People's Democracy

(Weekly Organ of the Communist Party of India (Marxist)


No. 39

September 27, 2009

Health Care Debate in US


R Arun Kumar



HEATED debate on health care is raging across the United States of America. As president Barack Obama had stated in his joint address to the Congress a few days back, this debate is not new and is nearly 100 years old. It is then natural for one to wonder the renewed interest. The answer lies in the fact that health insurance industry is one-sixth of the American economy. This is a powerful lobby that acts to prevent any change from the present status quo. On the other hand, the president expresses his determination to reform the health care system. This is bound to ruffle the feathers of the industry bosses and generate the heat we are witnessing.

In 34 of the 50 states in US, 75 per cent of the insurance market is controlled by five or fewer companies. In Alabama, almost 90 per cent is controlled by just one company while in states like Montana, two insurance companies control 85 per cent of the health care market. A recently released report shows that family premiums rose more than 130 percent over the last 10 years- three times faster than wages. They now average over $13,000 a year, the highest amount on record. It is expected that family health insurance premiums in the entire country could jump 71 per cent to over $22,000 within 10 years. According to the president, on an average a US citizen is spending nearly $5000 to $6000 more on health care than those in any of the advanced countries.

In this period of rising unemployment and poverty, health care and insurance thus is proving a burden to many. The president himself had stated that in 2008, before the downturn, family income fell to its lowest point in over a decade, and more families slid into poverty. The result is that the number of uninsured had risen over the last 12 months. It is estimated that the ranks of the uninsured have swelled by nearly 6 million people- 17,000 men and women every single day. The number of adults who get their coverage at the workplace has dropped by 8 million people. There are nearly 46 million people who are not covered under any health insurance scheme and even among those covered, 12.6 million are denied coverage by the insurance companies on the pretext of pre-existing conditions.





Health care reform was thus a popular demand of the working and middle classes in the US. They constitute the major constituency that had worked for the victory of Obama in the presidential election. Health care reform is one of the major election promises of Obama and he had promised to work on it immediately on assuming office.

On the contrary, Republicans feel that there is nothing wrong with the health care system in the country and thus there exists no need for reform. As this industry is controlled by big business and is profit generating, there is resistance against attempts to regulate their lucrative trade and control their profits. The conservatives represented by the Republicans and a section of Democrats have come out in open support of these interests. The Republicans took this also as an opportunity to redeem themselves and demean Obama who had handed them one of their crushing defeats.

To ensure status quo and stall the reforms they are resorting to all sorts of tactics, from out right slander to disruption of meetings and debates. There were reports that many of the disruptions of 'town hall meetings' were in fact carried out under the active guidance of insurance companies and Fox news network who have sent in their employees for this purpose. Wall street journal and NBC organised opinion polls to cook up opposition. Many of the media houses also gave poll results that Obama's poll ratings have seen a fall on health care reforms.

We can easily conclude that this opposition is misplaced by glancing at the main points in the Obama health care plan: (i)bringing all the citizens of the US under insurance cover (ii) offering a public option along with a host of private insurance options that are available in the market (iii) regulating insurance companies to: ensure that they do not retain more than 15 per cent as profits and administrative costs; control the growing health care costs; making it illegal to deny the payment of claims in the name of pre-existing conditions; asking them to cover the expenses incurred for preventive care and routine check-ups.

Republicans are projecting this as a governmental take over of health care. They are campaigning that the supposed reforms would increase budget deficit and also taxes for the majority of the Americans. Some other canards like the government would fund abortions (a contentious issue) and run death panels to decide on elder citizens are also spread.

Obama, in fact, had undertaken a campaign style tour around the country, together with a series of televised interviews to counter such campaigns. The entire campaign machinery that had worked for Obama's election was once again re-activised for this purpose. Organising for America (OFA), the activist group that evolved out of president Obama's campaign, has collected over 1 million signatures from voters in support of the president's health reform principles. They organised over 12,000 meetings since June and some 64,000 activists visited the members of Congress in every state and district in the country. None of this is being reported as the corporate media has refused to tell this story. They are more interested in reporting the disruption of the debates organised by the conservative Republicans.

After spending months in his futile attempts to mobilise bi-partisan support for his health plan and also due to the consistent demand from the people, Obama started taking a position. He stated that he �won't stand by, while the special interests use the same old tactics to keep things exactly the way they are�. He went on �right now the system works very well for the insurance companies but it doesn't work so well for the American people�.

Criticising the way insurance companies operate he stated in his speech to the Congress �Insurance executives don't do this because they're bad people; they do it because it's profitable. As one former insurance executive testified before Congress, insurance companies are not only encouraged to find reasons to drop the seriously ill, they are rewarded for it. All of this is in service of meeting what this former executive called 'Wall Street's relentless profit expectations'�. Countering the argument that his plan would increase the deficits or rise taxes he said, �the plan I'm proposing will cost around $900 billion over 10 years -- less than we have spent on the Iraq and Afghanistan wars, and less than the tax cuts for the wealthiest few Americans that Congress passed at the beginning of the previous administration�. He said that this money could be mobilised by eliminating �the hundreds of billions of dollars in waste and fraud, as well as unwarranted subsidies in Medicare that go to insurance companies -- subsidies that do everything to pad their profits but don't improve the care of seniors�. Expressing his resolve to move ahead he said that he �cannot be intimidated by some of these scare tactics� of the opponents.

It is for this, Obama is labelled as a 'socialist', though this is not for the first time that he is called as such. He is caricatured as both Hitler and Che Guevara. In spite of the repeated denials of Obama that he is not a 'socialist', the conservatives are sticking to this label. He himself had stated that �I have no interest in putting insurance companies out of business�. In a lighter vein, he stated that he can be called a 'socialist' for sharing a sandwich with his friend in his childhood and for nothing else.





These critics too are aware of this fact, but are levelling this charge only to curtail what they perceive as the increasing role of government. Mentioning that he is aware of the 'American character' and the debate on the amount of government in their lives Obama said �the danger of too much government is matched by the perils of too little; that without the leavening hand of wise policy, markets can crash, monopolies can stifle competition, the vulnerable can be exploited�. Many of the critics who are crying hoarse stating that Obama is increasing the role of government in health care have indeed welcomed government efforts to bail out the banks that were badly affected by the crisis. They had not only welcomed but also demanded government monies for the bankrupt automotive industries. It is clear that they need government to serve the interests of the ruling classes and are not ready to accept even a semblance of it in rescue of the toiling sections. Moreover, they demand competition when government is the only player but refrain from the same when a particular sector is under the monopoly of private players.

It is interesting to note that a similar debate took place in the US in the 1930s when the then president F D Roosevelt announced the New Deal. History shows that New Deal did not lead to socialism but only helped capitalism come out of crisis then. Of course, this period also witnessed lots of trade union activism, benefits won by the working class and also a surge in the ranks of the communist party and its sympathisers. This period is immediately followed by the establishment of the House Committee of Un-American Activities and the targeted haunting of the communist party members and sympathisers, popularly known as McCarthyism. This witch hunt of all those who were perceived to be even remotely related to the socialistic cause targeted many eminent personalities like Charlie Chaplin, Paul Robeson, Dashiell Hammett apart from the Rosenburgs.




Thus another reason for their usage of 'socialism' in a demeaning manner is, to ensure that people do not once again 'fall prey to its charms'. Surveys in the US have noted that in this period of crisis, where unemployment and poverty are on the rise, there is an increased interest among the people on knowing what socialism is. It is to snuff out any such interest that a constant ideological attack is unleashed. Angelina Merkel, the German chancellor, warning her colleagues in other countries about the possibility of the growth of Left, asked them to take steps to ward off this threat. This is what we are witnessing in the US. They are using all the powers at their disposal- media included, for this purpose of projecting socialism as an ogre. They know that any meaningful debate on socialism would only swell the ranks of socialists, so they just shout expletives without entering or encouraging a debate.

Obama's presidency can at best be seen as a departure from the right-wing extremist policies pursued by the previous administration and cannot even be imagined to be even remotely socialistic in nature. There is nothing in his health care plan that says the government would take entire responsibility and provide free universal health care as in Cuba. He at the most is calling for more controls and regulations as that would ease the pressure of discontent rising among the masses and help preserve the existing capitalist system. That a section of the ruling classes are not even ready to acknowledge or accept such a departure tells us about the reactionary nature of the finance capital that is dominating the world.