Ever feel like you've been cheated? #1: Obama and healthcare

Remember when the whole world seemed to feel the same way as Randy Marsh? It’s only just over a year since the US exploded with excitement at the idea that Barack Obama’s election meant that real change was coming to America.

But what has actually happened? Obama has been the latest of a series of governments elected on a wave of hope, only to disappoint their supporters. From the SNP Scottish Government to President Lula in Brazil to New Labour, people have learned again and again that promises of “change” are hollow unless those elected are really ready to fight the powerful forces that keep things the way they are.

In the first of a series exposing the bullshit promises of political fakers, Leftfield sets out to investigate the real record of the Obama Presidency so far. The best place to start seems to be the greatest battleground that the right has tried to defeat him on: healthcare reform.

If you did Higher Modern Studies, or you’ve seen Michael Moore’s brilliant ‘Sicko’, then you’re probably well aware the US isn’t a good place to get sick. Almost all hospitals and doctor’s surgeries are privately-owned profit making companies. They charge huge sums for life saving treatment, which people pay for by taking out insurance policies. The insurance companies and the healthcare companies form an unholy alliance that pours huge sums of money into the campaigns of all Presidential and Congressional candidates, making sure that both the Democrats and the Republicans continue to uphold their business interests.

Obama: Let down

Around 15% of Americans have no access to any kind of health insurance. That doesn’t sound like a lot until you realise it’s 46 million people. Far more people are “underinsured”, that is they can’t afford full insurance for everything that might happen to them. And, as Sicko so powerfully shows, even those with insurance are regularly cheated when insurance companies move the goalposts to try and avoid paying for treatment that is included within policies.

Insurance companies are some of the most publicly hated institutions in the US, precisely because people know that they care only about profit, and cheat thousands out of their right to life. Not content with this, the insurance and health companies have years been lobbying European governments to try and undermine socialised medicine over here, and so expand their potential market. A lot of the attacks on the NHS in the UK have received political support from these same companies.

Some limited numbers of people do get government help with their healthcare in America. War veterans get support. And there are also two government programmes, Medicare and Medicaid. Medicare is a federal (that is, provided by the national government) programme providing health insurance to the elderly and certain special categories of disabled people. Medicaid is a programme administered by the different states, but part funded by the federal government, that provides some means-tested help to poor people. Being poor however is no guarantee of support: an estimated 60% of Americans living in poverty do not receive Medicaid, because they don’t meet the required criteria.

One of the major problems in the US is that there are so many different programmes that provide health insurance-you can take out a policy with a company, have a programme through your employer, or a host of other options. It adds up to huge amounts of bureaucracy and costs to patients. 31% of the cost of healthcare in the US is spent on administration and bureaucracy.

An estimated 100, 000 Americans a year die because they couldn’t afford proper healthcare. Healthcare costs the individual more in the US than in any other country in the world, which shows how absurd it is to oppose a fairer system if it would mean raising taxes: they’re already paying way over the odds! Medical debt is a factor in 62% of American personal bankruptcies, as people struggle to pay the money required to keep their families alive. As a whole, the US spends more of its total income on healthcare costs than any other United Nations member apart from East Timor.

The USA is the only industrialised country on Earth that doesn’t recognise healthcare as a right, and provide universal access to free healthcare. When Obama came to power, many dared to hope that the US was about to catch up with what Britain was able to achieve in 1945, and establish universal healthcare.

Tea party protestors: Mental

Obama has made healthcare reform a major focus of his Presidency. In the process, the right wing has gone absolutely bananas, accusing him of being a socialist. Looking at the Tea Party crazies, it seems like what he wants must be at least a bit good if these people are against it. The stakes are definitely high: the right has won every battle on healthcare reform in the US since the ’40s.

There are two different versions of a healthcare reform bill that have gone through Congress, one passed by the House of Representatives and one through the Senate. The Senate bill will probably form the basis of the final laws, if they get passed.

All through the process of putting together his proposals, Obama has kept his door open to insurance, healthcare and pharmaceutical companies, meeting with them time and again to make sure, behind the scenes, and away from all the “socialism” bullshit, the capitalist healthcare industry was still happy with what he was proposing.

The Obama proposals will indeed extend health insurance to the uninsured-by forcing them to buy expensive private insurance or face a legal penalty. Obama has compared it to forcing drivers to buy a driver’s licence. Although initially there was a plan to set up a publicly run health insurance company, that was killed off by the right in Congress. Even if it had been set up, it was estimated it would only have helped 2% of Americans with their healthcare costs.

Obama has also made a big deal about how his proposals will stop insurance companies discriminating against those with pre-existing conditions. What this means is that when you get sick, insurance companies employ their own doctors who try to prove that you were already sick at the time you took out the policy, so they can avoid paying for your care. However, Obama’s plan won’t ban this. Instead, you’ll just pay up to 50% more. Oh, that’s ok then.

Part of the concessions made to insurance companies and the right in order to get something passed included scrapping a lot of regulation that currently tries to force them to behave themselves. Insurance companies will also be allowed to move their base of operations to states with the least consumer protection.

Other concessions to the right include the exemption of abortion from coverage under health plans, and the fact that undocumented migrants to the US will receive no coverage.

Effectively, the law, if passed, will force Americans to fork out more money to insurance companies, increasing their stranglehold over healthcare. At the same time, an “expert panel” is going to be appointed to try and “slash costs” in Medicare, i.e. try and reduce the quality of care the programme provides.

But the greatest scandal of all is the so-called “Cadillac tax.” A minority of workers in the US who are in jobs that are still well unionised have been able to force employers to provide “expensive” health insurance, that is health insurance that provides more money for healthcare than more basic policies. Obama proposes to put a 40% tax on these policies to pay for his reforms, taking away hard won benefits from struggling workers. The unions had promised to fight this proposal tooth and nail, but in January Obama pulled union leaders into the White House for a private meeting where he bullied them into accepting this outrageous proposal. In return they got a slight raising of the threshold required for this tax to kick in. However, the overall result will be that less employers will provide good health policies, forcing more workers to buy private insurance.

I see what you guys did there!

The so-called “Cadillac” policies aren’t even that great. Often, they aren’t more expensive because they provide better care, but because the private insurance companies have calculated that workers in dangerous industries, or older people or whoever are greater insurance risks, and so charge higher premiums.

The whole healthcare system in the US is incredibly complex and difficult to understand. Obama’s proposals are also really complex, and difficult to fathom. But the main upshot of them is that little will change for the better, and several things will change for the worse. Weakening and cutting the existing better health plans, they will force more people to buy private insurance out of their own pocket. In the process, billions of dollars will be transferred from the working class to insurance companies.

They do nothing to address the elephant in the room-insurance companies are hugely profitable entities that have massive control over the political process. The idea that the American health system represents free enterprise and competition is completely wrong, because these companies are big enough and powerful enough to operate as cartels, and completely control working class Americans’ access to life saving care.

A lot of the weakness of the final proposals has to do with the weakness of unions in the US. The fact that there is no socialised medicine is a major factor in why they are so weak. For 30 years unions have been forced into defensive battles against employers. Instead of fighting for higher wages, they’ve been fighting to try and prevent companies getting out of their obligations to provide healthcare for their employees, which effectively means a wage cut as workers have to pay more for essential help. As a result, wages haven’t risen seriously for decades, and union membership has collapsed. Union bureaucrats are so tied into the Democratic party as they only game in town they are willing to concede on what were once declared to be lines that wouldn’t be crossed, like the “Cadillac tax”.

Depressed yet? Looking at how all the enthusiasm of millions of working class Americans has been squandered by Obama’s sell out to corporate healthcare could well turn many away from attempting to bring about political change.

A protestor demanding Single Payer

But there is a silver lining to the cloud. The insanity of the current debate has galvanised a whole series of grassroots campaigners to fight for what, to the rest of us, seems blatantly obvious. A single payer system, i.e. all healthcare costs being paid for by the state, as happens in Europe, with the NHS, and in virtually every country with governments that have half a brain cell.

Radical trade unionists have been at the forefront of this battle. The Labor for Single Payer Campaign has correctly recognised the fight for an American NHS as one of the greatest battles that must be won if unions and the working class are to stand a chance of making any progress. Last year they forced the AFL-CIO (which is a bit like the American version of the TUC or STUC) to support the demand for single payer healthcare. Unfortunately, the AFL-CIO has not followed up this call with actual campaigning, or by putting demands on Obama. This just shows the need for socialists and radicals in the trade union movement to fight all the harder for control of their unions, to try and force them to take a fighting stance.

Doctors all across the US have come out in support of the campaign as well. Organised by the Physicians for a National Health Programme campaign, they have brought a lot of attention to the issue in the media.

One of the most prominent campaigning doctors is Margaret Flowers MD. In his State of the Union speech in January, Obama called for anyone that had a better idea for reform than his own to come forward. In response, Dr Flowers, a pediatrician from Baltimore, tried to hand deliver a letter outlining the case for Single Payer to the White House. The security guards turned her away, saying they couldn’t accept hand delivered letters. What they left out, of course, was unless you represent the insurance industry, in which case you’ll get invited in to meet White House staff.

Independent socialist Senator Bernie Sanders, who has had some contact with the SSP in the past, did introduce a bill proposing to extend Medicare to all Americans, and establish a single payer system for the US. Predictably, it was voted down. However, similar proposals look like having a good chance of passing in Sanders’ home state of Vermont. And the state of California’s State Assembly has passed Single Payer plans on several occasions, only to have them vetoed by Governator Schwarzenegger.

The proposal for a Single Payer health system is hardly radical stuff, or the final shape that we’d see healthcare being delivered if there was a socialist system. But even this first baby step in the right direction hasn’t been made in the US yet. The emergence of massive grassroots campaigns for decent, state provided healthcare is the first real sign of potential progress in decades.