Health Reform: Theirs and Ours

Corporate health “reform” has gotten the congressional votes it needed and the public relations spin is on. Now that the “deeply conservative” Barack Obama[1] and his fellow corporate Democrats have pushed their big business-friendly measure – devoid of any public insurance option to counter the power of the insurance oligopoly– through the House and Senate, the reigning bipartisan U.S. political-media culture is pushing two childish narratives:  the “liberal” Democratic one of an “historic" people’s victory and the “conservative” Republican one of a dangerous and “socialist” “government takeover.”

“The Industry Has Already Accomplished Its Goal” (August 2009)

These two, mutually reinforcing fairy tales both delete the harsh state-capitalist reality imposed by the “unelected dictatorship of money”[2] in this as in so many other Washington policy dramas. As Business Week candidly told its elite readers last August:  

“As the health reform fight shifts this month from a vacationing Washington to congressional districts and local airwaves around the country, much more of the battle than most people realize is already over. The likely victors are insurance giants such as UnitedHealth Group, Aetna, and WellPoint. The carriers have succeeded in redefining the terms of the reform debate to such a degree that no matter what specifics emerge in the voluminous bill Congress may send to President Obama this fall, the insurance industry will emerge more profitable. Health reform could come with a $1 trillion price tag over the next decade, and it may complicate matters for some large employers. But insurance CEOs ought to be smiling.”

“...The [insurance] industry has already accomplished its goal of at least curbing, and maybe blocking any new publicly administered insurance program that could grab market share from the corporations that dominate the business.”[3]

Significantly, Business Week noted that industry executives had “already offered” such “concessions…as accepting all applicants, regardless of age or medical history.” Such concessions “make a government-run competitor unnecessary,” UnitedHealth’s Oxford-educated Vice President Simon Stevens (a former advisor to neoliberal British Prime Minister Tony Blair) told leading administration and elected officials in Washington. "We don't think reform should come crashing down because of [resistance to] a public plan," Stevens argued. “Many congressional Democrats have come to the same conclusion,” Business Week noted.

The key point for the corporate “health” insurance syndicate was to block any public competition/alternative and the insurance moguls were quite ready to give on “pre-existing conditions,” lifetime benefit caps and the like. “Reform” was in the air and had support from many large business, political, and professional interests, not just the nation’s working-class majority. A popular new president had staked his reputation and perhaps his re-elections chances on some (almost any) version being passed. It was going to happen, the insurance and drug companies knew.  The leading insurance firms' goal,  successfully achieved more than half a year ago, was to “redefine” and set the terms of reform in a way that left core corporate prerogatives intact and unchallenged by popular public alternatives.

Of course, the insurance industry’s big managers and investors will make out like bandits in ways that go beyond killing the public option and which will more than compensate them for “concessions” on some of their most vile and egregious practices (which they knew to be doomed).  Insurance premiums can be expected to continue their deadly rise and the mandate that tens of millions of Americans buy private insurance or face fines will boost profits.  The “reform” bill prohibits the government from negotiating prices with drug companies and from permitting the importation of drugs.  The insurance companies will remain exempt from antitrust laws.

Irrelevant Public Opinion

"And dominate policy” in defiance of irrelevant public opinion," Business Week might have added to its description of the big insurance firms. Majority sentiment on the health care issue had long stood well to the left of business parties and the dominant political class and media, as polling data revealed.  Contrary to politicians’ and dominant (corporate) media pundits’ insistent claim that the public insurance option lacked popular support: 

* 69 percent of Americans think it is the responsibility of the federal government to provide health coverage to all U.S. citizens (Gallup Poll, 2006). 

* 59 percent of Americans support a single-payer health insurance system (CBS/New York Times poll, January 2009).

* 59 percent of doctors back a single-payer system (Annals of Internal Medicine, April 2008).

* In a remarkable CBS-New York Times poll conducted in late September of 2009, 65 percent of more than 1,000 Americans randomly surveyed by CBS and the Times responded affirmatively to the following question: “Would you favor or oppose the government offering everyone a government-administered health insurance plan – something like the Medicare coverage that people 65 and over get – that would compete with private health insurance plans?”[4]

But so what? Who cares? Certainly not the editors of Business Week or the executives and owners of the leading insurance companies, for whom the “reform” bill is a boon. Citizen opinion and democratic theory – according to which the government and the citizenry are the same – are fine and dandy. Things are different in the real world of wealth, power, propaganda, and policy, where government is beholden to the Few, the “real players” are the ones with the deep pockets, and “politics is the shadow cast on society by big business,” as John Dewey noted more than a century ago.

In detailing how the insurance giants were compromising Obama’s initial promise to increase government’s role in the health care market at every step last summer, Business Week noted the special contribution of John Sheils, an actuary employed by the Lewin Group, a corporate consulting firm in Falls Church, Va. According to Sheils, in a dubious “finding” that UnitedHealth used again and again to move federal legislators (including Democratic Senator Mark R. Warner of Virginia) off the public option, “88 million people, or 56% of those with employer-provided coverage, would desert private insurance for a government-run program. That would destabilize the marketplace and potentially kill the private insurance industry.” As it peddled this suspect “scientific” claim (questioned by the Congressional Budget Office) purporting to project a supposedly horrible outcome – many Americans would be less than devastated to hear that the extortionist insurance industry had collapsed (!)– resulting from a public insurance option, UnitedHealth did not advertise the fact that it owned the Lewin Group and therefore paid Sheils’ salary.

Obama’s Secret Accomplishment

Obama is already being hailed by his “liberal” and partisan base for “heroically” leading and the passing “the first comprehensive health reform in U.S. history.” This narrative should not be accepted without serious qualification. It is unwise for leftist critics of corporate power (I am one)  to downplay the significance of the bill’s promise to expand coverage to tens of millions who currently lack insurance or of the bill’s measures to end some of the insurance industry’s most revolting practices (yearly and lifetime benefit caps, slashing coverage for people who become sick, and refusing coverage to older people and those with pre-existing medical conditions).  These are changes that anyone who is not hopelessly alienated would want to support; we should not be seen as sneering at them (or as being allied with right-wingers denouncing the reform for some very ugly reasons).  

Still, a heath reform of some “comprehensive” nature has been in the offing for some time now, for reasons (not the least of which includes the fact that much of the corporate sector has come to want [business-friendly] “health reform”) already mentioned. And contrary to propaganda on both sides of the (narrow) bipartisan spectrum, the insurance companies have been more than ready to “give” on their most vile practices and to see coverage nearly universalized as long as the policy deal leaves their core cost-driving and profit-making powers and oligopolistic structure intact and as long as they were nicely compensated for their “concessions.”

The real question was not whether there would be a health care reform, but whether the reform would be on the people’s terms or on those of the big insurance and drug companies and their Wall Street backers.  Obama’s great hidden accomplishment – certain to be buried and ignored by dominant U.S. mass media – has been to secure a reform that expands coverage and abolishes vile and arcane industry practices without fundamentally challenging concentrated corporate and financial power in the health care sector.

What “the Left” (and the Majority of the Population) Wants as “Too Disruptive” and “Politically Impossible”

During an interview with FOX News’ Brett Baier last week, Obama said this about his health bill: “Now, we can fix this in a way that is sensible, that is centrist. I have rejected a whole bunch of provisions that the left wanted that are – you know, they were very adamant about because I thought it would be too disruptive to the system.”[5]

That was a very revealing statement.  It speaks volumes about Obama’s “deeply conservative” essence (see note 1 below). What horrid “disruptive” and “system”-threatening provisions were advanced by the “left” and properly rejected by the supposedly “progressive” president? The public option, drug re-importation, and direct Medicare drug price negotiations, not to mention single-payer option, designed to  save the country $350 billion a year in corporate insurance company bureaucracy (dedicated largely to denying care to and to marketing) and profits – the two major and interrelated factors behind  escalating health care costs.

Never mind that these sane and sensible “Left” measures were supported by most Americans. They had to be demonized by the President and his fellow noble “centrists” as too dangerous and radical because big insurance and drug companies and their Wall Street backers hate such policies - for obvious reasons.

Along the way, conventional political and media wisdom claimed that such measures lacked “political support.”  They “didn’t have ‘political support,” the leading left intellectual Noam Chomsky quips, “just the support of the majority of the population, which apparently is not political support in our dysfunctional democracy.” As Chomsky ads, “There should be headlines explaining why, for decades, what’s been called politically impossible is what most of the public has wanted.  There should be headlines explaining what that means about the political system and the media.”[6]

There’s a lot of big money behind the insistence that Obama and the Democrats advance the notion that the truly progressive health reform irrelevantly favored by most Americans is too hazardous and extremist to consider. The health sector poured a remarkable $178,252,901 into congressional and presidential campaigns between the beginning of the 2008 election cycle and the summer of 2009.  The insurance industry invested $52,739,320. Obama received more than $19 million from the health sector for the 2008 election cycle – a new record.[7]  The prolific author and former New York Times reporter Chris Hedges reports that “the five largest private health insurers and their trade group, America’s Health Insurance Plans, spent more than $6 million on lobbying in the first quarter of 2009. Pfizer, the world’s biggest drug maker, spent more than $9 million during the last quarter of 2008 and the first three months of 2009.”[8]

“About Increasing Corporate Profit at Taxpayer Expense”

What can we expect from the “historic reform” now moving its way to the president’s desk? After overdue and elementary changes (many maddeningly delayed until 2014 and after) that any civilized human would want (the expansion of Medicaid and abolition of the right to deny coverage to people with pre-existing conditions, for example), the bill gets much less than exciting from a progressive perspective.  Besides blocking single payer (banned from the health policy debate from the beginning of the neoliberal Obama administration) and a public option (downsized and then completely stripped out over the last year) and thereby leaving the for-profit insurance mafia essentially unchallenged, the bill will grant untold billions (trillions over multiple years and decades) of dollars worth of subsidies to that mafia.  It will identify “universal care” with government coercion requiring citizens who are not deeply poor to buy that mafia’s persistently pricey products.  As Hedges notes, “Families who cannot pay the high premiums, deductibles and co-payments, estimated to be between 15 and 18 percent of most family incomes, will have to default, increasing the number of uninsured. Insurance companies can unilaterally raise prices without ceilings or caps and monopolize local markets to shut out competitors. The $1.055 trillion spent over the next decade will add new layers of bureaucratic red tape to what is an unmanageable and ultimately unsustainable system….This bill is not about fiscal responsibility or the common good. The bill is about increasing corporate profit at taxpayer expense. It is the health care industry’s version of the Wall Street bailout. It lavishes hundreds of billions in government subsidies on insurance and drug companies.”

No wonder that “health care stocks and bonuses for the heads of these corporations are shooting upwards.”[9] It’s a good time to invest in the insurance syndicate.

“First We Have to Take Back the White House…”

For what its’ worth, my sense is that the United States cannot have truly progressive health reform in accord with the national majority’s longstanding support of progressive change without removing the for-profit insurance companies from the equation by introducing the obvious social-democratic and cost-cutting solution: single-payer government health insurance. Obama knows this himself - in a part of his mind rendered inactive by his love for power.  When Obama claims (soon) to be the first president to have passed real health reform in the U.S., he won’t say anything about the following comments (available on YouTube) he made as a state senator (speaking to the Illinois AFL-CIO) in the summer of 2003:

“I happen to be a proponent of a single--payer universal health care program. I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14 percent of its Gross National Product on health care cannot provide basic health insurance to everybody. And that's what Jim is talking about when he says everybody in, nobody out. A single payer health care plan, a universal health care plan.”[10]

This statement was made just prior Obama's realization that he had a serious shot at national office - a realization that sharpened his willingness to subordinate himself to the aforementioned “unelected dictatorship.”

Speaking of the struggle for single-payer in 2003, Obama said “we may not get there immediately. Because first we have to take back the White House, we have to take back the Senate, and we have to take back the House”[11].  Nearly seven years later, the federal legislative and executive branches have been “taken back” by the Democratic Party.  Sadly, however, the United States’ corporate-managed “dollar democracy” and its narrow “one-and-a-half party system” (Sheldon Wolin) have yet to be taken back from concentrated wealth and the related giant military industrial complex that Dwight Eisenhower had warned about upon leaving the White House.[12]  The United States’ “representative democracy” remains crippled by “too much [corporate and military] representation” and too little [actual popular] democracy” (Arundhati Roy)[13] under Obama no less than in the Bush-Cheney years.  Far from being an exception to this tragic reality, the current “health reform” is an epitome of it.

The Conyers-Kucinich Congressional Cave

The most pathetic part of the story, perhaps, is the willingness of such supposed fierce congressional single-payer advocates as John Conyers and Dennis Kucinich to support the corporate reform model advanced by Obama, Pelosi, and Reid et al. One might (naively) think that a president who exhibits such clear and unprincipled scorn for progressive ideals he once trumpeted would face strong resistance from the Progressive Caucus.  But no, every single member of that group that once pledged to oppose any final bill without a public option caved in and traded in their not-so deeply held principles to help score a partisan victory for a bill that will “enrich and strengthen the same industries that comprise our immoral health care system.”[14]

Yet again we see that true progressive change can never come from within or through the Democratic Party.[15] Nor can such change be achieved with or through such “progressive” and activist organizations as Move.On, which gathered more than $1 million to pressure House Democrats who had originally voted “no” on corporatist health reform to recant their previous rejection of Obama’s proudly "centrist" (by his own description) bill [16],  The corporate-managed fake democracy that cloaks the unelected and interrelated dictatorships of money and empire in the U.S. is a richly bipartisan affair.  The Democrats’ health reform offers more evidence of this harsh reality.  

Paul Street (paulstreet99@yahoo.com) is the author of many articles, chapters, speeches, and books, including Empire and Inequality: America and the World Since 9/11 (Boulder, CO: Paradigm, 2008); Racial Oppression in the Global Metropolis (New York: Rowman & Littlefield, 2007; Segregated School: Educational Apartheid in the Post-Civil Rights Era (New York: Routledge, 2005); and Barack Obama and the Future of American Politics (Boulder, CO: Paradigm, 2008). Street’s next book The Empire’s New Clothes: Barack Obama in the Real World of Power (Boulder, CO: Paradigm, 2010), will be released next summer.

NOTES

1. This accurate description of Obama belongs to the centrist journalist Larissa MacFarquhar in the spring of 2007. “When he talks about poverty,” MacFarquhar noted, “he tends not to talk about gorging plutocrats and unjust tax breaks: he says that we are our brothers’ keeper, that caring for the poor is one of our traditions.” Such refusal to advance large reform – e.g. single payer health insurance on the Canadian model (which Obama claimed to advocate as late as the summer of 2003 however) – reflected what MacFarquhar found to be Obama’s “deeply conservative” take on history, society and politics: “In his view of history, in his respect for tradition, in his skepticism that the world can be changed any way but very, very slowly, Obama is deeply conservative. There are moments when he sounds almost Burkean. He distrusts abstractions, generalizations, extrapolations, projections. It’s not just that he thinks revolutions are unlikely: he values continuity and stability for their own sake, sometimes even more than he values change for the good. Take health care, for example. “If you’re starting from scratch,” he says, “then a single-payer system”—a government-managed system like Canada’s, which disconnects health insurance from employment—“would probably make sense. But we’ve got all these legacy systems in place, and managing the transition, as well as adjusting the culture to a different system, would be difficult to pull off. So we may need a system that’s not so disruptive that people feel like suddenly what they’ve known for most of their lives is thrown by the wayside”…Asked whether he has changed his mind about anything in the past twenty years, he says, “I’m probably more humble now about the speed with which government programs can solve every problem. For example, I think the impact of parents and communities is at least as significant as the amount of money that’s put into education.” MacFarquhar found that Obama’s “deep conservatism” was why “Republicans continue to find him congenial, especially those who opposed the war on much the same conservative grounds that he did.” She noted that some of Bush’s top fund-raisers were contributing to Obama’s campaign and observed that Obama garnered 40 percent of the Republican vote in his 2004 Senate victory. See Larissa MacFarquhar, “The Conciliator: Where is Barack Obama Coming From?” The New Yorker (May 7, 2007).

2. This excellent phrase belongs to Edward S. Herman and David Peterson, “Riding the ‘Green Wave’ at the Campaign for Peace and Democracy and Beyond,” Electric Politics, July 22, 2009.

3. Writers and editors are often more candid about things in the business press since the relatively privileged and heavily indoctrinated audience of that press is considered safe. At the same time, the elite business and coordinator class audiences/markets of the business press have (since their members commonly play managerial roles that matter) to be somewhat accurately informed about events and developments. They can't be kept in the fantasy world that corporate media creates for the dangerous working- and lower -class majority – the dreaded citizen mass or “rabble.” 

4. New York Times-CBS Poll, “Confusion Over Health Care,” survey of 1,042 adults, September 19-23, question number 57, p. 15 of 26, poll results at http://documents.nytimes.com/new-york-times-cbs-news-poll-confusion-over-health-care-tepid-support-for-war#p=15

5. “President Barack Obama Talks to Bret Baier About Health Reform,” FOX News, March 17, 2010, read at http://www.foxnews.com/story/0,2933,589589,00.html. 

6. Sahil Kapur, “Chomsky: Health Bill Sustains the System’s Core Ills,” The Raw Story (March 22, 2010), read at http://rawstory.com/2010/03/noam-chomsky-health-bill/.

7. Data from the Center for Responsive Politics “Open Secrets” Web site.

8. Chris Hedges, “The Health Care Hindenburg Has Landed,” Truthdig (March 22, 2010), read at http://www.truthdig.com/report/item/the_health_care_hindenburg_has_landed_20100322/.  To make matters worse, Hedges notes that “Up to 30 members of Congress …who hold key committee memberships have major investments in health care companies totaling between $11 million and $27 million. President Barack Obama’s director of health care policy, who will not discuss single payer as an option, has served on the boards of several health care corporations.” Pretty vile.

9. Hedges, “Health Care Hindenburg.” “Take a look at the health care debacle in Massachusetts, a model for what we will get nationwide,” Hedges rightly ads.    ”One in six people there who have the mandated insurance say they cannot afford care, and tens of thousands of people have been evicted from the state program because of budget cuts.”

10. "Obama on Single Payer Health Insurance," June 30, 2003, YouTube video clip at http://www.1payer.net/All-Videos/obama-on-single-payer.html. See also YouTube link at http://www.youtube.com/watch?v=fpAyan1fXCE

11. “Obama on Single Payer Health Insurance.”

12. “Eisenhower’s Farewell Address” (January 17, 1961), read at http://en.wikisource.org/wiki/Military-Industrial_Complex_Speech

13. Arundhati Roy, “Democracy’s Fading Light,” Outlook India Magazine (July 13, 2009) at http://www.outlookindia.com/article.aspx?250418.

14. Firedog Lake, March 18, 2010, read at http://seminal.firedoglake.com/diary/35866.

15. For an excellent history and analysis of the Democratic Party, see Lance Selfa, The Democrats: A Critical History (Chicago: Haymarket, 2008). For a detailed review of Selfa’s book, see Paul Street, “A Left Case Against the Democrats,” International Socialist Review (May-June 2008).

16. Hedges, “Health Care Hindenburg.”