Barack Obama betrays Americans on For Change messages on Healthcare

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by Stephen L. Strauss, M.D.

When President Obama announced that health care reform would be a top priority of his presidency, there was a predictable sense of optimism among millions of people. In the course of a year, however, this mood has turned sour, and now many people are just hoping that something, anything, gets passed.

Indeed, the Obama euphoria that characterized the early days of the new administration has been steadily disintegrating. His approval rating now stands at less than fifty percent. A president who promised to get the U.S. out of Iraq now says that withdrawal means maintaining the presence of 50,000 allegedly “non-combat” U.S. troops. A president who complained that No Child Left Behind was inadequately funded now threatens to withhold federal dollars from local school districts unless they comply with the law’s draconian measures.

And in health care, the president who once said he is in favor of single payer now says that such a program is off the table, that it is “too disruptive”, even though the majority of Americans support replacing private insurance with a well-run, profit-free government program. More and more, the bait-and-switch game played by the Democrats and Republicans is becoming exposed to U.S. workers.

It is a game because the agenda they are trying to sell is not in the interests of the overwhelming majority of Americans. It is an agenda in the interests of corporate America, one that is fundamentally opposed to the needs of working people. To do this, they have to lie.

When the corporations want war, the big business parties sell it as the way to achieve peace. When corporations want public schools to be the training ground for a workforce with new set of skills to exploit, they call it education reform. And when the corporations want to unload their financial obligations to workers’ health insurance, in order to keep more for themselves and increase their profits, they call it health care reform.

Indeed, the current legislation is not the reform of health care that most Americans had in mind when Obama’s smile was still taken to be sincere. Most Americans want and expected better access to doctors, diagnostic tests, safe and effective treatment, acute care, long term care, and rehabilitation. They want cost to not stand in the way, for themselves, their parents, and their children.

But this straightforward and eminently reasonable expectation among millions of Americans is not what we’re getting. Instead, we are bombarded with swirling dust-devils of confusing rhetoric about penalties for not buying insurance, a public option not open to the public, and cutbacks in Medicare. This is hardly what working people expected.

Confusion is what fills the chasm between what was expected and what we are getting. A problem that seems so straightforward can’t get a straightforward solution from the White House and Congress. We need a surge in health care and we need it to be financially accessible. What’s so difficult about that?

Nothing really. Except that this was never what the so-called debate was about. It was never about health care. It was and is about corporate profits and the efforts of big business to unload the drag on those profits represented by the money it must contribute to employee health insurance. And the debate will stay that way as long as the two parties of big business are the only ones carrying it out.

And that’s not confusing at all. Since when did the Democrats and Republicans ever act out of the goodness of their hearts on behalf of working people? Social advances are achieved by struggle against corporate power and their agents in Washington. That’s how union workers won employer health care contributions in their contracts. That’s how the American people won Medicare.

The only confusion should be in imagining that the two parties of big business are now somehow establishing a new precedent, that they are motivated by sincere empathy for working people.

The Need

The initial optimism over health care reform was based not only on Obama’s promise to make it a top priority of his presidency; not only on Obama having a cultivated image as representing real change; not only on health care feeling like the good news we’ve all been wishing for. It was based on the real, deep need people have for real change in how to get the care they need. There is nothing abstract about getting sick and about getting unpayable bills in the mail.

Thus, the need is both medical and economic. Health care is prohibitively expensive for most working people. In fact, it is essentially unaffordable. A heart bypass operation costs as much as a BMW, about $55,000. If a BMW is a luxury car that most working people can’t afford, then the same applies to coronary bypass. From a financial standpoint, it’s a luxury operation.

Health care insurance makes it somewhat easier for people to access the medical care they need. But people are still stuck with their premiums and deductibles. And this runs so high that 60% of all personal bankruptcy cases in the United States are due to unaffordable medical bills.

Having health care insurance does not protect someone against such bankruptcy. About three-quarters of these personal bankruptcies are among people who have insurance. Obviously, the insurance that most people have is entirely inadequate.

Imagine the even graver situation for people with no insurance. We are talking about 48 million Americans. Half of the uninsured are women. Half of the uninsured are Blacks and Latinos. Half of the uninsured have not seen a medical doctor in more than a year, even though they actually do have medical conditions that need surveillance and treatment, conditions like hypertension, diabetes mellitus, heart disease, and cancer.

How often have you seen a picture of a child with leukemia pasted on a neighborhood telephone pole with a plea for money to pay for chemotherapy? Or a child who needs a major heart operation or liver transplant? Or surgery for a cleft lip and palate? How often is this the child of a CEO of a major health insurance company? Never. This is a class issue.

Women obviously have health care issues quite distinct from men. Yet women are penalized for the chronic “condition” of having a uterus. In some private plans, women are charged up to 48% percent more than men for exactly the same overall coverage. In some plans, having had a Caesarian section is considered a pre-existing condition that the insurance company uses to deny coverage. Hard as it may be to believe, there are some plans that count being a victim of domestic abuse as a pre-existing condition.

The so-called “don’t ask, don’t tell” policy in the military that allows gays and lesbians to enlist has led to some interesting health care problems. Military officials are finding that the “don’t tell” part seems to carry over to the medical clinic, so that gays and lesbians in the military are not getting the care they need.

Job injuries create disabilities. Becoming elderly creates disabilities. People need long term care.

Being young and naïve makes one a target for tobacco pushers, cholesterol pushers, and sugar pushers. Draconian classroom practices, launched into the stratosphere by No Child Left Behind, are associated with increasing rates of childhood depression, anxiety, and suicide. There are all kinds of medical and psychological problems that ensue from the commodification of plants, animals, food, and learning. We need broad health education, including sex education, for young people. We need to create healthful contexts for young people.

There is virtually no end to what needs to be done. And yet this level of need leaps exponentially if we go beyond our immediate political borders, even just to nearby countries. In Haiti, for example, some poor people live on a concoction of mud mixed with cooking oil and sugar. The oil provides a smooth texture, and the sugar a flavorful taste, to the brown substance that will provide a feeling a being full once it lands in a hungry child’s stomach. Most people would agree that this is wrong. Its solution clearly shows that health care is intimately connected to politics and poverty.

A recent New York Times study revealed that, since 2004, 49 million Americans are drinking tap water containing higher concentrations of arsenic, radioactive substances, disease-bearing organisms, and other pathogens that are legally permitted. This wasn’t from an unfortunate natural disaster. It was from federal oversight agencies looking away, over and over again. The Times reported that “fewer than 6 percent of the water systems that broke the law were ever fined or punished by state or federal officials, including those at the Environmental Protection Agency, which has ultimate responsibility for enforcing standards.” Many of these pathogens are dumped by corporate polluters, for whom the nation’s waterways are just one big toilet bowl. According to the Times, “as many as 19 million Americans may become ill each year due to just the parasites, viruses and bacteria in drinking water.” In addition, breast, prostate, and other cancers, whose rates have risen over the past three decades, are linked to drinking water pollutants.

In other words, the same system that puts obstacles in the way of adequate health care is making people sick. A comprehensive health care plan must include forcing the corporate polluters to clean up the water systems. This won’t be easy, since it will cost them money. Private profit both causes disease and stands in the way of treatment.

The Solution

There is a solution to this problem. Not an immediate one, but one that has an initial step that can be launched immediately. And that initial step is single payer.

A Business Week poll in 2005 revealed that about 62% of Americans support single payer, when it is clearly characterized and they understand what it is. Hundreds of locals of the AFL-CIO are on record as supporting single payer. In a recent poll, 48% of medical doctors supported it. A single payer bill, HR 676, has been introduced regularly into Congress by Representatives John Conyers (D-Mi.) and Dennis Kucinich (D-Oh.).

Single payer is a set-up in which there is only one agency to whom medical bills are sent. This agency reimburses the doctors, hospitals, and other health care providers. Crucially, it is not private. It is a government agency. In the Conyers-Kucinich bill, no private insurer is allowed to compete with the federal insurer. In other words, the private insurance industry is no more.

Some single payer advocates would still permit doctors and other health care providers to remain private. They all just submit their bills to the federal insurer. This may be a goal most easily attainable in the short run. But a far more manageable situation, one that would not allow the arrangement to be sabotaged from within, would be to have all physicians, nurses, and other health care providers be federal employees. This, of course, will take some convincing at the present stage of the struggle.

But doctors, for example, can be won to such an arrangement. The one obvious advantage is that being a federal employee eliminates the need for malpractice insurance. This does not in any way imply that doctors are no-longer periodically peer-reviewed, even censured if necessary for poor care. Rather, it means that if an unfortunate outcome occurs, a patient will still have his or her medical needs covered, as in any other situation. There will be no need to bring a lawsuit against doctors and hospitals.

One of the most important features of quality health care is the doctor-patient relationship. The patient must trust the doctor enough to feel comfortable revealing the most private of feelings and physical concerns. The doctor must demonstrate that trustworthiness through both a caring personality and professional expertise.

Single payer poses no inherent obstacle to choosing one’s physician. That means you can stay with whomever you choose, or move on to someone else. That’s your right and prerogative.

Under privately insured medicine, there is a profit-driven basis for insurers telling you whom you may or may not see. The insurers seek contracts with medical practices that will accept their reimbursement schedules. Private physicians may themselves reject insurers who, they feel, reimburse too little. Thus, not every physician is available for every insurance plan. This means that if your insurance plan changes, your doctors can change right along with it.

Under single payer, there are no co-pays or other out of pocket deductibles. There is only a single payer, the government agency. The patient is no longer a payer in a fee-for-service arrangement. As most working people understand, co-pays and deductibles are merely obstacles created by private insurers to discourage people from seeking medical care. They of course become unavoidable within the private system when you land in the hospital because of a heart attack, stroke, or other medical catastrophe.

Single payer has a stake in preventive care, since it is all about keeping the population healthy. Preventive care includes educating teens about the medical risks associated with tobacco use, unprotected sexual activity, and drug use. Preventive care is proactive in screening for breast cancer, cervical cancer, and colon cancer. Preventive care makes the population healthier.

But preventive care is not something private, for-profit insurers want to spend their money on. Even if they could be convinced that their profits would be increased because of reduced rates of preventable diseases, they are too myopic to reckon that far in the future. No capitalist seriously invests now for a return 30, 40, or 50 years in the future, especially when the economy is in a serious downturn and the goal is to squeeze through the present crunch.

Obama on Single Payer

In 2003, Barack Obama said “I am in favor of single payer.” He made this statement before an audience of the Illinois AFL-CIO. He was getting ready for a run for the U.S. Senate from Illinois, and clearly was courting labor support.

For the bureaucrats who run the union, words are a cheap way to buy an endorsement. The ambitious politician became the first African-American president of the United States, and immediately denied he ever made a statement in support of single payer. “I never said I supported single payer”, he stated.

What was he for now? He was for “health care reform”, of course, just like everyone else. But in whose interests?

Obama stated at the beginning of his presidency that health care reform would be a top priority. So important was it to have a reform measure pass in the Congress, he announced that he endorsed a bipartisan approach, and charged House and Senate committees to work out various portions of a comprehensive bill.

Now, what does it mean to endorse a bipartisan approach? It is important to keep in mind that the other party in power is the Republican Party. It is no secret that there is not one Republican who supports single payer, and virtually none who supports a meaningful public option.

If Obama’s bipartisan strategy were based on a sincere desire for everyone in Congress to work together to find a common solution to the problem facing all of us, then it is exceedingly naïve. But certainly such naivety would have been caught early on by all of Obama’s advisors.

No, the bipartisan approach was a signal to the insurance companies and the other private interests that they had nothing to fear. Their sacred profit ledgers would be protected. Behind a veneer of “working together”, Obama took sides.

Bipartisanship is a sign that something bad is coming down the pike. Bipartisanship is the watchword for the U.S. occupation of Afghanistan and Iraq, and for the occupation of the public school classroom via No Child Left Behind. Bipartisanship is the watchword for the USA Patriot Act. Bipartisanship is the watchword for Mumia Abu Jamal, the Cuban 5, and Lynne Stewart. It is why Obama’s “change we can live with” makes no dent in the ongoing terrorist activities of the Central Intelligence Agency. Bipartisan means the capitalist class, corporate America, big business. Two parties representing a single class.

When Obama held his famous health care summit in March, 2009, advocates of single payer were not invited. They staged an embarrassing demonstration outside the White House and were given visas. But their proposals were never taken seriously.

Obama pronounced in his speech that, at the present time, single payer would be “too disruptive”. Too disruptive to whom? Lack of health insurance is directly responsible for 48,000 deaths a year in this country. That’s disruptive too. Whose disruption counts more, the private insurers or working people?

Obama said that he has “no intention of doing away with the insurance industry” since they perform “a useful role”. He proposed instead a “public option” to “keep them honest”.

Perhaps Obama knows something we don’t. Most Americans regard the tobacco industry as more honest than the private health insurance industry.

In truth, the private health insurance industry performs no useful role in society and is inherently dishonest.

What is a health insurance company anyway? What does it sell? An automobile company sells cars. A soap manufacturer sells soap. A brewery sells beer. What does a health insurance company sell?

It sells risk reduction. If you are alive you are at risk for getting ill. Medical care is out there. Without it, you can become seriously disabled, even die. But it is extremely expensive, literally out of reach for most people. Thus, there is a financial risk associated with the medical risk of getting sick.

Working people know that the financial risk can economically disable them, or kill them. So an insurance company comes along and says, essentially: “If you pay us $500 a month, we will take on some of your risk. For $1500 a month, we will take on some of the risk of your family.” This seems like a good bet, and a deal is struck.

Of course, like any good gambling casino, the insurance company won’t let three cherries come up every time the slot machine is rung. Not every illness will be covered. Not every claim will be granted. The insurance company will do everything it can to shell out as little as it can get away with.

That’s the source of the company’s profits. It collects premiums. The less it spends on health care, the more it keeps for itself. The California Nurses Association discovered that 21% of claims in California are denied. The private insurance companies are in the business of denying health care.

That’s inherently dishonest. But the deception doesn’t stop there. The company has a medical director who signs off on the denials. This is a medical doctor, someone who graduated medical school and has an M.D. after his or her name. The insurance company can claim that its denials are based on a careful, medical review.

Except that these medical directors often haven’t seen a patient, or taken care of a clinical problem, in five, ten, or more years. I myself have encountered denials from medical directors who did not know the disease for which they were denying care, or the medicine they were not paying for. That is dishonest.

They say they are not denying care. They are just not paying for it. For most people, that amounts to the same thing.

Between 2000 and 2005, the private insurance industry increased its administrative staffing by 32%. This was not to provide health care, but to further bureaucratize the manufacture of health care denial.

What they do with their money is, of course, no surprise to anyone. The salaries of the CEOs of the ten biggest insurance companies averaged around $11 million in 2008. That’s the equivalent of about 2000 heart bypass surgeries.

Profits to shareholders have gone up 428% in the major companies. While denial of payment to patients is widespread, campaign contributions are quite healthy, about $19 million since 2007 just to federal candidates for the House and Senate. Fifty-six percent of these went to Democrats.

And for working people, premiums have gone up 131% over the last ten years.

It is a lie that this way of doing things has made the U.S. system the best health care system in the world. It certainly is the most costly, with about twice the per capital spending compared to countries like France, Germany, and the UK. It amounts to 16% of the gross domestic product (total spending) in the United States, versus 8% in other advanced capitalist countries.

Yet the World Health Organization reported that on their Disability Adjusted Life Expectancy scale, that is, how long someone lives healthy and without disability, as opposed to immobilized in a nursing home bed, the U.S. ranks 24th in the world!

We pay more and get less. Because we pay an astonishing $350 to $500 billion a year for private health insurance bureaucracies, from which the CEOs and stockholders amass their fortunes, from which Democrats and Republicans get bought off with campaign contributions and lobbying efforts. The administrative costs of actually running a health care system just to provide health care is about 3% of their revenues, as is the case, for example, with Medicare. The administrative costs of a typical for-profit insurer are about 32% — an utter waste of society’s resources.

And if the Democrats and Republicans get their way, we will be paying even more and getting even less.

The Public Option

It is instructive to consider what Obama said about the “public option”, the plan that would be the compromise with those opposed to a truly non-profit, government run insurer. In his speech to Congress, he praised it and called for its inclusion in the health care reform legislation. He compared the health care public option to the public option in higher education, where truly outstanding public universities co-exist alongside private universities.

Of course, the public university option is shrinking day by day, as cutbacks in capital and personnel expenses are making life more difficult for faculty and students. But even so, the kind of public option that the federal legislators debated bears no resemblance whatsoever to high quality public universities.

There are public options and there are public options. In Los Angeles, if you don’t have a car, you can take the public option – the bus. Using your bicycle on the public roads is also a public option. In fact, all these are better than the health care public option, because no version of the latter discussed by the Democrats and Republicans in Congress was in fact an option open to the public.

Indeed, like welfare and social security disability, the criteria for approval are quite stringent, designed to keep out as many people as possible. The Congressional Budget Office estimated that fewer than 5% of the currently uninsured would be eligible for the various public options being debated.

It is hard to imagine that Obama was not aware of the kinds of public option plans being considered, and that he really thought a health care equivalent of UC Berkeley or the University of Michigan or the University of Texas was in the works.

What the discussion is all about

At last count, the Senate bill was 2074 pages in length. Quite a bit of work went into something that should take only three sentences to summarize: 1. All medically approved health care will be available for everyone who resides in this country. 2. It will be paid for entirely from a non-profit government fund. 3. That fund will obtain its revenues by taxing corporations and the billionaires and millionaires of this country.

But these are not the three sentences that would express, in condensed form, what the Senate and the House have in store for U.S. workers and poor people. Their summary sentences will read more like the following: 1. The government will require everyone to purchase insurance and will levy fines on those who do not. 2. Businesses will not be obligated to contribute to employee health care premiums, but the government will subsidize the costs of premiums for those who cannot afford them. 3. The government will pay for these subsidies by gutting Medicare an estimated $460 billion over ten years and increasing taxes on working people.

This is the core of health care reform from the Democrats and Republicans. It needs to be very clearly understood, because it is not at all about health care, and never was. It is about financial restructuring in the midst of a crisis of capitalism, in which capitalist markets are getting saturated, speculative investment bubbles burst, and the corporations are scrambling to find ways to both boost and safeguard their profits.

The core of health care reform is a massive transfer of money from the working class to corporate America. Instead of big business having to contribute to employee health care, this will eventually come entirely from workers. Instead of private insurers being replaced with a single, non-discriminatory public payer, they stand to gain millions in new “customers” and billions in new profits.

To entice working class support, the government will subsidize some of those who cannot afford the premiums. But this will be paid for by taxing workers and by raiding Medicare, ultimately leaving Medicare too weak to be meaningful.

Democrats and Republicans alike have praised the core content of reform as leading to a lowering of the deficit by about $130 billion over the next decade. It should be crystal clear that it is workers who will be paying off this deficit. That will make it easier for big business and the U.S. government to continue borrowing money to pay for their wars.

Taxes to pay for this, that is, taxes that will unload big business’s financial obligations, increase insurance company profits, and pay off the deficit, will start immediately. But the reform measures won’t actually begin for five years. They plan to suck workers’ limited financial resources for five years to help build up the fund they need to make this thing work.

Some estimates of the impact of the bill include a figure of 24 million as the number of Americans who will remain uninsured even by 2019. Even if a working family qualifies for federal subsidies to pay the premiums, co-pays and deductibles will remain unsubsidized and still amount to about 20% of a family’s income, that is, before the actual insurance coverage kicks in. So, for example, a family with an income of $66,000 will pay about 10% of that for co-pays and an additional 10% for deductibles.

It will be no big deal for private insurers to cover people with “pre-existing conditions”, that is, people who pose a higher financial risk to them. They will more than make up for this with the millions of new customers they gain.

None of this should be a surprise. Since when did Democrats and Republicans take the initiative in giving working people something they needed, either economically, socially, or politically? The gains of our class have come from struggle, and only from struggle. Women’s right to vote, workers right to organize, civil rights and the end of Jim Crow, Social Security, Medicare – in short, every social gain for workers and poor people – has been won through organized confrontation with the corporations and their politicians.

The politicians have known all along what this is all about. They are wined, dined, and refined by the private insurers, the private pharmaceutical companies, the planetary polluters, the military monsters. Senator Baucus got millions from the private insurance industry. According to Physicians for a National Health Program, Senator Reid’s main staff writer of the Senate bill is none other than Elizabeth Fowler, former vice-president of Wellpoint, the nation’s largest private health… [CONTINUED.. see comment below]

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