Health Care in the United States and the Debate for ‘Health Reform’
The population of the United States (U.S.) as per the U.S. Census Bureau is slightly above 300 million (July 2008). 47 million Americans do not have any kind of medical insurance. In 2006, 108 million Americans had insufficient coverage or were underinsured. The definition of underinsured varies but includes individuals who spend more than 10% of their post tax incomes on medical expenses. 62 percent of all bankruptcies filed in 2007 were linked to medical expenses. Research released in September, 2009, in the American Journal of Public Health estimates that 45,000 deaths per year in the United States are associated with the lack of health insurance. The researchers examined government health surveys from more than 9,000 people aged 17 to 64, taken from 1986-1994, and then followed up through 2000. They determined that the uninsured have a 40 percent higher risk of death than those with health insurance because of inability to obtain necessary medical care. A 2007 report ranked the U.S. 42nd in the world for life expectancy and 41st in infant mortality rate – worse than most of Europe and even Cuba.
Health Insurance - Private and Government:
Having viewed the grim statistics above, what exactly constitutes the health care system in the richest country in the world? The health care system in the U.S. has been described as ‘highly decentralized and fragmented’ and there is no Ministry of Health. There are 3 types of health care facilities - government facilities which include federal (central), state and local, private non-profit and private for-profit health facilities. Although the private sector dominates the health care delivery system, it is the government-funded programmes and facilities that treat the mentally ill, native Americans living in dire poverty in reservations, short and long term care of the elderly, those with end-stage kidney disease on dialysis, patients with AIDs etc.
There are about 1,300 private health insurers. The government insurances are Medicare, Medicaid and the Veterans Administration (VA) hospitals that treat the veterans (those who have fought in the innumerable wars that American imperialism has waged in the last 100 hundred years). A research team at Harvard just released a study which reported that over 2200 veterans died in 2008 from lack of insurance. The VA covers all veterans with illnesses related to the wars and poor veterans for other illnesses as well. It does not cover illnesses in those with mid- and higher level incomes which are not war-related. Medicare was established in 1965 during the peak of the civil rights and anti-Vietnam War movements in the US. Medicaid, established at the same time, provides some medical coverage for poor people. It is supported both by federal and state taxes and benefits vary by the states. A 2007 study by Public Citizen’s Health Research Group reported that 60% of poor Americans are not covered by Medicaid. The Federal Agency for Healthcare Research and Quality estimates that the government pays for two-thirds of the nation’s health care, the private health insurances cover two-thirds of the population and pay for a third of the total health expenditures. The private health insurance companies are known to ‘cherry pick,’ insuring only healthy people and refusing to insure those who were unhealthy or are likely to become unhealthy.
Health Care Debate
CBS News/New York Times poll found in June 2009 that 72% of Americans supported a government-sponsored health care plan. Most also thought the government would do a better job than private industry at keeping down costs and believed that the government should guarantee health care for all Americans. The mood of the working class and the middle class has been increasingly angry in response to the economic recession and the trillions of dollars doled out to Wall Street. The ‘change’ desired by the vast majority of Americans which led to the ‘historic’ election of Obama has been missing in action. Whether on immigration policy, on national security or on the bail outs to banks and corporations the two ruling class parties have been united. Health care became the most controversial issue in 2009 as millions were forced into unemployment. The Taft Hartley Act established in 1947 forced the workers to get health care benefits through collective bargaining agreements at the place of employment. Workers who lose their jobs lose not only wages, but also health benefits for themselves and their family. The lack of universal health care has resulted in important U.S companies like the big automakers like Ford and General Motors closing factories in the U.S. because of huge health care expenditures for their employees (Ray O. Light Newsletter, July 2007). Interestingly, corporations like Walmart known for extremely unfair labour practices have supported health reform as they would like some sort of public health insurance for their employees. The Democratic Party which has traditionally been supported by organized labour and other ‘progressive’ and liberal groups in its election campaign had promised to bring changes to the health care system. President Obama who vociferously supported universal health care during his campaign changed his position in deference to the health care industry from universal care to ‘health reform’.
After months of debates and intense lobbying by the ‘medical industrial complex’, the House of Representatives (the lower house) on November 7 passed a health care bill by a vote of 220-215. The 1,990-page bill will fail to deliver even any real ‘reform’. While a small proportion of people will have improved access and that too in 2013 when they will be offered a public health insurance option, private insurance’s grip on the healthcare system will increase as uninsured Americans will be mandated to buy private insurance or else pay a hefty fine. There will be little assistance for individuals and families who presently have employer-sponsored health plans and face frequent erosion of their coverage and health security. According to California Nurses Association (CNAO, with no effective limits on the insurance industry's price gouging, out-of-pocket costs for premiums, deductibles and other fees may eat up from 15 to 19 percent of family incomes.
Senator Max Baucus of the Democratic Party who has been prominently involved in the health reform bill had reached agreements with his colleagues in the Republican Party (the so called ‘right’ wing of the ruling class) in private on the health bill. The Montana Standard a paper from the Senator’s home state reported that he received more campaign money from health and insurance industry than any other member of Congress in the past six years. Nearly 25% of the money raised by Baucus and his political action committee has come from groups and individuals associated with drug companies, insurers, hospitals, medical supply companies, and other health professionals.
At the peak of the heated discussions over national health insurance in June,2009, when the Democrats and Republicans appeared to be at loggerheads, a deal was struck between the Pharmaceutical Research and Manufacturers of America (PhRMA), the White House and Senate Democrats. As detailed in a memo first published by The Huffington Post, the Obama administration agreed to oppose congressional efforts to use government leverage to bargain for lower drug prices. This will result in a net gain of more than $137 billion dollars in total market sales over the next four years.
The pharmaceutical and health insurance industry have used lies and propaganda in the last several months to create hysteria about the Obama administration’s efforts to bring in health reform. United Healthcare and WellPoint, two of the largest health insurance companies in the country, sent memos to their employees to take part in the town hall meetings. They are both under government investigation in California for these activities. (Los Angeles Times, Sept. 3) The fascist section of the ruling class has worked with these groups to fan chauvinism. Town meetings where Obama and other democrats addressed people over health issues have been attacked and disrupted. Stories have been spread about how universal health care will affect health care for the elderly and how it will benefit illegal immigrants and other dregs of the society like poor people and people of colour at the expense of good hardworking whites. Obama has been called a socialist for supporting a health plan which has been described by progressive health care activists as a gift to the private health industry! While there are differences and internal conflicts between the two ruling parties in the U.S which manifested in the debates over the health care system the bill that passed will continue to further the profits of the medical industrial complex that serves both parties.
Health Care as a Right – A Brief History
In the late 19th century largely middle class professionals called ‘Progressives’ created a reform organization American Association for Labour Legislation (AALL). AALL campaigned for compulsory health insurance plan for all. The American Federation of Labour (AFL) teamed up with organization of business leaders and defeated the implementation of the plan. Samuel Gompers the president of AFL described compulsory health insurance as ‘a menace to rights, welfare and liberty of American workers”. The AFL union leadership felt that social insurance would lower wages as the contributions would have to come from the wages of workers. The AFL was in direct conflict with the Socialist Party which endorsed the national health insurance.
After the end of the World War afraid of the influence of the Soviet Union, imperialist countries made concessions to their working class which included national health care. In the U.S too national health care began to assume a central place in the discussions. The communists and their sympathizers had organized large numbers of the working class into unions. This period became infamous for the witch hunts of communists and their sympathizers in an organized fashion by the American state. The American Medical Association (AMA) and its supporters ardently opposed national health insurance. They succeeded in linking socialism with national health insurance. They had one pamphlet that said, “Would socialized medicine lead to socialization of other phases of life? Lenin thought so. He declared socialized medicine is the keystone to the arch of the socialist state.” The anti communist propaganda of the government and the efforts of the AMA helped to defeat the plan to have universal free health care. Private insurance systems expanded and provided enough protection to prevent any great agitation for national health insurance in the 1950’s and early 1960’s.
In the mid 1960s the civil rights movement was at its peak. Two thirds of people over 65 had no coverage for hospital treatment. There was militancy in the air with leaders like Malcolm X and Martin Luther King posing serious challenges to the system. The Black Panther party, a revolutionary party with its goal of real economic, social, and political equality across gender and color lines, was becoming popular with the youth. Against this background Medicare and Medicaid were established in 1965. However, universal health care remained elusive.
Medical Industrial Complex
Vicente Navarro, Professor of Public Policy at the Johns Hopkins School of Public Health, describes the private health insurance companies, for profit health care facilities and the pharmaceutical companies as the medical industrial complex. In 2002, the ten most profitable drug corporations earned about 36 billion dollars more than the other 490 corporations on the Fortune 500 combined! In 2007, insurance industry profits reached $12 billion, and pharmaceutical industry profits $49 billion, the highest in the U.S. and in the world. The top executive of United Health a powerful private health insurer makes 37 million dollars year and has billions in stocks. All this comes from hardworking Americans with many going without adequate coverage even after paying premiums! The health sector contributed $54.5 million to Democrats and $46.1 million to Republicans in the 2008 elections. Contributions linked to manufacturers of pharmaceutical and health care products were split about evenly between the parties.
The Struggle for National Health Care Now
California Nurses Association (CNA) and Physicians for National Health Program (PNHP) are two organizations which have been in the forefront of the struggle for implementation of universal health care in the form of single payer health care or ‘Medicare for All’. Healthcare-NOW! is a coalition that has been mobilizing a large community of advocates composed of organizers and activists in more than 300 cities in all 50 states. There have been many rallies, sit-ins and voluntary arrests in front of large private insurance companies this year. Thousands of unionized workers have supported these actions. American Federation of Labor and Congress of Industrial Organizations (AFL-CIO), the largest federation of unions in the United States and Canada representing about 10 million workers and Service Employees International Union (SEIU) a labor union representing about 1.8 million workers have supported the health reform bill. They have not gone all out for a national health insurance/single payer as demanded by other health care activists.
When Health Care is Not for Profit
In 1932 Sir Arthur Newsholme of the Local Government Board of England and Wales, and John Adams Kingsbury, former commissioner of public charities for the City of New York, travelled to the Soviet Union to examine that country’s health care system. Their observations were published in 1933 as “Red Medicine: Socialized Health in Soviet Russia.” Among their conclusions is the following… “It has surpassed all other countries in its socialization of medicine. It has removed the doctor almost entirely from the field of monetary competition…. it has made medical service of an astonishingly complete character promptly available for the vast majority of urban populations, a service which is being rapidly extended to rural Russia; and it has given the whole of this service an admirable turn in the direction of social as well as medical preventive measures”. In China after the revolution, life expectancy doubled from 32 years in 1949 to 65 years in 1976. One of the important achievements at the time in China was community participation and people taking responsibility at the grass roots over health issues.
Cuba’s achievements in providing free quality health care at all levels are very well known. The New England Journal of Medicine, a premier U.S. journal reported, “Cuba has engineered a national medical apparatus that is the envy of many developing nations. For some of these nations, it is not Boston, but Havana that is the centre of the medical world.” This small country has approximately 28,000 health professionals now providing care in 68 countries.
The example of the ‘health reform’ bill in the U.S. shows that the so called public-private enterprise is really about putting the profits of the private corporations over people’s health. With the struggle for “Medicare for All” in the U.S., the struggle for health care can become part of the larger struggles for economic and social rights.