US: Healthcare debate

The limits of reform from above – the need for struggle from below

He has been called a “socialist” and “Nazi.” They say there will be “death panels” where government bureaucrats will make decisions on whether or not to let grandma live. These are just some of the attacks raised against US President Obama and his plans for health care reform by enraged Fox News-sponsored right wingers who are disrupting recent ’town hall’ meetings around the US. Of course none of them are true.

The right-wing hysteria is not simply opposition to health care reform or concerns about a government-run health plan. Much of the backlash is part of the general fear and anger developing in US society. It is part of the anger around massive bank and Wall Street bailouts while poverty, unemployment and anxiety about the future continue to increase. Given the absence of a mass left-wing anti-corporate alternative to the establishment parties, health insurance companies and conservative forces have been able to whip up these sentiments and direct them against any attempts to restrict their huge profits.

A warning for workers

This right-wing offensive should be seen as a warning to the left and the labor movement. The health care debate for reform is taking place in the context of the worst economic crisis since the 1930s. An enormous vacuum has been created, demanding real and urgent solutions, which the Democrats have failed to provide. This is what opens up the space for the rabid right wing populists who try to give it a right-wing expression.

The problem is not that “Obamacare” is “socialized medicine.”The problem is that it is not socialized medicine. Even before the Obama administration began to waver on the so-called “public option”—a step towards the likely abandonment of it altogether—the plan would have only been a limited reform, at best, given that it did not confront the biggest obstacle to providing health care for all, the private health care “industry.”

Health insurance companies make billions in profits every year by systematically denying adequate health coverage. These are profits made on top of enormous administrative overhead and advertising, which could be eliminated by a single government-run health insurance agency, or single-payer system.

Who is “rationing”?

But would a government-run plan mean rationing, as some conservatives claim? In reality, the current system is heavily rationed. It is the “natural” rationing of a market-based system where those that cannot afford health care do not get it – in the case of the US about 47 million or 16% of the entire population. This is not to mention the totally inadequate coverage of millions more insured by profit-hungry private companies.

What about the “death panels”? Once again, the current system condemns over 20,000 people to death every year from curable diseases, simply because they lack access to proper health care. In the wealthiest country in the world why would there be any need for rationing or “death panels” for the elderly?

Some commentators point to problems with the government-run health systems like Canada’s or the British NHS. While there are problems with these systems, mostly due to government budget cuts, none are inherent to government-based health care, and these health systems do not compare to the problems of the US health system.

The basic facts speak for themselves. Canada’s life expectancy ranks 8th highest in the world, while the US ranks 50th! In fact, every industrialized country in the world ranks higher than the US in life expectancy.

Fundamental change needed

Moderate reform of a deeply flawed health care system will not work; we need fundamental change starting with single-payer insurance. And it is not only private insurance companies. Private hospitals are known for shutting down in low-income areas and even cutting crucial services like emergency care because it is not profitable.

A study of Cleveland Clinic, a non-profit health provider, showed that private hospitals are also wasteful and inefficient. Instead of the incentive-based system where doctors’ pay is connected to the expensive tests, drugs and operations they order, the doctors at the Cleveland Clinic are paid a fixed salary. This massively reduced the cost of the clinic, while providing quality care, based on the patients’ needs, not on the cost of the care.

Then there are the drug companies that spend nearly $60 billion a year on advertising, twice what they spend on research and development.

We need fully socialized medicine where pharmaceuticals and health delivery systems—the hospitals and clinics—would be publicly-run, as well. This system should be run democratically placing the decision-making power into the hands of doctors, nurses, patients, and the broader public.

The further we are from a market solution the better. Socialized medicine would be the most cost-effective, efficient way of providing free, high-quality health care for all, and a single-payer system is a crucial first step.

But this would mean challenging the very foundation of the existing private health industry, something the Democrats are clearly not willing to do. They are too tied to these corporate interests to put up a real fight. Now they have indicated that they are prepared to completely drop the idea, as limited as it was, of a so-called public option.

Fear of backlash?

Will the union leadership and community organizations backing the Democrats follow health care reform into oblivion? Many of these leaders argued that while they were in favor of single-payer, it was “too radical” and we had to focus on whatever the Democrats had to offer. What exactly were they afraid of – that single-payer would provoke a backlash?

But it was precisely the watered-down minor health care reform that provoked the vicious right-wing backlash. At the very least, we could be countering the backlash with a real alternative. No one can accuse you of trying to implement socialized medicine in ‘disguise’ if you are actually advocating socialized medicine and clearly demonstrate that the fears about the costs, care, and control of socialized medicine have little to do with reality.

This means that the unions, health care advocacy organizations and working people, in general, need to wage a battle for health care, independent of the Democrats, putting forward the clearest first step towards socialized medicine – single-payer. Unfortunately, so far the healthcare reform struggle has been limited by its main leaders to accepting whatever the Democrats have to offer and expecting nothing more.

An alternative strategy needed

A top AFL-CIO [union federation] official recently threatened that the unions would withdraw their electoral support from the Democrats if they drop the public option. If the union leadership is actually prepared to make good on this threat, that would be a step in the right direction. But if they are really willing to break with the Democrats over the public option, why not fight for what working people and the poor really need, a single-payer system?

The unions, single payer and health care advocates have the resources to organize mass demonstrations across the US, to demonstrate loud and clear that working people want single-payer and an end to the domination of the insurance companies and the pharmaceuticals.

While surveys show that a majority of people in the US support some form of a government-run health care system similar to single-payer, hundreds of thousands of energized workers in the streets demanding it would really put the “public outcry” of these small town hall meetings into perspective.

There is no time to waste with watered-down half-measures. Fight for single-payer now!

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August 2009