posted by Matt Anderson, MD

As Medicare celebrated its 45th anniversary July 30, the White House sent its present: a Deficit Commission, composed by some of the very folks who were unable, or unwilling, to see the $8 trillion housing bubble that brought the financial system to a halt. Nope. It’s no joke: these folks are now at the forefront of the campaign to “save” Medicare and the budget.

But, does Medicare need to be saved? Let’s do a little history.

When Medicare was signed into law by President Lyndon Johnson, almost overnight millions of seniors, and later disabled Americans, were able to meet their health care needs, and rates of poverty among them dramatically decreased. Eventually, Medicare added benefits, laid the foundation of studies of health care quality, and provided a model of administrative efficiency still unmatched by for-profit insurers. Today, Medicare meets the health care needs of over 45 million Americans.

To be sure, aging baby boomers will add pressure to Medicare, and the program can be improved: rather than allowing dubious “Advantage” plans, benefits in traditional Medicare could be expanded; gaps, now covered through Medigap policies, a source of profit for insurers yet a financial burden for seniors, could be eliminated; the Kafka-esque Part D could be dumped and Medicare could be allowed to use its huge purchasing power to negotiate prices directly with drug companies, rather than banned from doing so; and doctors’ payments could stop being subject to flawed accounting formulas liable to political manipulation.

So if everything is on the table, how about saving Medicare by expanding it to include everyone living in America? How about replacing the insane patchwork of thousands of plans and paper-pushing designed not to provide access to care, but to undermine it, with a single paying public agent? Over $400 billion could be saved with this move alone, without adding a dime to overall costs. This amount would generously cover all — not “near” all — the uninsured, and improve the coverage of a growing number of Americans who must settle for skimpy policies and unaffordable out-of-pocket costs that drag thousands to bankruptcy annually.

And whatever taxes were needed to finance Medicare-for-All would be generously offset by eliminating increasingly unaffordable out-of-pocket costs and premiums. American families and individuals would see their health care costs precipitously fall and their health care fears vanish. Imagine the change this move would unleash — Americans no longer worried that their dream jobs offer no “health benefits” and businesses finally able to compete internationally with countries guaranteeing public health care.

There is nothing to “wait and see” about the Orwellian Patient Protection and Affordable Care Act signed into law this past March. Close to a century of failed experiments with for-profit insurance for everybody but the most vulnerable among us, who are dumped on taxpayers’ shoulders, should suffice. While millions continue to suffer and die unnecessarily, we already pay for universal health care yet not get it.

Let’s not be misled by propaganda and demand our legislators support a financially sustainable and socially just, publicly funded, privately delivered, universal health care system — a single payer national health program. It’s not too late to do things right. Let’s not take no for an answer so that we can soon sing together “Happy Birthday, Medicare for All!”

Claudia Chaufan received her medical degree in Argentina and her doctorate in sociology at UC Santa Cruz. She is an assistant professor of Sociology and Health Policy at the Institute for Health and Aging at UC San Francisco and vice president of Physicians for a National Health Program — California.

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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PNHP welcomes comments on its blog by its physicians and medical student members, and other health professionals active in the movement for single payer national health insurance. Comments by other readers are welcomed but may not be posted.

At least this much was admitted in a recent article in the New York Times, even as the very New York Times editorial board, and key reporters such as David Leonhardt, have been all along major supporter of the science and philosophy underlying Dartmouth and of the many “cost-saving and quality improving” measures that will be implemented under the new law, the “Patient Protection and Affordable Care Act”. One key measure is to reduce “superfluous” services to Medicare patients, and thus “rein on waste, fraud and abuse“.  Somehow, this will not undermine, but rather improve, the quality of care provided to them, or so says the law.

Indeed, for New York Times editors one key problem in our health care system has been all along the “profligate” behavior of doctors. If we can tame this behavior, our collective savings will be extraordinary, the Times and its health reporters have asserted repeatedly, and will enable us to eventually provide health care to all Americans at lower costs. Promoting this view, The Cost Conundrum, by Atul Gawande, a Harvard-affiliate doctor and author, became “required reading” in the White House, and turned its author into a Washington star virtually overnight.

But as it turns out, the research may have been faulty.

Just so as not to clog cyberspace with redundancies, here an excellent analysis of what the Dartmouth study really showed (you guessed it: correlation is not causation), and what may have been the motivations of researchers who  promoted the study (you guessed it: money!).

Single payer anyone?

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.

1. Place your letter on organizational letterhead (if it’s from an organization).
2. Mail, fax or email the letter to Assembly Health Committee
   1. Email: AssemblyHealthCommittee@asm.ca.gov
   2. Fax: (916) 319-2197
3. Be sure to cc: Senator Leno at (916) 445-4722 or email at senator.leno@sen.ca.gov
4. 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

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”.

By Kate Randall (originally posted here).
29 March 2010

In keeping with its campaign in support of Obama’s recently passed health care legislation and its agenda of cost cutting, the New York Times carried an article Saturday by Lesley Alderman headlined, “Doctors Offer Thoughts on Cutting Health Care Costs.”

The article takes as a given that the health care overhaul is a genuine social reform, whose effect will be to provide “substantial” benefits to the general population. It bemoans the fact, however, that the new legislation “does not tackle head-on the staggering cost of health care in the United States.”

In fact, the Obama-promoted legislation is aimed first and foremost at cutting costs for corporations and the government. It will slash hundreds of billions from the Medicare program for the elderly, and contains numerous cost-cutting mechanisms to ration and reduce care for ordinary Americans. This is well known by the Times editors. However, these cuts are seen as only a first step in a campaign to limit testing and treatments for the majority of Americans.

The entire framework of the health care “reform” is not to be challenged. Nor is the fact that insurance company and health care industry profits will by all accounts be boosted by the plan. But the ultimate question for patients, the author argues, is “How can the country reduce health care costs while not compromising quality?”

Alderman is not speaking here about reducing premiums, co-pays and deductibles for working families. There are no restrictions in Obama’s plan on what insurers can charge for coverage—and numerous studies have shown that these payments will actually increase.

No, the Times’ aim here is to promote the cost-reducing features of the health care bill for big business and the government and offer advice on how they might be strengthened. The author cynically attempts to palm off the suggestions of a select group of “doctors on the medical front lines” as a balanced cross-section of medical professionals.

It is notable that in the (“edited and condensed”) comments quoted, none of these doctors openly oppose the health care legislation; none openly promote nationalized health care, a single-payer system or even a government-run “public option.” Where appropriate, Alderman also helpfully notes how the Obama plan will advance the generally regressive proposals presented by this selection of physicians.

Jacques Moritz, M.D., director of gynecology at St. Luke’s-Roosevelt Hospital Center in New York, offers the first suggestion: insuring for catastrophes only. Dr. Moritz states, “When you buy auto insurance, you don’t insure yourself for every dent and nick—you insure yourself for serious accidents. This is the way the health system should work.”

He says that the current insurance model “doesn’t reward patients for being healthy, it rewards them for being sick”—as if patients now are getting sick on purpose just so they can take advantage of insurance payouts. Likening the health of a human being to dings on an auto body is a poor analogy, but one that serves a definite purpose. Patients should be discouraged from seeking treatments for supposedly non-catastrophic medical conditions, and the insurers would be rewarded by not paying out for them.

In health care, however, it is generally impossible to determine beforehand what is “catastrophic” and what is not. Is a chest pain an early signal of heart problems or is it simply a muscle ache? Is a persistent headache the result of stress or a brain tumor? The impact of the doctor’s suggestion, enthusiastically promoted by the Times, would be to prevent those who cannot afford to pay from getting tests and consultations aimed at answering these and many similar questions.

Next, James A. Reiffel, M.D., professor of clinical medicine and director, electrocardiography laboratory, Columbia University Medical Center, New York, argues for tort reform, something long campaigned for by Congressional Republicans and supported by Obama. Dr. Reiffel says, “Some doctors often order tests to confirm a suspected diagnosis—even when the suspected diagnosis is likely correct with a high degree of certainty—out of concerns regarding the potential for malpractice suits in our current litigious climate.”

The effect would be to prevent patients and their families from seeking legal and financial redress for injuries and deaths caused by medical errors. Alderman notes that the Obama plan already makes a step in that direction, including a provision awarding “five-year grants to selected states to develop alternatives to current tort litigation.” Again, the impact is to encourage doctors to stop giving supposedly “unnecessary” tests.

Dr. Lisa Bernstein, internist and associate professor in the department of medicine at Emory University School of Medicine in Atlanta, Georgia, advocates “spending adequate time gathering information and using actual research data to guide judicious ordering of tests and prescribing of treatments.” This is known in the medical community as utilization of “comparative effectiveness research.”

The Times notes that the new legislation calls for the creation of the Patient Centered Outcomes Research Institute. The goal of this panel is to identify treatments that have not been shown to provide adequate levels of positive patient outcome—i.e., they may have benefited what they consider an insignificant number of patients.

While the function of this body is clearly aimed at targeting treatments and services for rationing, the Times laments the fact the “institute’s findings could not be construed as mandates though, or used to deny coverage.”

Under the subheading “Stop Overtreating,” the article quotes Dr. H. Gilbert Welch, who says, “There are some people who would benefit from more medical care, but there are many more who are getting too much.” Dr. Welsh is a professor of medicine at the Dartmouth Institute of Health Policy and Clinical Practice in Lebanon, New Hampshire, publisher of the Dartmouth Atlas of Health Care.

The WSWS has analyzed the Dartmouth Atlas study in depth. (See “The Dartmouth Atlas of Health Care study: Shoddy science in support of health care cuts” ) Its methodology has been promoted by the Obama administration as a justification for reducing and rationing care.

Among those who are “overtreated,” according to Welch, are those who are dying (“for whom our aggressive care can be inhuman”) and the healthy, “in whom we feel increasingly compelled to look hard for things to be wrong.” Welch bemoans the fact that “screening scans, for instance, find more small cancers and early heart disease.” Presumably, it would be better if cancer and heart disease were only discovered in its late stages.

Welch also worries that “contracted definitions of what’s normal label more people as having disease, such as hypertension and diabetes.” These people should be denied treatment, Welch implies, even if doing so can improve their living conditions and potentially save their lives.

In a September 2008 speech, Obama budget director Peter Orszag, then director of the Congressional Budget Office, hailed Dartmouth Atlas, asserted there is “little evidence that extra spending gets us anything in terms of reduced mortality rates or higher quality.” There is nothing accidental in the Times dropping in this quote from Dr. Welch, and it also gives the lie to the suggestion that this is an ordinary cross section of doctors.

Finally, Ms. Alderman quotes Edward Hallowell, a psychiatrist practicing in New York City and Massachusetts, who states, “What’s in jeopardy in medicine—for a host of reasons—is the human connection between doctor and patient.”

Dr. Hallowell’s sentiments undoubtedly reflect a widespread concern among health professionals who experience firsthand strains between doctors and their patients. He says, “Doctors, patients and insurers alike should work together to recreate the familiarity, the warmth, the trust and the friendly alliances that used to define patient-caregiver relationships.”

Under the for-profit system of medical care in the United States, however, which is upheld and enshrined by the Obama health care legislation, these relationships are assured to erode even further, as patient costs rise and services are limited on the basis that life-saving treatments are “unnecessary” or have not been proven “cost-effective.”

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.

Obama health bill sets the stage for assault on Medicare and Social Security

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.

The New York Times and the Obama health care plan

By Kate Randall
23 March 2010

The New York Times weighed in predictably on Monday with praise for passage of the Obama health care plan. The editorial appearing the morning after the US House vote—titled “Health Care Reform, at Last”—caps a yearlong campaign by the newspaper to promote the legislation.

In keeping with that effort, the piece gushes, “Barack Obama put his presidency on the line for an accomplishment of historic proportions.” The newspaper’s editors argue that the legislation is “a triumph for countless Americans who have been victimized or neglected by their dysfunctional health care system.”

The piece provides misinformation and half-truths about what is actually contained in the bill in a cynical attempt to portray it as a monumental reform crafted with the interests of working families in mind. The analysis is deliberately vague on details, while making sweeping generalizations as to the expected impact of the legislation.

As the representatives of what passes for the liberal establishment in the United States, the New York Times has played a key role in promoting Obama’s health care agenda and characterizing it as a progressive reform. In fact, the Times represents those privileged sections of the ruling elite who stand to profit most from its cost-cutting features and the gutting of health care for ordinary Americans.

In this latest piece lauding passage of the bill, they take their cue from Barack Obama, who stated Sunday night that the legislation represents “another stone firmly laid in the foundation of the American Dream.” The Times argues dramatically, “Over time the reforms could bring about sweeping changes in the way medical care is delivered and paid for. They could ultimately rival Social Security and Medicare in historic importance.”

When the editorial begins to break down the features of the plan, however, even on the basis of the Times’ timeworn brand of convoluted reasoning, it is apparent that the bill has nothing in common with these genuine pieces of reform legislation. While significant tangible benefits were gained through these federally funded programs, the new health care legislation will cut government spending and reduce care and services for the vast majority of Americans.

Social Security and Medicare were wrested from the ruling establishment as a result of great social struggles on the part of working men and women. But the Obama health care plan is being imposed from above by that very ruling elite, with no input from the American people. Its features bear no relation to genuine reform, but in fact comprise a retrograde package of cutbacks and rationing that will serve to boost the profits of the health care industry.

The Times hails the plan for providing what it describes as “near-universal coverage.” After noting that the “United States is the only advanced industrial nation that does not provide or guarantee health care coverage for virtually all of its citizens,” they intone, “It is a moral obligation to end this indefensible neglect of hard-working Americans.”

The reality is that the bill has nothing in common with universal health care, something Obama pledged to fight for in his presidential bid. An estimated 23 million people will be left uninsured by 2019, including about a third who are undocumented immigrants and barred from coverage.

About 16 million of those newly insured will be dumped into the cash-starved Medicaid program. Another 24 million will obtain coverage through purchasing it on the insurance “exchanges.” These exchanges will not include even a fig leaf of reform in the shape of a public option, a feature ditched long ago by Obama in a backroom deal with the private insurance companies. As the president was at pains to emphasize last night, the bill “is not the government-run system some feared.”

Under the subheading “Insurance Reforms,” the editorial asserts, “The legislation would rein in many of the insurance industry’s worst practices.” The practices listed include rejecting applicants for pre-existing conditions, dropping sick people from coverage, and capping annual or lifetime benefits.

The Times then notes that reform of these insurance practices “cannot be achieved unless nearly all Americans are required to have coverage, so the costs can be spread among the healthy and the sick.” Precisely. This patient mandate will require individuals and families to purchase insurance or pay a penalty, funneling billions of dollars into the insurance industry’s coffers, in effect forcing the insured to finance the insurers’ reform of their own “worst practices.”

It is notable that the editorial fails to mention that the Health Insurance Rate Authority—a proposal floated by Obama before his bipartisan health care summit as a potential brake on skyrocketing premiums—has been eliminated from the bill. While the Times suggests that the plan will stop insurers from charging “exorbitant rates,” it provides no evidence of any mechanism in the bill that would actually do this because none exists.

The section of the editorial titled “A Start at Cost Control” gets down to the real meat of why the Times has been a consistent cheerleader of the Obama health care overhaul. It concerns the proposed tax on so-called Cadillac insurance plans, and is valuable to quote at some length:

“The legislation will impose an excise tax in 2018 designed to drive employers and their workers away from the highest-cost insurance policies, which typically provide generous benefits at little out-of-pocket cost to the workers. Health economists consider the excise tax a very strong cost-control measure, because if workers have to pay more of the cost themselves, they and their doctors are apt to think more carefully about whether a test or procedure is really needed” (emphasis added).

In other words, millions of workers, including a large number of unionized workers who receive insurance under company-sponsored plans, will see their benefits cut and the out-of-pocket expenses increased. In the drive to cut corporate costs, a crackdown is to be initiated against plans that provide such “generous benefits” and that encourage people to seek “unnecessary” tests and procedures.

The editorial then goes on to allude vaguely to a major cost-cutting component of the Obama plan, which the newspaper endorses, noting, “The reform measure will establish an independent board to push approaches that work into widespread use in Medicare and ultimately, by force of example, the private sector.”

The board to which they so favorably refer is the “Independent Payment Advisory Board,” an unelected body of presidential appointees that will wield sweeping powers to reduce costs and services and rewrite Medicare regulations. Changes proposed by this panel can only be overruled by a super-majority vote in Congress.

While chiding Republican leaders “who see opportunities to gain seats in the elections,” the Times makes no analysis of why the Republicans hope to make political gain by opposing legislation that supposedly benefits the majority of the population. In fact, the Republicans are seeking to capitalize on growing opposition to the plan among significant sections of the population who rightly view the legislation with mistrust, a skepticism that is bound to grow as the real implications of the bill become clearer in the coming period.

The Times, which claims to be a staunch defender of abortion rights, also fails to mention the wretched deal reached with the most right-wing sections of the Democratic Party in the final push to get the votes needed in the House to pass the legislation. Despite the already severe restrictions in the bill placed on the legally protected right to abortion, Obama agreed to sign a last-minute executive order confirming that no federal funds would be used for abortions under the terms of the legislation.

While the editorial characterizes the health care legislation as a triumph for “hard-working Americans” that will have the effect of reining in the “worst practices” of the insurance companies, another take on the situation was provided in the paper’s Business section.

An article headlined, “In Health Care Reform, Boons for Hospitals and Drug Makers,” explains that the plan would result in “millions more Americans buying private health insurance” who would be “better able to pay for their hospital stays, doctor’s visits, prescription drugs and medical devices.”

Drug makers, the article notes, “have the most clear reason to celebrate the legislation … they can look forward to tens of billions of dollars in additional revenue as more people with insurance visit doctors and fill prescriptions.”

Indeed, US stocks rebounded on Monday following the health care vote, hitting fresh 17-month highs lifted by health care-related stocks. Pharmaceutical shares surged, with Pfizer leaping 1.42 percent to $17.15 and Merck adding 0.63 percent to hit $38.30.

Among the insurers, Aetna gained 0.52 percent, hitting $34.64, and Cigna was up 0.54 percent at $37.28.

The author also recommends:

An attack on health care in the guise of reform
[22 March 2010]

Obama’s health care agenda and the case for a socialist alternative
[27 February 2010]

Once again: The New York Times and Obama’s attack on health care
[17 November 2009]

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