In 1954, President Truman called for the creation of a national health insurance fund to be run by the federal government.
This fund as proposed would have been open to all Americans, but would have remained optional. Participants would have paid monthly fees into the plan, which would cover the cost of any and all medical expenses that arose in a time of need. The government would pay for the cost of services rendered by any doctor who chose to join the program. In addition, the insurance plan would give a cash balance to the policy holder to replace wages lost due to illness or injury.
Since then this, and every other step towards universal coverage has been — with the very notable and honorary exception of Medicare coverage for the elderly and Medicaid coverage for the poor, passed in 1964 — an elusive promise. Federal law ensures public access to emergency services regardless of ability to pay. However, this unfunded mandate has contributed to a health care safety net that is increasingly strained, in no small part because routine preventative care is not similarly covered. For sixty years the Democrats have failed to deliver on this promise and Truman's program — a single payer system - is essentially off the table. Americans to this day cannot claim to have a recognized right to health care, the very notion being an anathema to the American right and its impressive propaganda machine.
Currently over 46 million Americans are without insurance and millions more are under insured. This includes individuals and families denied affordable coverage, in the first place, due to pre-existing medical conditions. It has resulted in, on average, 20,000 people a year who die in the United States due to lack of adequate coverage, including those who die due to caps on lifetime treatment for chronic and debilitating conditions, which causes them to delay or avoid seeking care until they become medically untreatable. And this is a conservative estimate; others have it an even more scandalous 40,000 figure. A lack of health insurance is the third-leading cause of premature death following heart disease and cancer for people between the ages of 55 and Medicare eligibility at age 65. Even when insured, 2-5 percent of documented claims are routinely denied through a variety of bureaucratic ruses by private insurance companies' “death panels,” all designed to postpone or avoid costly procedures that might eat into profits. And this figure is surely an understatement, since no law exists requiring insurance companies to keep records of denied claims from doctors for additional treatment modalities. It would therefore not be unreasonable to assume, that the worst offenders would prefer to avoid public scrutiny. It also fails to measure the impact of self-rationing with respect to health care practiced by one-fifth of insured Americans. because they cannot afford to bridge the gap between covered costs and the actual price of tests and treatments.
A secondary result of the American way of health care delivery is that nearly 62% of bankruptcies stem from medical bills, and this also encompasses people with health insurance who face financial disaster if they experience a serious illness, according to a recent study published by the American Journal of Medicine. Between 2001 and 2007, the proportion of all bankruptcies attributable to medical problems rose by about 50 percent. Strikingly, this study does not take into account the additional effects of the current economic crisis. Moreover, about 1.5 million families lose their homes to foreclosure every year due to unaffordable medical costs.
That aside, it is the uncontrolled growth of health coverage itself that is a looming disaster for capital accumulation. The cumulative increase in employer-sponsored health insurance premiums has grown at four times the combined rate of inflation and wage increases during the last decade. This increase has made it much more difficult for businesses to continue to provide coverage to their employees and for those workers to afford coverage themselves. The pharmaceutical, health insurance and medical products and equipment sectors rank within the top 10 profit earners in the American economy according to Fortune magazine. Health insurance costs alone are the fastest growing expense for employers to the point that employer-based health insurance costs overtook profits in 2008, and the gap, absent remediation will continue to grow unchecked. It is a tribute to the lemming like idiocy of American business, increasingly held hostage to the health care industry, that it has not demanded government relief from the stranglehold of the health insurance sector.
By international comparison, the United States spends more that twice per capita on health care than the British; as a percentage of GDP (2006) 15.3% vs. 8.2%. Americans, in fact, spend twice the cost per capita compared with most other developed nations, yet are ranked 37th in overall quality, according to the World Health Organization. Americans face higher infant and maternal mortality rates and a shorter life span than our counterparts in other industrialized nations that offer comprehensive health coverage for all their residents. On a class basis, the gap between the lifespan of America's wealthiest and its poorest has doubled since 1980. Overall the lifespan of the average American has plummeted from 13th in world ranking in 1960 to 50th today, below Portugal and above Albania according to the CIA World Factbook. Yet, conservatives constantly dance out examples of celebrities and other elites who come from abroad for treatment in the US as “proof” of the superiority of American health care, deliberately confusing the state of the medical arts with the comprehensiveness of a health delivery system, which is what is actually at stake here. That this nonsense continues to be taken seriously among sections of the working class is testament to the low level of political culture in a socialist – free America.
That the Republicans are absolutely indifferent to the health care crisis should surprise no one. That they are ruthless and unprincipled in their hostility to the well–being of average Americans is standard fare. Their method of operation is as simple as it is ubiquitously applicable: all social problems, insofar as their reality cannot simply be denied, are to be divided and reduced to those that require individual solutions and those which require state repression. Where Republican political representation is weak, individuals are encouraged to organize in the streets on an ad hoc basis in the form of mobs or near mobs solely for the purpose of counteracting all collective, and social programs that seek to address inequalities. Those who cannot solve their own problems, who succumb to poverty, disease and discrimination, are simply slandered as morally irresponsible. Republican leaders parade themselves, thumbs smugly snapping their suspenders, the stout champions of the individual uniquely proud of their success in sabotaging the aspirations and pretensions of the American rank and file for a democratic say in its own affairs against the free market of corporate domination.
The conservative wing of corporate America will ride the Republican mob in order to defuse the cause of universal health care, which they fear may be revisited to their detriment in the future should Obama’s solution prove unworkable. The Republicans, for their part, simply seek partisan gain by the defeat of a major initiative upon which much of this administration’s prestige resides. Still, only a party uniquely devoid of scruples, utterly demagogic, without an alternative, an argument or a clue would resort to ginning up hostility to Obama’s health program by raising the specter of nazi eugenics boards ready to pull the plug on grandma; the opening gamut in a diabolical plot to turn the United States into an amalgam of the Soviet Union and fascist Germany. The “townhall” disruptions are the intersection of the tea baggers, the birthers (those who believe Obama to be a non-American born Manchurian candidate planted by evil one worlders, possibly with roots in the Illuminati) and those for whom the election of a Black president, the selection of a female head of the state department and a Latina supreme court judge is simply a world gone mad. In the long run, the question will be whether the Republicans can demobilize this increasingly gun-toting lunacy as easily as they conjured it forth.
Make no mistake, this Saint Vitas dance was well funded by Ruport Murdoch’s publishing and broadcasting empires, and a huge raft of the insurance companies, for-profit hospitals, pharmaceutical and medical groups, who are spending close to $1.4 million a day to influence the outcome. They have hired a virtual army of ex-Republican lawmakers, staffers and flunkies to lobby congress, to produce talking points, to influence editorial writers and op-ed pages, to produce commercials, in short, to get their message out to the street. They lit the fire, but the economic crisis seasoned the timber. In an age of mass insecurity—of disappearing jobs, homes, savings, pensions; of collapsing industries, cities and financial institutions —how hard would it have been to spook a trembling public into believing that those who still have health care might loose that as well; that those who suffered at the blind mercy of economic forces, will be prematurely buried by unelected, indifferent government bureaucrats?
Still the Democrats essentially conceded the debate at the outset by preemptively removing the single payer option and deciding, as they habitually do, to “govern from the center.” The case for universal health care should not have been difficult to make, and would not have been, if the Democrats were simply answerable to their base. At one point, a majority of physicians and even larger majority of the American populations supported single payer. But being a corporate entity—an integral part of the ruling machine—they have institutionally split loyalties, seeking always to find the type of hybrid solution that nominally addresses the needs of their base, while appeasing the interests of their corporate masters. Had the Democrats proposed a Medicare for All program, they might have won the public over to their side and taken command of the issue. It is simple, has a proven track record, contains realistic cost control—by eliminating the quest for profits, vastly reducing administrative overheads and obscene CEO compensation packages—and it could have been easily explained. Medicare, along with social security, is a hugely popular program that has virtually eliminated the problem of health coverage and poverty for the aged, previously a major constituency to this unfortunate category. Had the administration argued that socialized care does indeed exist for military veterans and that their care is considered superior to that offered by the private sector, he may have made some inroads.
But Obama was only able to make the case for universal health coverage by promising a boondoggle of additional enrollment for private insurers, in effect, mandating what will be, in the context of unchecked premium growth, a regressive tax on wage earners. It is true that the Obama plan will prevent coverage from being withheld for preexisting conditions, or caps being placed on lifetime coverage, or portability of insurance being tied to employment. These would be real advances. But comprehensive coverage under a hybrid plan will, down the line, prove to be unaffordable, which is why an additional federal tax on the health care benefits of covered workers is still not off the administration’s agenda. Obama has backtracked even further in the direction of corporate America, and away from cost control, by negotiating a truly repulsive deal with the pharmaceutical industry--a promise not to use government bargaining power to bring down drug prices. An administration that cannot stand up to big Pharma, will not exactly be in a position to “soak the rich.”
Obama’s hybrid plan foregoes hundreds of billions in administrative savings, because the multiplicity of insurers requires a corresponding army of administrators and billing clerks to negotiate between doctors, hospitals, pharmacies and insurance companies. Even the modified public option, which at this time may be sacrificed in the further interests of feckless bipartisanship, would quickly fail to control health care costs. It would not stimulate competition and cost containment as the Obama administration would have it and the Republicans fear, but most likely succumb to it. As the Physicians for a National Health Plan have explained: “Insurers compete by not paying for care. Competition in health insurance is a race to the bottom, not the top. A public plan that did no marketing would soon be saddled with the sickest patients, whose high costs would overwhelm any administrative efficiencies and drive premiums to uncompetitive levels. Similarly, eschewing private insurers’ schemes that shift costs to patients and other payers would be a crippling competitive disadvantage. To survive, a public plan would have to initiate private plans’ bad behaviors.” This is, of course, an application of the most basic case that socialists routinely make against the viability of co-ops within a capitalist context. Single payer, on the other hand, would have been integrated with Social Security allowing automatic enrollment and eliminating the cost of marketing, and automatic premium paying. It would save $400 billion on bureaucracy and the $10 billion in yearly profits now required by the health insurance sector. It would eliminate, in other words, the 30 cents of every healthcare dollar now diverted to CEO salaries, profits and paper work. These would be essential to covering the uninsured in a way that would not burden one section of the working class at the expense of another.
The American trade union movement, for its part, has acquiesced to this pale version of reform for risk of ruining Obama’s presidency by calling him out on this. They have, in effect, already lost the Employee Free Choice Act by the same tactic of self-intimidation. If enacted at all, it, like EFCA, will be done in diluted fashion, hardly suitable for advancing the cause of American workers. The Democrats, on the other hand, are so timid at being identified with their base, that they risk near lynch mob venom, rather than holding their townhall meetings in union halls or black churches, where such behavior would be overwhelmed from the floor. If the AFL-CIO shows some militancy in the end to preserve the public option as left-leaning Democratic representatives are now threatening to do, it will simply be too little, too late. Real health care reform that also provides true economic security for the American worker will again have to wait for another day.