked through the House. History will compare it to LBJ's historic Civil Rights Act of 1964. Or even his creation of Medicare the following year. A couple of minutes into the live interview, though, I realised that I was in danger of getting carried away. I switched mood and said that it will be at least a decade before we know what the effects of the bill will actually be.

You really have to have lived in a country that has a pretty good national health-care system, such as Britain's (the "socialised medicine" so dreaded by Americans), or a superb one, such as France's (also financed by the government, but largely through non-profit-making insurance companies), before you fully understand what it is like to live in a country that has such a truly dire health system as America does.

Here, you have to pay almost twice as much as in Britain for medical treatment, yet must expect to die a year earlier. The French, still so patronised here, live three years longer than the average American. So, now that health insurance, under Obama's bill, will cover 32 million more Americans (note, a further 24 million will still be left with no medical insurance what­soever in 2019), is this legislation the big breakthrough for US health care?

Profit of doom

“Now let [the Republicans] tell a child with a pre-existing condition, 'We don't think you should be covered,'" exulted David Axelrod, Obama's very own Svengali, after the vote on 21 March. What Axelrod failed to add was that insurance companies still won't have to cover that kid with a pre-existing condition until 2014 - by which time, the Republicans plan, the GOP will have romped back to controlling Congress, from where they will swiftly kill off that kind of large-scale reform.

I, too, have a "pre-existing condition" - an artificial heart valve that has ticked away happily for more than two decades, but which makes me uninsurable here. Profit-making health insurance companies, after all, only want to insure fully fit and healthy young people. The number of health-care lobbying organisations in DC grew from 398 to 1,541 during Obama's first year in office. The Republicans and their lobbyist chums are already frothing at the mouth to prevent other major reforms, most of which are not due to come into effect for four or nine years anyway, from seeing the light of day.

That is the fundamental weakness of the reforms: they all still revolve around the profit-making insurance companies, which will forever be devoted to keeping down costs and creating huge wealth for themselves. And they will do that by denying patients treatment.

If you think I am back to Obama-bashing again, I recommend an edition of BusinessWeek - not known for being a friend of the poor and downtrodden - from last August. "The health insurers have already won", its cover headline pronounced. "How UnitedHealth and rival carriers, manoeuvring behind the scenes in Washington, shaped health-care reform for their own benefit."

It went on to describe, to take just one example, how the former senator Tom Daschle - leader of the Senate Democrats from 1994-2004 and Obama's choice as health secretary until a tax scandal was unearthed - now advises UnitedHealth, despite having publicly advocated a government-run health system.

Herein lies the problem: between 2000 and 2007, the cost of health insurance in the US went up by 100 per cent. Doctors, justifiably terrified of litigation over wrong diagnoses, will send you for MRI and PET scans if you turn up with so much as an ingrowing toenail - just as they will wearily write prescriptions for useless but hugely expensive medications advertised ceaselessly on television.

The already ludicrous costs of US health care will continue to soar - meaning, inevitably, that the premiums charged by profit-hungry insurance companies will follow suit. One of the pledges that got Obama into the White House (that he would reduce the average family's health premiums by $2,500 per year) is now as doomed as his promise to shut down Guantanamo by the end of last year.

Hasty applause

Those who congratulate him for pushing the bill through without a single Republican vote are sadly mistaken, too, because the political costs will be enormous. LBJ managed to rustle up nearly half the House Republicans to vote for Medicare. By contrast, Obama made 92 direct interventions with House Democrats and, to snatch the crucial eight additional Democratic votes he needed, agreed at the last minute to ban government funding of abortion.

So much for the dreamy post-partisanship he also promised to bring Washington. Instead, he antagonised part of the Democratic base with his frantic abortion deal and, in effect, declared war for ever on the Republicans. Hell hath no fury like a scorned Republican, and the midterm elections in November are certain to be an electoral bloodbath.

What few in Europe understand is that, far from being grateful to Obama, even Americans deprived of decent health care - brainwashed by PR that first dreamed up the horror term "socialised medicine" in 1947 to combat Harry Truman's attempts at reform, and woefully ignorant of much better and less expensive health systems elsewhere - are not supporting his efforts. A CNN poll the day after the vote showed 59 per cent against the reforms and only 39 per cent for them.

I hope I'm wrong - I would rather like some insurance myself, after all - but the triumphalism, at best, is premature.

Andrew Stephen was appointed US Editor of the New Statesman in 2001, having been its Washington correspondent and weekly columnist since 1998. He is a regular contributor to BBC news programs and to The Sunday Times Magazine. He has also written for a variety of US newspapers including The New York Times Op-Ed pages. He came to the US in 1989 to be Washington Bureau Chief of The Observer and in 1992 was made Foreign Correspondent of the Year by the American Overseas Press Club for his coverage.

This article first appeared in the 29 March 2010 issue of the New Statesman, Hold on tight!

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This Ada Lovelace Day, let’s celebrate women in tech while confronting its sexist culture

In an industry where men hold most of the jobs and write most of the code, celebrating women's contributions on one day a year isn't enough. 

Ada Lovelace wrote the world’s first computer program. In the 1840s Charles Babbage, now known as the “father of the computer”, designed (though never built) the “Analytical Engine”, a machine which could accurately and reproducibly calculate the answers to maths problems. While translating an article by an Italian mathematician about the machine, Lovelace included a written algorithm for which would allow the engine to calculate a sequence of Bernoulli numbers.

Around 170 years later, Whitney Wolfe, one of the founders of dating app Tinder, was allegedly forced to resign from the company. According to a lawsuit she later filed against the app and its parent company, she had her co-founder title removed because, the male founders argued, it would look “slutty”, and because “Facebook and Snapchat don’t have girl founders. It just makes it look like Tinder was some accident". (They settled out of court.)

Today, 13 October, is Ada Lovelace day – an international celebration of inspirational women in science, technology, engineering and mathematics (STEM). It’s lucky we have this day of remembrance, because, as Wolfe’s story demonstrates, we also spend a lot of time forgetting and sidelining women in tech. In the wash of pale male founders of the tech giants that rule the industry,we don't often think about the women that shaped its foundations: Judith Estrin, one of the designers of TCP/IP, for example, or Radia Perlman, inventor of the spanning-tree protocol. Both inventions sound complicated, and they are – they’re some of the vital building blocks that allow the internet to function. 

And yet David Streitfield, a Pulitzer-prize winning journalist, someow felt it accurate to write in 2012: “Men invented the internet. And not just any men. Men with pocket protectors. Men who idolised Mr Spock and cried when Steve Jobs died.”

Perhaps we forget about tech's founding women because the needle has swung so far into the other direction. A huge proportion – perhaps even 90 per cent - of the world’s code is written by men. At Google, women fill 17 per cent of technical roles. At Facebook, 15 per cent. Over 90 per cent of the code respositories on Github, an online service used throughout the industry, are owned by men. Yet it's also hard to believe that this erasure of women's role in tech is completely accidental. As Elissa Shevinsky writes in the introduction to a collection of essays on gender in tech, Lean Out: “This myth of the nerdy male founder has been perpetuated by men who found this story favourable."

Does it matter? It’s hard to believe that it doesn’t. Our society is increasingly defined and delineated by code and the things it builds. Small slip-ups, like the lack of a period tracker on the original Apple Watch, or fitness trackers too big for some women’s wrists, gesture to the fact that these technologies are built by male-dominated teams, for a male audience.

In Lean Out, one essay written by a Twitter-based “start-up dinosaur” (don’t ask) explains how dangerous it is to allow one small segment of society to built the future for the rest of us:

If you let someone else build tomorrow, tomorrow will belong to someone else. They will build a better tomorrow for everyone like them… For tomorrow to be for everyone, everyone needs to be the one [sic] that build it.

So where did all the women go? How did we get from a rash of female inventors to a situation where the major female presence at an Apple iPhone launch is a model’s face projected onto a screen and photoshopped into a smile by a male demonstrator? 

Photo: Apple.

The toxic culture of many tech workplaces could be a cause or an effect of the lack of women in the industry, but it certainly can’t make make it easy to stay. Behaviours range from the ignorant - Martha Lane-Fox, founder of, often asked “what happens if you get pregnant?” at investors' meetings - to the much more sinister. An essay in Lean Out by Katy Levinson details her experiences of sexual harassment while working in tech: 

I have had interviewers attempt to solicit sexual favors from me mid-interview and discuss in significant detail precisely what they would like to do. All of these things have happened either in Silicon Valley working in tech, in an educational institution to get me there, or in a technical internship.

Others featured in the book joined in with the low-level sexism and racism  of their male colleagues in order to "fit in" and deflect negative attention. Erica Joy writes that while working in IT at the University of Alaska as the only woman (and only black person) on her team, she laughed at colleagues' "terribly racist and sexist jokes" and "co-opted their negative attitudes”. 

The casual culture and allegedly meritocratic hierarchies of tech companies may actually be encouraging this discriminatory atmosphere. HR and the strict reporting procedures of large corporates at least give those suffering from discrimination a place to go. A casual office environment can discourage reporting or calling out prejudiced humour or remarks. Brook Shelley, a woman who transitioned while working in tech, notes: "No one wants to be the office mother". So instead, you join in and hope for the best. 

And, of course, there's no reason why people working in tech would have fewer issues with discrimination than those in other industries. A childhood spent as a "nerd" can also spawn its own brand of misogyny - Katherine Cross writes in Lean Out that “to many of these men [working in these fields] is all too easy to subconciously confound women who say ‘this is sexist’ with the young girls who said… ‘You’re gross and a creep and I’ll never date you'". During GamerGate, Anita Sarkeesian was often called a "prom queen" by trolls. 

When I spoke to Alexa Clay, entrepreneur and co-author of the Misfit Economy, she confirmed that there's a strange, low-lurking sexism in the start-up economy: “They have all very open and free, but underneath it there's still something really patriarchal.” Start-ups, after all, are a culture which celebrates risk-taking, something which women are societally discouraged from doing. As Clay says, 

“Men are allowed to fail in tech. You have these young guys who these old guys adopt and mentor. If his app doesn’t work, the mentor just shrugs it off. I would not be able ot get away with that, and I think women and minorities aren't allowed to take the same amount of risks, particularly in these communities. If you fail, no one's saying that's fine.

The conclusion of Lean Out, and of women in tech I have spoken to, isn’t that more women, over time, will enter these industries and seamlessly integrate – it’s that tech culture needs to change, or its lack of diversity will become even more severe. Shevinsky writes:

The reason why we don't have more women in tech is not because of a lack of STEM education. It's because too many high profile and influential individuals and subcultures within the tech industry have ignored or outright mistreated women applicants and employees. To be succinct—the problem isn't women, it's tech culture.

Software engineer Kate Heddleston has a wonderful and chilling metaphor about the way we treat women in STEM. Women are, she writes, the “canary in the coal mine”. If one dies, surely you should take that as a sign that the mine is uninhabitable – that there’s something toxic in the air. “Instead, the industry is looking at the canary, wondering why it can’t breathe, saying ‘Lean in, canary, lean in!’. When one canary dies they get a new one because getting more canaries is how you fix the lack of canaries, right? Except the problem is that there isn't enough oxygen in the coal mine, not that there are too few canaries.” We need more women in STEM, and, I’d argue, in tech in particular, but we need to make sure the air is breatheable first. 

Barbara Speed is a technology and digital culture writer at the New Statesman and a staff writer at CityMetric.