Archive for the 'Health Activism' Category
Add a comment July 2nd, 2010 by Claudia Chaufan
Posted in Physicians for a National Health Program (PNHP blog) on Friday, Jul 2, 2010
By Claudia Chaufan MD, PhD
In a recent issue in the New England Journal of Medicine, economist Jonathan Gruber praises the Patient Protection and Affordable Health Care Act (PPACA) as a “step in the right direction,” even as he expresses a healthy skepticism about PPACA’s capacity to control escalating health care costs, which he recognizes as “key to the long-term viability of our health care system.” Gruber also argues that there is “shortage of evidence” regarding which approach will meet Americans’ health care needs while controlling costs; therefore there is “no consensus” on what works [1].
Had Gruber looked beyond the U.S. borders, however, he would have found plenty of evidence. For instance, he would have found that U.S. consumption of health care as measured by critical indicators — per capita annual doctor visits, length of stay following heart attacks, or length of stay following normal childbirth – is no greater than the OECD average, and therefore cannot justify the extraordinary level of U.S. spending [2].
He would also have found that U.S. prices for medical care commodities and services are significantly higher than in other nations and constitute a key determinant of U.S. overall spending [3]. And had he looked into why this is the case, Gruber would have found that US high prices are determined by the exceptionally high administrative overhead caused by the system’s fragmented, public-private financing [4] and by the comparatively limited market power of American patients vis-à-vis their counterparts in countries with national health systems where the government negotiates prices with drug and medical device companies [5]. And he might have concluded that PPACA will do predictably little to change all this.
Moreover, the international literature would have shown the author the extraordinary international consensus around nonprofit financing to cover medically necessary services [5].
But what about the dramatic expansion of coverage promised by PPACA? Is this not a step in the right direction? The problem is that insurance coverage, as desirable as it may be, is not health care, but just a means to that end. And the U.S. system is notorious for providing coverage without care. High co-pays and deductibles are significant obstacles to access. Nor does health insurance offer financial security: nearly 78 percent of personal bankruptcies in 2007 that were linked to medical debt involved persons who were insured at the onset of their illness or injury [6]. PPACA, by allowing the sale of premiums for policies that will cover only 60 percent of health expenses [7], will do predictably little to change this state of affairs.
There is, however, an alternative proposal whose financial and policy soundness are based on decades of international experience and evidence. It would improve and expand Medicare to include all residents in the nation or in one state. That alternative may have to wait until PPACA unravels, as it predictably will [8].
President Obama argued that a model of reform as that implemented by PPACA would allow Americans to build on “what works” [9] – a decades-long experience with employer-sponsored for-profit health insurance. Maybe paradoxically, however, PPACA will unravel as employers realize that it is cheaper to pay a fine than pay for increasingly more expensive and inadequate policies, and employees enter the individual health exchanges implemented by the new law and find them so expensive that they “clamor for a nationalized health care system” [10].
References
1. Gruber, J., The Cost Implications of Health Care Reform. N Engl J Med: p. NEJMp1005117.
2. Peterson, C.L. and R. Burton, U.S. Health Care Spending: Comparison with Other OECD Countries. 2007. Order Code RL34175(September 17): p. http://assets.opencrs.com/rpts/RL34175_20070917.pdf (Accessed November 10 2007).
3. Anderson, G.F., et al., It’s The Prices, Stupid: Why The United States Is So Different >From Other Countries. Health Affairs, 2003. 22(3): p. 89-105.
4. Woolhandler, S., T. Campbell, and D.U. Himmelstein, Costs of Health Care Administration in the United States and in Canada. The New England Journal of Medicine, 2003. 349(August 21): p. 768-75.
5. White, J., Competing solutions: American health care proposals and international experience. 1995, Washington D. C: The Brookings Institution.
6. Himmelstein, D., U. , et al., Medical Bankruptcy in the United States, 2007: Results of a National Study. The American Journal of Medicine, 2009. 122(8): p. 741-746.
7. Dorgan, B., The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act. http://dpc.senate.gov/dpcdoc-sen_health_care_bill.cfm, 2010. Democratic Policy Committee.
8. Angell, M., Is the House Health Care Bill Better than Nothing? Physicians for a National Health Program, 2010: p. http://www.pnhp.org/news/2009/november/is_the_house_health_.php (May 17, 2010).
9. The New York Times, Obama’s Health Care Speech to Congress. 2009: p. http://www.nytimes.com/2009/09/10/us/politics/10obama.text.html?_r=1&pagewanted=print (Date accessed September 12, 2009).
10. Helderman, R., Gingrich in Va.: A Republican Congress could defund health care law. 2010: The Washington Post. p. http://voices.washingtonpost.com/virginiapolitics/2010/05/former_speaker_of_the_house.html.
Claudia Chaufan, M.D., Ph.D., is assistant professor at the Institute for Health and Aging at the University of California, San Francisco. She teaches sociology of health and medicine, sociology of power, public health, comparative health care systems and sociological theory. Dr. Chaufan is also vice president of Physicians for a National Health Program-California (http://pnhpcalifornia.org/).
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6 Comments May 29th, 2010 by bronxdoc
Walter Lear, MD, MPH, a long time gay rights, public health advocate, physician and health care activist passed away earlier today, Saturday, May 29th, 2010 at Keystone Hospice. Walter had been in ill health for more than a year. A Memorial service will be held at the Rare Book Collection on the 6th Floor of Van Pelt Library at the University of Pennsylvania on Saturday June 19, 2010 at 2:00 p.m. Over many years Walter built the US Health Left Archive which he had donated to the University of Pennsylvania in the past few years. He leaves his partner, James Payne and many, many friends.
Walter had collaborated with our online journal Social Medicine in the past several years. He wrote an editorial in 2007 entitled: US Health Professionals Oppose War. Last year we published an extensive interview with Walter about his life and his work. He had also loaned us materials from his collection some of which we have published in the journal.
In the words of his friend, Walter Tsou: “I will greatly miss his attack on corporations and those who put profits over patients. He was an ever vigilant defender of the poor, underserved and those who did not have a voice. And he was a vocal spokesperson for single payer, national health insurance.”
Walter, we will miss you.
Matt Anderson, MD
Add a comment May 24th, 2010 by justin
Two articles in the Perspectives section of a recent issue of the New England Journal of Medicine (May 6, 2010) provide an interesting view into the state of the U. S. public health system. In the first, Dr. Howard Koh provides an evaluation and reaffirmation of the Healthy People initiative, started in 1979 by the Department of Health and Human Services as a way of systematically setting health goals, collecting relevant data, and monitoring outcomes for health-improvement activities in the U.S.(1) He points out that while small but measurable improvements in quality of life have been acheived in the last decade, the goal of eliminating disparities in health outcomes has been largely unmet. In the second, Dr. David Hemenway, laments the state of funding for public health in the U.S. and attempts to explain the underfunding of public health measures.(2) Taken together, they highlight a trend that is widely understood by advocates in social medicine: underfunding of public health initiatives directly impacts the level of disparity in health outcomes.
Healthy People 2010 focused on two main goals: increasing quality (and quantity) of life for Americans and eliminating health disparities. Dr. Koh demonstrates that the results have been mixed. For 28 focus areas, ranging from access to quality health services to oral health to vision and hearing, just over half have seen improvement and nearly 20% have seen their target met. By some measures, we have either remained discouragingly far from stated goals or actually worsened. Cigarette smoking, for example, which is the leading cause of preventable death worldwide, decreased from a baseline of 24% in 1998 to 21% in 2008, far from the stated goal of 12%. We are significantly more obese as a nation than we were ten years ago. Approximately 1/3 of all adults over 20 years of age are obese, up from under ¼ two decades ago. Unfortunately, the gains and losses in the health of Americans are not equally shared. The goal of eliminating disparities remains, according to Koh, “unmet.” Increased rates of obesity, for example, are greater in Blacks and Mexican Americans than they are in Whites. Dr. Koh cites a review by Sondik et al (3), who demonstrate numerous examples of increased disparities in indicators of quality of life and overall health. They conclude that “overall, in the area of disparity reduction, there is not much good news.”
Dr. Hemenway points out that “it is generally acknowledged that public health is systematically underfunded and that shifting resources at the margin from cures to prevention could reduce the population’s morbidity and mortality.” He cites four reasons for the underfunding of public health: first, the benefits of public health measures are not immediate and therefore require a delay of gratification. The costs are immediate but the results are both distant and unpredictable. Second, “the beneficiaries of public health measures are generally unknown.” Money flows more readily towards identifiable victims than hypothetical victims of future events. Third, the benefactors of public health intitiatives are unknown by the beneficiaries: “when people benefit from public health measures, they often don’t recognize that they have been helped.” The current TEA party movement provides a wonderful, if tragic, example of this, blind as it is to the concrete benefits of taxes and government. Fourth, public health efforts often suffer from disinterest or, worse, outright opposition. Hemenway cites “status quo bias” and “tradition-bound resistance” as examples of human characteristics that impede progress in public health initiatives.
It is reasonable to hypothesize that the systematic underfunding of public health initiatives contributes directly to disparities in health care. And it is likely that the Healthy People Initiative will never realize the goal of eliminating disparities until public health funding can be consistently and meaningfully funded. After all, it is the poor, the under- and un-insured, who tend to benefit most from public health initiatives like vaccinations, clean water supply, and clean air, and who suffer disproportionately in their absence. Michael Harrington, in his landmark book, The Other America (1962), wrote about an America that was “hungry, and sometimes fat with hunger, for that is what cheap foods do. They are without adequate housing and education and medical care.” Nearly five decades later, these problems have not gone away. As Healthy People 2010 comes to an end, in some cases they are worse.
It might be tempting to use Healthy People 2010 as an example of the ineffectiveness of public health initiatives. Or one could argue that the Healthy People initiative sets unrealistic goals. I would argue that the US government has a chance to prove otherwise with Healthy People 2020. As the DHHS plans for the next decade, healthcare professionals must push our legislators to assure adequate funding for the public health initiatives that improve all of our lives in unseen but measurable ways. We must urge them to block out the loud voices of those who would stop paying taxes without knowing what taxes pay for. Finally, and most importantly, we must ask for more coordination between those that initiate public health interventions and those that measure the results. Those who implement public health programs must work directly with those who establish goals for their efficacy. Measuring our own failure can only be of value if we have the means to turn it around.
1. Koh H. A 2020 Vision for Health People. NEJM 2010;362:1653-6.
2. Hemenway D. Why We Don’t Spend Enough on Public Health. NEJM 2010;362:1657-8.
3. Sondik EJ, Huang DT, Klein RJ, Satcher D. Progress toward the Healthy People 2010 goals and objectives. Annu Rev Public Health 2010;31:271-81.
Add a comment May 20th, 2010 by Claudia Chaufan
The shortcomings of the federal legislation are beginning to unravel, with people either not being able to afford a policy, affording policies that fail to eliminate financial barriers to medically necessary care, or risking financial penalties for failing “wellness” tests.
At the same time, a strong movement in support of a publicly funded privately delivered health care system is gaining steam in California, providing a model to the nation.
We do not have the money lobbyists have, but we can gather the numbers.
Support a right to health care, by supporting the growing single payer movement in California, embodied in SB810, using the sample letter below. Use this advocacy tool as a model for starting a movement in your own state.
SAMPLE SUPPORT LETTER
SB 810, the California Universal Health Care Act
Directions: Please use the following letter as a template for your own personalized support letter.
- Place your letter on organizational letterhead (if it’s from an organization).
- Mail, fax or email the letter to Assembly Health Committee
- Email: AssemblyHealthCommittee@asm.ca.gov
- Fax: (916) 319-2197
- Be sure to cc: Senator Leno at (916) 445-4722 or email at senator.leno@sen.ca.gov
- You may also mail or fax the letter to your own legislator found at www.leginfo.ca.gov.
The Honorable Bill Monning
Chair, Assembly Health Committee
State Capitol, Room 6005
Sacramento, CA 95814
Fax: (916) 319-2197
Dear Assemblymember Monning:
I am writing to express my organization’s strong support for single payer, universal health care and for SB 810, the California Universal Health Care Act. I urge your support for this important legislation and request that you work hard to bring it to the Governor’s desk this year.
Passage of federal health reform has greatly increased the importance of California’s advocacy for universal health care. Federal health reform is the tipping point for health reform, not the end goal. Single payer remains the gold standard for health care reform and is the only model that will achieve truly universal coverage.
SB 810 will dramatically reduce premiums for businesses and families, will cover all medically necessary health care, will eliminate the risk of medical bankruptcy, and is proven to contain health care spending over the long term. Importantly, SB 810 will save California businesses and state and local government millions of dollars in employee health care costs and is the only plan that responsibly funds retiree health care.
Around the world, every wealthy nation except the United States achieves universal health care through some variation of a single payer model of health care. All other nations spend far less than we do and in return receive higher quality care and more of it. California families and employers can no longer afford to foolishly waste 30% of every health care dollar on a private health insurance bureaucracy designed to minimize the payment of claims instead of maximizing the health of the people.
SB 810 would dramatically increase patient choice and provider competition by guaranteeing every Californian total choice over his or her doctors and hospitals instead of the narrow provider networks that restrict choice today.
SB 810 would significantly lower health premiums for businesses and families that are struggling to pay unaffordable premiums that rise as much as 40% every year. This legislation will help middle and lower income families and businesses that are the backbone of California’s economy.
SB 810 will create jobs, ease the burden on California’s budget and improve health care for every single Californian. I urge your support.
Sincerely,
Name
Organization
1 Comment April 21st, 2010 by Claudia Chaufan
Oh yeah! The progressive, single payer community did look forward to the screening of the Public Broadcasting Service (PBS) Frontline production “Obama’s deal”, frustrated as we were by our voice having been buried in a misleading, media-backed “debate” that portrayed all opponents of the “Patient Protection and Affordable Care Act” as right-wing lunatics “against reform” – yes, the usual trick “you’re with us or with the terrorists”.
And to their credit, Frontline did a terrific job of documenting the countless back-room deals struck by the White House and Congress with Big Pharma and Big Insurance. As the production illustrated, these deals chipped away whatever progressive features the Act may have initially had, and turned it into a weapon of mass destruction of the pockets of ordinary folks who already barely make ends meet, and into an extraordinary sweet deal that will substantially increase the political and economic power of for-profit insurers for years to come. Unsurprisingly of course, given that the Act was almost literally dictated by WellPoint Inc., as the Frontline production pointed out.
Disappointingly, however, Frontline did not live up to its promise. While it did reveal some of the “realities of American politics, the power of special interest groups and the role of money in policy making”, it omitted showing viewers just what “Obama’s deal” had sacrificed, and what single payer advocates were being dragged to jail for, as they entered the meetings of the Senate Finance Committee chaired by health care czar Max Baucus. Rather, it merely portrayed them as yet another disaffected group within “President Obama’s liberal base”, which had to be appeased so that our president could move on with the serious stuff — “reforming” healthcare.
But it is precisely what the deal sacrificed that matters. Because single payer advocates, including many doctors such as Margaret Flowers, risked arrest, and were arrested, for standing up for a right to health care, through a publicly-financed and publicly delivered single payer system, that was being sacrificed at the altar of special interests, even as President Obama asserted, with a straight face, that “all options (for health care reform) are on the table”.
Now, could the reason for sacrificing a right to health care be that our charismatic president received at least ten times the money that his designated health care czar, Max Baucus, received from the very industries they were supposed to rein in? We don’t know, but the hypothesis is not implausible, and Frontline producers would have done their viewers a service had they explored this or any other plausible and alternative to the mainstream hypothesis further. In so doing they would have spoken truth to power, the least we can expect from progressive mass media.
Americans have by now gotten used to having the best Congress (and Presidency) “that money can buy”. Let us not be forced to put the progressive media into an equivalent category — “it’s the best media money can buy”.
1 Comment April 9th, 2010 by Sophia Constantino
As the U.S just passed its “healthcare overhaul” – an individual mandate to purchase a private policy with lots of promises that the government will reign on the industry’s most egregious practices — China, with a population of 1.3 billion, is advancing a plan to provide universal access to all of its residents. In January China announced that the government would spend $125 billion to jumpstart a new program that will provide comprehensive health services to 90% of the population by 2011, and to 100% by 2020.
China provides health care by dividing its residents into three pools: The Ministry of Labor and Social Security covering the urban health sector, The Ministry of Health covering the rural residents, and The Ministry of Civic Affairs covering the poor urban and rural populations. All three programs have in common that they are government-financed, social welfare programs that put both healthy and sick residents into shared pools of health risk.
In the mid 1980s, China had enacted a health reform that went the “market way”, and intended to increase the supply of medical treatment by allowing hospitals to profit from medical care. So far, and much like the US health care system, this has not allowed all residents, or even most residents, to access health care, due to increasingly high costs. In China, rural residents, many unemployed, and the elderly suffered from this lack of access.
As the 1990s progressed, the failure of a for profit model of health insurance led the Chinese to rethink health care reform. Lack of access due to high cost is only a failure if the goal is to eliminate financial barriers to care, which for the Chinese it was, rather than to yield the greatest profit possible for health insurers. What’s important about China’s reform is that the Chinese have taken profit out of the equation, and the centerpiece of their health care plan is public financing and universal enrollment.
Follow the money: How health care will be paid under China’s health care reform
Under this plan, all companies (private enterprises, joint ventures, or self employed) must pay 10% of their total payroll to the government for health spending. Half of this goes to a fund accessible by all the ministries described above for social risk pooling, and the other half goes to their employee’s individual health accounts. In addition, each employee must pay 2% of his or her wages directly to their individual account.
Employed residents, under the Basic Medical Insurance (BMI), would first use the money from their own account to pay for health services. If the account were exceeded, the resident would pay out of pocket up to 5% of their annual wage, after which expenses would be covered by the social risk pooling fund. Importantly, these subsidies and financing plans are different dependent on which Ministry you are under.
Because of the poverty and geographical separation of the rural population, the Chinese have developed the New Cooperative Medical Scheme (NCMS), a government run voluntary insurance program that provides an initial subsidy of 120 yuan per farmer, and the farmer is expected to pay up to 10 yuan our of pocket. The government plans to increase these subsidies with the newly announced tripled public spending towards health. Rural communities have a certain degree of autonomy in that they can spend their moneys on different types of services or distribute it differently from how the national government does in urban areas.
For children, the unemployed, disabled, or elderly, China has established the Urban Resident Basic Medical Insurance (URBMI), which, like the NCMS scheme above, also supplies each member with 120 yuan per year for medical expenses. Enrollment in the URBMI is at the household level in order to reduce administrative costs and adverse selection – enrolling only those likely to need health care and financially burdening the collective pool.
Lastly, similar to American Medicaid, there is a social risk pool for the poorest Chinese residents, known as Medical Assistance (MA), where all expenses are covered.
However complex these arrangements may seem, developed as they are to meet the diverse needs of a huge population, once again, they share the principle of universal enrollment and social insurance, thus taking profit out of the financing equation.
Controlling costs of health care
In an effort to control costs of health care, the Chinese are implementing caps on prices of essential drugs. Already 307 drugs are under prices control, and the plan is to include 770 more this year. Prices for common treatments will also be under government control in order to prevent providers from charging different prices for the same treatments, but medical professionals will be largely paid fee-for-services. Further, the plan requires that all revenues raised by public medical facilities be funneled to the state in order to restrict profit and to finance the program.
Chinese economists argue that health care will stimulate domestic spending, critical given the current economic downturn. Bai Zhongen, Chairman of the Economics Department at Tshinghua University’s School of Economics and Management in Beijing, has said that establishing universal health care with government-financed insurance will increase general consumer spending. Already in 2007, a survey at the School examined the effect of rural health insurance on consumer behavior and “found that in government-sponsored health insurance areas, people are spending more.” Chairman Bai expanded on this finding saying that the government already gives many people a small subsidy to pay for their health care needs, but that a unified, national health insurance program would strengthen the economy, as people would have more money in their own pockets.
It will be exciting to watch China make this progressive change towards a universal right to health care with a plan built upon public model of financing, and contrast it with the American experiment of a universal obligation to buy a for-profit policy, which the Congressional Budget Office has estimated will leave 23 million people uninsured by 2020.
While the outcomes of the Patient Protection and Affordable Care Act for patients are anybody’s guess, William Hsiaso, a Professor of Economics at the Harvard School of Public Health, has said that China’s plan is likely to work because of its “strong role of government in health, commitment to equity, and willingness to experiment with regulated markets”.
1 Comment March 24th, 2010 by Claudia Chaufan
Is the new health care bill “an attack on wealth inequality”, as New York Times reporter David Leonhardt asserts? For those who are about to uncork the champagne, my advice is to hold off, take a step back, and analyze the “big picture” with a healthy dose of skepticism.
It may help to read, and ponder about, the op-ed below by Barry Grey. And if words like “socialism”, “class struggle”, etc., make the reader uncomfortable, my suggestion is to go beyond word choices and focus on the argument instead.
It is well worth examining in some detail, because it does a good job of pulling apart the campaign of deception about health care reform led by the corporate media, and it highlights features of the recent “health care overhaul” that there are strong reasons to be concerned about, and are likely to have huge implications, and not necessarily positive, for the welfare of Main Street.
Assuming one agrees with Grey’s analysis of this campaign of deception, one has to admit that it still requires a stroke of genius to lead millions to believe that an individual obligation to buy a private product, a for-profit health insurance policy, with subsidies if necessary from your own money and with vague promises to rein on the manufacturer’s “worst practices”, is something that would have made Karl Marx jealous.
Yet this is precisely what New York Times reporters Robert Pear and David Leonhardt argue that the bill signed today by President Obama is all about: it is no less than “the most sweeping social legislation in decades” and “the federal government’s biggest attack on economic inequality since inequality began rising more than three decades ago”.
It is even more concerning that the next step towards “greater social equality” may be an attack on Social Security. This program, announces the New York Times, “now stands as the likeliest source of the sort of large savings needed to bring projected annual deficits to sustainable levels, many budget analysts agree.”
And these “savings” are necessary because, as Times reporter Jackie Calmes suggests, they would “immediately reassure global markets fretful that the United States’ debt is already its highest since World War II...[sending] “a very important signal to the world.”
Savings? To whom? Global markets and important signals? Of what sort? How does this euphoria translate into any intelligible improvement in the much eroded quality of life of millions of America is hard to say, but worth asking about.
Barry Grey
24 March 2010
The passage of the Obama administration’s health care bill has been greeted with a wave of media commentary hailing the measure as a milestone in progressive social reform and a political triumph for Barack Obama.
“A historic first step,” editorialized the Los Angeles Times. “Health Care Reform, at Last” was the headline of the New York Times’ editorial. As always, the revving up of the American media to overwhelm and manipulate popular consciousness has been impressive.
If anything, the major organs of international finance capital have been even more effusive. Financial Times columnist Gideon Rachman published a commentary in which he writes, “By pushing through a social reform that eluded generations of presidents from Teddy Roosevelt to Bill Clinton, Mr. Obama can now point to a genuinely historic achievement.” The Financial Times editorial board published a similar piece, under the headline “Obama secures his place in history.”
Behind the celebrations of the health care overhaul lies a definite perspective. The authors of these commentaries see the legislation as a major step in confronting profound problems facing American and world capitalism. They are hailing what they consider a breakthrough in reining in massive US deficits that are destabilizing the world financial system.
It has for decades been deemed politically impossible to attack basic entitlement programs in the US, such as Social Security and Medicare, which account for an enormous and rising portion of the federal budget. Now, with Obama’s health care plan, the stage has been set for slashing these programs. This is the reason for the general jubilation in media and financial circles.
The claim that a genuinely progressive social reform has been dispensed as a gift from above flies in the face of the whole of American history. This is a country where every significant social reform has been the outcome of decades of the most bitter and bloody struggles against a ruling class that savagely resists social progress.
The enactment of such reforms has always followed brutal state repression and been associated with martyrs to the cause who were hunted down, jailed or murdered.
Slavery was abolished only by a Civil War that raged for four years and cost the lives of 620,000 soldiers and an undetermined number of civilians.
The eight-hour day was the result of mass strikes in the 1870s and 1880s that culminated in the Haymarket Massacre and the hanging of key leaders of the eight-hour movement.
The suffragettes endured repeated beatings and jailings in their battle for the right of women to vote.
Official recognition of the right to form industrial unions in America was the outcome of a 60-year struggle that began in the 1870s and continued even after Franklin Roosevelt recognized the right in 1934. It involved general strikes in major US cities, including the 1934 strikes in Toledo, Minneapolis and San Francisco.
In struggles such as the Flint sit-down strike, workers occupied factories and faced off against police and troops in industrial battles that verged on civil war. Ten workers were gunned down in cold blood and many others were wounded by Chicago police in the 1937 Memorial Day massacre.
It was in the context of such mass working class struggles fueled by the Great Depression that Roosevelt enacted Social Security.
The enactment of Medicare in the 1960s was the byproduct of the mass mobilization of African-Americans and their allies in the civil rights movement of the 1950s and 1960s, in which hundreds of thousands marched in the face of killings and terror by vigilantes backed by the state. By the time of the passage of Medicare, the civil rights struggle had been joined by an upsurge of militant labor struggles and the initial eruption of the most oppressed sections of the working class in urban uprisings.
The right of 18-year-olds to vote was secured as a result of the mass movement against the Vietnam War.
In every case, the victories for social reform represented the frightened response of the ruling class to mass movements from below. And in every case, these victories were partial and limited, diluted with all sorts of caveats, and containing the seeds of their eventual undoing—due to the limited political perspective imposed on the insurgent movements by their reformist leaderships.
The moment the working class relaxed its pressure, the gains were watered down or eliminated.
In stark contrast to this historical experience, Obama’s health care plan has been enacted in the absence of a mass movement—indeed, in the face of mounting popular distrust and hostility. The final push for the bill came after the Democratic candidate was massively defeated in January’s special Senate election to fill the seat vacated by the late Edward Kennedy in Massachusetts.
That defeat was the result of growing disillusionment with Obama and the Democratic-led Congress, which have done nothing while millions have been thrown out of their homes, millions more have had their light and heat turned off, personal bankruptcies have broken all previous records, and wage-cutting—encouraged by the government’s Auto Task Force—has become epidemic.
The same administration whose policies have encouraged a further growth in social inequality and the continued erosion of existing social programs has now, it is claimed, handed down a historic piece of progressive legislation.
Amidst the official jubilation, no one has asked an obvious question: If the Obama administration dropped all of those provisions deemed “progressive” and “liberal”—such as the public option—in order to gain Republican support, why were they not restored when it became clear that the Republicans would offer no support and the final bill would be a purely Democratic measure?
There is another question. In what, precisely, does Obama’s success in passing health care “reform” consist? Why has he succeeded where previous Democratic administrations failed?
The basic answer is that discussions of health care reform previously assumed either some form of nationalization or significant provisions to rein in the power of the health care industry. Obama, however, has not only rejected any such measures, he has worked out his overhaul in the closest consultation with the insurance, pharmaceutical and hospital companies. The same corporate giants will continue to exert unfettered control over the health care system.
Far from the health care bill being an exception to the historical rule, it could be enacted only because of the absence of a mass movement of working people and under conditions of the collapse of the old organizations such as the trade unions. It is the product of a political system in which broad sections of the population have been effectively disenfranchised and become alienated from the entire political establishment.
Neither of the two big business parties has any substantial base of popular support. Politics has become little more than the artificial creation of public opinion, involving an unprecedented level of media manipulation.
This social and political vacuum gives the ruling class a degree of latitude it would otherwise not have to impose legislation that in the past would have been considered unacceptable. Immense resources have been devoted to pushing through Obama’s health care bill, but there has been nothing approaching a serious public discussion in which the details of the measure are examined. The people have had no say and do not know what this legislation will mean for them.
In the form of the current administration, the American people have become the victims of a colossal fraud, in which Obama, capitalizing on his carefully crafted popular image, is carrying out policies that previously would have been deemed unfeasible.
The US ruling class is playing the long game. It is seeking to impose a regime of economic rationalization that has been worked out between the White House, Congress and big business.
The dire consequences of this overhaul for the broad masses of the population will become clear over time. They are indicated, however, in some of the commentaries by supporters of the legislation. The Washington Post, for example, speaks openly in its editorial of the “opportunity” to slash costs by rationing care to the general population.
“It means,” the newspaper writes, “establishing pilot programs to reward quality over quantity—keeping people healthy rather than administering more tests. It means holding hospitals, doctors and others accountable… to minimize unnecessary or conflicting care.”
The repeated claims that those who are satisfied with their existing health plans have nothing to fear are not believable. In the first place, existing plans are constantly being cut back by employers, private insurers or both, a process that will only be accelerated under the health care bill. More and more people will be forced into plans that provide far fewer services, under which they will be compelled to pay out of pocket for drugs, tests and procedures beyond a bare-bones minimum.
The overall strategy underlying the health care bill is indicated by the New York Times, which writes in a front-page article published Tuesday that “central to the health care changes are hundreds of billions of dollars in reductions in Medicare spending over time.” The newspaper goes on the declare that the victory on health care sets the stage for an assault on Social Security, the bedrock social program that currently provides (highly inadequate) pension benefits to 51 million Americans over the age of 65.
“Proponents of acting soon,” writes the Times, “also argue that changes to benefits or taxes… would immediately reassure global markets fretful that the United States’ debt is already its highest since World War II. An agreement on Social Security ‘would send an important signal to the world,’ said Robert D. Reischauer, a former Congressional Budget Office director.”
As the consequences of these policies become more clear, the disgust and anger of working people will deepen. They will resist in ever growing social struggles. What is critical is that these struggles be guided by a new political perspective.
The entire experience of Obama’s health care overhaul demonstrates once again the critical importance of the development of a Marxist leadership in the working class and the fight for a socialist perspective. Universal, quality health care as with any other social advance is possible only on the basis of the building of a mass socialist movement of the working class.
2 Comments March 22nd, 2010 by Claudia Chaufan
A letter from Dr. Quentin Young, founding member of Physicians for a National Health Program
March 22, 2010
Dear colleagues and friends,
We have some good news and some bad news.
The bad news is that the president’s health plan, which was drafted by the insurance and pharmaceutical industries, will leave about 23 million Americans uninsured and over 100 million Americans underinsured nine years after implementation. Here is how single payer compares with the reconciliation bill soon to be signed and declared the law of the land.
Activists are encouraged to send our information to their local media contacts and physician colleagues.
The good news is that there is growing awareness that the bill won’t work, and, sooner rather than later, we need single-payer national health insurance. As noted by Harvard economist Dr. William Hsiao, the architect of Taiwan’s successful health reform, “You can have universal coverage and good quality health care while still managing to control costs. But you have to have a single-payer system to do it.”
What you can do:
1. Talk to the press. Please forward the following press release, chart, and key PNHP research findings to your local media with a cover note that you would be willing to be interviewed (if you are!).
2. Publish opinion pieces in the medical and lay press. Use the following materials (recycle our prose as you wish!) for letters to the editor, op-eds, and other articles. PNHP communications director Mark Almberg can help with editing and submitting articles for publication. Mark@pnhp.org
3. Deliver grand rounds, or invite a PNHP speaker. PNHP will have new slides on health policy in the Obama era and the reconciliation bill soon. Please contact Dave Howell at Dave@pnhp.org if you would like a PNHP speaker or would like a copy of our new slide set when it comes out.
Because of the enormous power of the insurance and drug companies, we in PNHP have always known that ours is a long-term struggle. Of the women who participated in the Seneca Falls convention, only two survived to see women win the right to vote. Susan B. Anthony was not not one of them, but her final words on her deathbed were “failure is impossible.” We agree.
In memory of the 45,000 Americans who die annually for lack of health insurance, and in memory of the many tireless activists for single-payer national health insurance and health care as a human right who died this year, including Dr. Linda Farley, Dr. David Prensky, Dr. John Shearer, Dr. Bud Goodrich, PNHP staffer Nicholas Skala, and others, PNHP will continue the struggle.
With your help, failure is impossible.
In solidarity,
Quentin Young
Add a comment February 24th, 2010 by Sophia Constantino
I ask you to you join the Medicare for All Rally, tomorrow February 25, 2010 in San Francisco! This is an important time to be active and let President Obama know about Health Policy that really works!
At 10 AM outside the San Francisco Federal Building (90 7th St., between Market and Mission – Civic Center BART/MUNI) join activists from the California Physicians Alliance, California Alliance for Retired Americans, Gray Panthers, and Single Payer Now to let President Obama know that we want Medicare for All.
This will be a Sidewalk Summit to tell President Obama that the policy that meets his goals of bringing down premiums, bringing down the deficit, covering the uninsured, strengthening Medicare, and stopping insurance company abuses, is Improved Medicare for All.
On Thursday in Washington, DC, President Obama is meeting with Republicans and Democrats to search for solutions to our healthcare crisis. But once again the president and congress are not including any discussion of the only real solution to America’s health care problems – expanding and improving Medicare to cover everyone in America.
For further information:
Single Payer Now
415-695-7891
1 Comment February 18th, 2010 by Claudia Chaufan
The following letter was sent to the White House on Feb. 9, two days after President Obama announced his plans to convene a bipartisan summit on health reform on Feb. 25 in Washington. Unsurprisingly, even if disappointingly, we’re still waiting for an answer.
February 9, 2010
President Barack Obama
The White House
1600 Pennsylvania Avenue NW
Washington, DC 20500
Dear Mr. President,
Physicians for a National Health Program, an organization of 17,000 doctors who support single-payer national health insurance, respectfully requests that you invite one or more of our representatives to participate in your White House health care session on Feb. 25.
We note that in your call for the meeting you urged Republicans, Democrats and health policy experts to gather, go over all the options and “walk through them in a methodical way so that the American people can see and compare what makes the most sense.”
We would like to offer several of our members as health policy experts for this important task.
As you may know, two key research studies that helped drive the health reform process forward this past year – one in the American Journal of Public Health that found 45,000 deaths annually are linked to lack of health insurance, another in the American Journal of Medicine that found 62 percent of personal bankruptcies are linked to medical bills and illness – were the work product of Harvard Medical School research teams guided by PNHP co-founders Drs. David Himmelstein and Steffie Woolhandler.
Drs. Himmelstein and Woolhandler, who are also primary-care physicians in Cambridge, Mass., have had several other groundbreaking studies published in our nation’s leading medical journals, including one in the New England Journal of Medicine that shows administrative costs consume 31 percent of U.S. health spending, most of it unnecessary. They have also frequently testified before Congress on their research. We urge that you invite them to participate in the Feb. 25 meeting.
The presence of Dr. Margaret Flowers, our congressional fellow, would also enhance the meeting. Dr. Flowers, a Maryland pediatrician, has met with numerous members of Congress and testified before two congressional committees last year about the urgent need for single-payer health reform.
Finally, we ask that you invite our president, Dr. Oliver Fein, to participate. Dr. Fein, an internist and professor of clinical medicine and clinical public health in New York City, attended the March 5 White House Summit on health care. He is a past vice president of the American Public Health Association.
Detailed biographies and contact information for each of these doctors are available upon request. Please feel free to call me (312-782-6006) or e-mail me (ida@pnhp.org) should you need any additional information.
