The United States spends almost twice per capita for health insurance coverage than most other advanced capitalist nations and still leaves almost 50 million Americans uninsured.
About 45,000 people die each year due to lack of insurance or the inability to access the insurance they have due to inadequate coverage. At the rate in which health care costs have been climbing, 20% of consumer spending would be captured by health care costs by 2017.
But thirty cents of every dollar spent on private health insurance is eaten by paperwork and bureaucratic overhead costs. Three thousand lobbyists honeycombed Washington while Obama was promoting his health care bill. They needed to make sure that their influence was decisively felt. Members of Congress from both parties have significant investments in health care and pharmaceutical companies. Obama’s director of health care policy has served on the boards of several health care corporations. It is no coincidence that the health bill resembles the legislation written by a former Vice President of Public Policy for Well Point, one of the nation’s largest health insurance companies.
If Eisenhower worried about a military industrial complex, the debate over health care has highlighted the very real existence of a health care industrial complex every bit as viral as the former.
The health care bill — which has yet to win the support of even half of the American population — is touted by its supporters as a “realistic” alternative to single-payer, or Medicare for All, which has the support of well over three-fifths of the population. But realism in American politics is measured first against the gauge of corporate accountability.
Still, even by this standard, it is amazing that the profit-starved American economy had few corporate advocates for socialising this cost and reabsorbing the massive profits otherwise realised in the health insurance sector. Health care costs are, after all, generally recognised as a major overhead impediment to American global competitiveness.
Yet for all that, it was greeted by the Republican Party and its Tea Party ancillary as “Armageddon.” This is despite the fact that the bill in its final form resembles the Republican alternative to the Clinton’s proposals of twenty years ago, and the Massachusetts health care program championed, at the time, by its Republican governor, Mitt Romney.
There is no greater tribute to liberal incompetence than the fact that the Republicans — the avowed champions of market based solutions — were later able to cash in on the public antipathy that their own free market program generated.
The fact that one out of six Massachusetts residents cannot afford care, and tens of thousands have been ejected from health care due to budget cutbacks, may, in no small part, account for the astounding victory of a Republican in a seemingly safe senate race that was brilliantly transformed into a plebiscite on Obama’s health care bill.
The Democrats, of course, learned nothing from this, but to soldier on. And soldier on they did to an ugly national legislative victory now moronically being compared to Social Security, Medicare and civil rights, but which retroactively cheapens all these previous victories. But as the Physicians for a National Health Program have pointed out, the Democratic hype of surrounding the bill is belied by the facts.
It is true that children can now be kept on their parents’ insurance until the age of 26; that Medicaid has expanded to cover 16 million low income people; that the caps on lifetime health insurance spending limits has been removed; that companies are prohibited from denying coverage to people with preexisting conditions; that it “ends” the practice of rescission in which health care companies have been able to retroactively cancel policies on the basis of an “unreported” illnesses.
But in nine years time 23 million people will remain uninsured. Millions of workers will be forced by law to purchase commercial health insurance policies costing up to 9.5 percent of their income but covering only 70 percent of their health care costs. Many will find such policies too expensive — even after government subsidies — and will face mandated fines. Or, if they buy them, will find them too expensive to use because of high co-pays and deductibles.
Insurance firms will be handed $450 billion in taxpayer money to subsidise purchases of these useless products, much of which will come from workers who have employer-based contracts and now face steep taxes on their “Cadillac” benefits as the cost of insurance grows.
Women’s reproductive rights will be further eroded, owing to the burdensome segregation of insurance funds for abortion from all other medical services. And the much ballyhooed end of rescission (sick people being dropped by their insurance company) that this legislation promises is so riddled with loopholes, owing to the part played by the insurance companies in crafting the law, as to be just a tad better than useless.
What next? All the drawbacks to this legislation fall on the backs of the working class and the poor, that is, on Democratic Party constituents.
This is the ultimate victory of bipartisanship, insofar as political suicide by the Democrats is as real a concession as one party can offer another.
Liberal groups such as Move-on.org, the Progressive Democrats of America and the AFL-CIO, all ostensibly in favour of single-payer, played no small role in abandoning their principles to strong-arm recalcitrant Democrats into falling into line with the administration. Former radicals such as Tom Hayden even offered the shame-faced self-justification that channeling billions of dollars into this health care bill will help “starve” the military.
The real question is whether, in the end, the labor movement can find in this legislation anything on which to build.
Failing that — and it is difficult to see a path to progress in a market based framework — the issue is whether activists within the labor movement can seek sufficient allies to build a movement outside the Democratic Party that can force this issue to be revisited, based on a platform that puts working people first.