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JOURNAL OF THE 25TH YEAR
Edward S. Herman
Obama & OIRA
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Health Care Reform, Year Zero
The ideological ambiguity of healthcare reform during Obama’s first term concedes few absolute truths. The enterprise of reforming health care by way of corporate regulation ignites debate across the left-spectrum about the Affordable Care Act’s (ACA) place in the 2012 election and beyond. Like it or not, the rules of the ACA are now the chessboard for health activism today. Meanwhile austerity-minded state governments provide an ominous backdrop.
The ACA’s complex provisions are a way to reconcile the paradoxical goals of preserving a costly profit- driven system of health financing while expanding access to the poor, the sick, the jobless, the young, the middle class. Rather than ending private, for-profit health financing, the ACA preserves it, including many of its faults. Among these, the ACA still does not achieve universal care and the recent Supreme Court ruling may set this back further.
This is what health care reform looks like in an era of corporate ascendency. Consistent with the regressive social values of our time, the ACA is not predicated on the longstanding notion that preventive health care is a fundamental human right. It does, however, make tentative but potentially significant shifts toward preventive medicine. Realizing this potential will take political support inside the halls of power, activism outside them, and an abundance of state level innovation. This is a sensitive time for the ACA and a hostile leadership during its nascent years could neutralize hard won gains and undermine the potential for progressive change moving forward.
Another misconception regards the ACA’s supposed unpopularity. True, overall support for the ACA hovers below 50 percent (keeping in mind that many opponents would rather expand than repeal state-led health provisions), but polls have also shown that antipathy toward that law was driven more by the process of lawmaking than by the substance of the law.
The provision barring discrimination for pre-existing conditions had 67 percent public support, according to the Henry J. Kaiser Family Foundation. Expanding prescription drug coverage for seniors drew 74 percent support. Subsidies for individuals purchasing health insurance drew 75 percent support. Expanding Medicaid—a provision many states may reject—had 69 percent popular support. Even a redistributive measure, a modest increase in the payroll tax for wealthier Americans, was supported by 59 percent of the public.
What “consumer” of private health care would not want the simplified health plan summaries that are part of the forthcoming state healthcare exchanges? It turns out, very, very few. That provision had 84 percent support in Kaiser Foundation sampling. Of the major provisions, only the individual insurance mandate is unpopular. Regardless of the makeup of power in future terms, it will be difficult to tell the voting public that its repeal would throw out a number of popular babies with the unpopular bath water.
Perhaps the most overlooked bright spot in the ACA is its emphasis on preventive medicine. The American Public Health Association argues that the ACA, if properly implemented, could “transform our health system from one that treats sickness to one that promotes health and wellness.”
Appalling bellwethers illustrate the need. The infant mortality rate in the
Innovations in modern medicine may be proceeding apace, but an unfair system of health financing combined with inadequate public health infrastructure is leaving people behind. The harsh truth is that expensive treatments without preventive public health measures only make inequality worse.
The ACA has the potential to breathe new life into preventive care, long a low priority. Health insurance by its nature is modeled to address costly, catastrophic health problems on the back end, rather than preventive measures up front. This could well change under the ACA, which requires that insurers, including Medi- care, provide preventive health services without co-pay (though provocatively it does not fully require this of Medicaid, whose impoverished clientele apparently remain a lesser priority).
The ACA creates a new body within the Department of Health and Human Services to coordinate public health at the federal level. This promises more effective allocations of new resources, but questions remain over how much new funding will be there at all in the coming years. The ACA promises $15 billion in new funding for public health, including community prevention initiatives, disease surveillance, research, and accessible community clinics. These funds could be misused or diverted in the best of times, let alone if future leaders are hostile to the enterprise.
With new funding at stake, the time- honored question of “who gets what” will only intensify. Public health activism at the grassroots level will be essential. Preventive care must be politicized, thus subject to democratic scrutiny. The movement for universal “primary care” by village activists and health workers in developing countries spearheaded one of the most concerted efforts to realize health equality. By doing so this movement raised awareness about the political, social, and economic determinants of health.
The primary care movement’s culminating document, the World Health Assembly’s 1978 Alma Ata declaration, in effect served as an indictment to extreme laissez faire capitalism. Grassroots care coincided with grass- roots activism.
Will the ACA help or hinder a similar movement domestically? Time will tell, but what is clear is that the ACA increases the number of stakeholders in our public health system. It grants access to the poor, the sick, the young, the unemployed, and relies on emerging classes of health professionals who promise to play expanded roles in underserved communities. Better education, monitoring, and surveillance embedded in the ACA may well make evidence-based public health activism more effective, as well as more likely.
Finally it is worth remembering that, far from being top-down, much about the ACA’s implementation is left to states. This is frustrating because many states will defy principles of health equality in the coming years. More funding for preventive care may merely replace funds cut by cash strapped states. Promising new funds for Medicaid, a system the ACA relies on to expand coverage, will meet state health systems that have undergone devastating divestitures.
This is what health care reform looks like in the age of austerity.
Lingering state budget crises remain an existential threat to expanding access. Nevertheless, state innovation will be essential. Recall that
Joshua K. Leon is an assistant professor of Political Science and International Studies at
Z Magazine Archive
CUBAN 5 - From May 30 to June 5, supporters of the Cuban 5 will gather in Washington DC to raise awareness about the case and to demand a humanitarian solution that will allow the return of these men to their homeland.
Contact: email@example.com; firstname.lastname@example.org.
BIKES - Bikes Not Bombs is holding its 24th annual Bike- A-Thon and Green Roots Festival in Boston, MA on June 3, with several bike rides, music, exhibitors, and more.
Contact: Bikes Not Bombs, 284 Amory St., Jamaica Plain, MA 02130; 617-522-0222; mailbikesnotbombs.org; www.bikesnotbombs.org.
LEFT FORUM - The 2013 Left Forum will be held June 7-9, at Pace University in NYC.
Contact: 365 Fifth Avenue, CUNY Graduate Center, Sociology Dept., New York, NY 10016; http://www.leftforum.org/.
VEGAN FEST - Mad City Vegan Fest will be held in Madison, WI, June 8. The annual event features food, speakers, and exhibitors.
Contact: 122 State Street, Suite 405 B, Madison, WI 53701; email@example.com; http://veganfest.org/.
ADC CONFERENCE - The American-Arab Anti-Discrimination Committee (ADC) holds its annual conference June 13-16 in Washington, DC, with panel discussions and workshops.
Contact: 1990 M Street, Suite 610, Washington, DC, 20036; 202-244-2990; convention @adc. org http://convention.adc.org/.
CUBA/SOCIALISM - A Cuban-North American Dialog on Socialist Renewal and Global Capitalist Crisis will be held in Havana, Cuba, June 16-30. There will be a 5-day Seminar at the University of Havana, plus visits to a co-op and educational and medical institutions.
Contact: firstname.lastname@example.org; http://www.globaljustice center.org/.
NETROOTS - The 8th Annual Netroots Nation conference will take place June 20-23 in San Jose, CA. The event features panels, trainings, networking, screenings, and keynotes.
Contact: 164 Robles Way, #276, Vallejo, CA 94591; email@example.com; http://www.netrootsnation.org/.
MEDIA - The 15th annual Allied Media Conference will be held June 20-23, in Detroit.
Contact: 4126 Third Street, Detroit, MI 48201; http://alliedmedia.org/.
GRASSROOTS - The United We Stand Festival will be hosted by Free & Equal, June 22 in Little Rock, Arkansas. The festival aims to reform the electoral process in the U.S.
LITERACY - The National Association for Media Literacy Education (NAMLE) will hold its conference July 12-13 in Los Angeles.
Contact: 10 Laurel Hill Drive, Cherry Hill, NJ 08003; http://namle.net/conference/.
IWW - The North American Work People’s College will take place July 12-16 at Mesaba Co-op Park in northern Minnesota. The event will bring together Wobblies from across the continent to learn skills and build one big union.
PEACESTOCK - On July 13, the 11th Annual Peacestock will take place at Windbeam Farm in Hager City, WI. The event is a mixture of music, speakers, and community for peace. Sponsored by Veterans for Peace.
Contact: Bill Habedank, 1913 Grandview Ave., Red Wing, MN 55066; 651-388-7733; firstname.lastname@example.org; http://www. peacestockvfp.org.
LA RAZA - The annual National Council of La Raza (NCLR) Conference is scheduled for July 18-19 in New Orleans, with workshops, presentations, and panel discussions.
Contact: NCLR Headquarters Office, Raul Yzaguirre Building, 1126 16th Street, NW, Washington, DC 20036; 202-785-1670; www.nclr.org.
ACTIVIST CAMP - Youth Empowered Action (YEA) Camp will have sessions in July and August in Ben Lomond, CA; Portland, OR; Charlton, MA. YEA Camp is designed for activists 12-17 years old who want to make a difference.
Contact: email@example.com; http://yeacamp.org/.