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May
was not a good month for liberals with illusions in President Barack Obama. Parallel to
a series of statements indicating he would continue his predecessors’
attacks on civil liberties came a well-orchestrated show in the White
House making clear that Obama’s health-care
"reform" would be done by, for, and with the profit-makers in
the industry.
On
May 11, Obama welcomed to the White House
representatives of the industry’s elite, to thank them for a letter
they had issued promising to contain costs. Attendees included
executives from the trade groups for insurers, drug companies, medical
device manufacturers, hospitals, and doctors.
Obama’s "health-reform czar," Nancy-Ann DeParle, comes from these same rarefied circles.
She has made her living advising health-care investors and sits on the
board of many for-profit health-care firms. Also included was the
Service Employees International Union, which The New York Times
credited with having "led efforts to bring the industry groups
together."
Obama portrayed the groups’ promise as a pledge to cut
1.5% each year over the next 10 years from the growth in health-care
costs. The day after the event, industry reps said Obama
was mistaken, that they had made no specific pledges in either amount
or timing. And even Obama couldn’t claim that
the pledge came with any specifics on how the growth in costs would be
restrained.
Obama hyped the industry pledge as "a historic day,
a watershed event." But the privateers were quite open about what
they expected in return: that Obama kill
inclusion of a public plan in his reform package, and that it include a
mandate to force the uninsured to buy insurance from them.
The
industry pledge comes on the heels of other concessions made to fend
off the threat of a new public plan. These include lower rates, or
easing access to coverage, for millions of women, the aged, and the
already sick, who have been the victims of the most flagrant discrimination—which
is only the worst example of insurers’ norm of charging the most, or
denying care altogether, to those most direly in need of care.
Insurers
have been unashamed to say they can’t compete with a public plan. They
admit this is so for the same reasons that single-payer advocates have
always said there should be no private insurance: a government plan
would have an "unfair advantage" because it doesn’t have to
spend on advertising, lobbying, profits, or high salaries. It would
also enjoy economies of scale—an advantage that would aid in
coordination of care, an increasing concern of health-care providers.
Mandates
to buy private insurance are already included in draft legislation put
forward by some Democrats. The party is split on whether to include a
public plan alongside the existing private ones—but all the serious
players in the party are united in their insistence that single-payer
(i.e. Medicare For All) is off the table. Said Democratic House Speaker
Nancy Pelosi: "Over and over again, we hear single-payer,
single-payer, single-payer. Well, it's not
going to be single-payer."
A
Fairness & Accuracy in Reporting study showed that "in the
week leading up to the White House forum, there was a media blackout on
single-payer."
Karen
Ignagni, president of America’s Health Insurance Plans,
said that if Congress required everyone to carry health insurance,
"we could guarantee issue of coverage with no pre-existing
condition exclusions and phase out varying premiums based on health
status"—something that single-payer would do by definition!
However, she said insurers wanted to retain the right to charge
different premiums based on age, residence, and family size.
Ignagni added, "There’s no way to run a side-by-side
competition within the current structure." In a show of heartfelt
concern for her worries, leading Democrats have pledged to hamstring
any new public plan to prevent such "unfair" competition.
For
instance, The New York Times backed a plan put forward by Senator Chuck
Schumer of New York, which it praised for
ensuring that "competition between a new public plan and private
plans would be waged on a regulated field of battle.
"Schumer
has come up with some reasonable principles to ensure competition
between a public plan and private plans would be fair. He suggests that
a public plan should have to comply with the same rules and standards
as private plans: "The public plan could not be supported by tax
revenues or government appropriations but by premiums and
co-payments." In short, the public plan is to be denied many of
the advantages making it superior in the first place.
In
any case, the proposal for a public plan alongside private ones is
generally rejected by single-payer advocates, who point out correctly
that this would not stop the waste of trillions due to the inefficiency
and profit-making of the privateers.
Obama’s dismissal of single-payer advocates had already
been on display at a White House meeting on March 5 to hear proposals
for health-care reform. Single-payer advocates were left off the guest
list until threats of protest forced a last-minute invitation to the
author of the single-payer bill before the House (HR 676), John
Conyers, and to Physicians for a National Health Program leader Dr.
Oliver Fein. Conyers excused Obama’s refusal
to support single-payer by saying, "he's got too much on his
plate—two wars and an economic crisis—and he's got to settle for the
health-care reform he can get."
Obama’s contempt for single-payer was paralleled by the
legislator heading health-care "reform" efforts in Congress,
Democratic Senator Max Baucus. At a hearing on May 5, eight
single-payer advocates, three of them physicians, were arrested for
standing up to ask why their position had been excluded. The
"Baucus Eight" were followed on May 12 by five more,
including two from the California Nurses Association and two doctors
from PNHP. When they shouted, "we need single-payer," Baucus
smirked and replied, "we need more police!" Baucus has
received more campaign contributions from health-insurance and
pharmaceutical corporations than any other current Democratic
legislator.
Single-payer
advocates were also excluded from Senator Ted Kennedy's secret meetings
to craft a legislative approach—but he let in insurance and drug
company lobbyists. The Times reported that the meetings produced a
consensus in favor of mandates. It is increasingly likely that mandates
will be part of the final bill, regardless of whether a public plan is
included or not, and despite Obama’s
dismissal of mandates during the campaign. Thus we seem headed for a
nationwide replay of the failed Massachusetts experiment, which has
been a boon for insurers but has done little to increase coverage or
lower costs for patients.
Certainly,
single-payer will not be passed by Congress. But widespread protest and
educational efforts of its supporters during these discussions have
gained it many new activists.
What’s
more, the question of socializing aspects of health care beyond payment
is already being broached. In a May 16 letter to The New York Times,
Arnold Relman and Marcia Angell,
physicians and former editors of the New England Journal of Medicine,
wrote that "runaway costs are due largely to high overhead
expenses and to the excessive use of expensive technology. Both of
these result from a system organized like a profit-seeking industry
instead of a social service.
"If
we want health care to be a universal entitlement, it cannot be
controlled by market forces and the financial interests of insurers and
providers (and the investors who own such a large part of the system).
Some kind of government-regulated single-payer insurance plan and a
reorganized nonprofit medical care delivery system may be ‘off the
table’ for policy makers right now, but we will never achieve
affordable universal coverage without major reform that deals with the
real causes of medical inflation."
What’s
most striking about their letter is the rare but welcome mention of the
need to socialize not just payment for care, but also its delivery.
This broadening of the discussion comes as the most important actor in
winning genuine health-care reform is stepping up to the plate:
One
of the Baucus Eight was Mark Dudzic, national
coordinator of the Labor Campaign for Single-Payer. The Campaign was
formed at a meeting attended by over 150 representatives from labor
organizations in 31 states that have endorsed HR 676.
The
group has pointed out, "As the economic crisis worsens, unions
have begun to make the connection between the fight at the bargaining
table and the fight for single-payer. In Collinsville, Illinois,
members of the United Steelworkers picketed a Republican Congressman’s
office to demand that he support national health insurance on behalf of
the growing number of furloughed steelworkers faced with the loss of health
insurance. In Santa Ana, California, United Electrical Workers members
challenged their company to support single-payer rather than seek
concessions from the already stressed workforce. ‘Don’t expect us to
pay the costs of the dysfunctional corporate health-care system,’ they
told the company."
Unions
demonstrated at the Obama administration's
second regional Health Care Summit in Burlington, Vt., on March 17 to protest the
exclusion of single-payer and labor voices from the summit. The Labor
Campaign also organized supporters to participate in the May 30 day of
nationally coordinated local actions for single-payer.
The
question of health-care access for workers is becoming more urgent
every day. Some 14,000 people a day are losing their employer-based health-care
benefits—2.4 million just since the beginning of the recession. Less
than 60% of American workers are now covered.
Management
demands for health-care benefit concessions in union contracts have
gotten even harsher since the economic crisis broke. AT&T is right
now demanding steep givebacks in such benefits from 112,500 workers in
the Communications Workers of America, and retired auto workers at GM,
Ford, and Chrysler have been pushed into new health-care plans
half-financed by worthless company stock.
The
initial actions by some in labor are encouraging, especially as they
come in the face of passive acquiescence to Obama’s
support for the privateers by most labor officials—or in the worst
case, that of SEIU—by collaboration with the profit-makers.
Whatever
bill finally issues forth from Washington, the Labor Campaign for
Single Payer has positioned itself well for a second national
conference, at which it could discuss more nationally-coordinated
actions, or perhaps even the first-ever national march in DC for an end
to profiteering at the expense of our health and pocketbooks.
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