Against Obamacare
CHRIS MAISANO
The fight over healthcare reform enters a crucial phase this week. The Congressional committee charged with drafting legislation on reform is scheduled to start voting on Wednesday. President Obama made a major speech outlining his intentions to the American Medical Association, which has come out in opposition to important aspects of his proposed reforms, especially the so-called “public option.” And the Congressional Budget Office, the agency charged with reviewing the budgetary implications of proposed legislation, released a study on the likely outcomes of the leading Democratic plan. It wasn’t pretty.
As a report in the New York Times made clear, the administration’s “reform” proposals fail to do what any sort of legitimate reform should have as its two central goals: cost containment and universal coverage. The CBO estimates that establishing the Obama plan would cost a staggering $1 trillion over ten years, and would only cover a net total of 16 million people who currently lack insurance, leaving 36 million people uninsured by 2017.
Some Democrats have proposed introducing taxes on soft drinks and a value-added tax in order to raise the funds necessary to pay for the plan. But why spend an additional $1 trillion when we already spend far more on healthcare than every other industrialized country, with inferior health outcomes? Why resort to labyrinthine legislative schemes that don’t even accomplish the president’s stated goals for healthcare reform? The answers to these questions are obvious, of course. The private health insurance industry and the doctors’ lobby want to sabotage any effort at serious reform, and they have lined the pockets of politicians in both parties (including President Obama) to ensure that single-payer, or at least a legitimate public option that can possibly lead the way to single-payer, remains off the agenda. And Obama’s healthcare proposals once again point up the deeply conservative nature of his conciliatory approach to politics. The private insurers can’t be “brought to the table.” They must disappear, and the only way to do that is through the mobilization of public opinion (which clearly supports single-payer) and through conflict, something that Obama seems congenitally allergic to.
It’s becoming increasingly clear that any sort of healthcare “reform” that comes out of Congress this year is going to be so mutilated by the corporate-dominated legislative process that we’ll wind up with a healthcare system that’s even worse than the one that we have now. Advocates of real universal healthcare need to draw a line in the sand, oppose Obamacare, and continue to organize for single-payer.
For more information on single-payer health insurance, see Physicians for a National Health Program.
On the radio in Massachusetts (and I assume elsewhere) the right wing is launching an short ad saying that politicians are scheming to put in federal healthcare with all the “efficiency” of the post office and the warmth of the IRS. Listening to NPR today, callers were totally out to lunch about what Obama proposes (on one level, it’s nothing, since the plans are in the Senate and House). One caller, of course, called it socialist. Another said we needed a “unique” single-payer system where government is the insurer and hospitals are still private. I said out loud (alone) “that IS single-payer!”
To me the second greatest tragedy of this national debate is no one is being honest. If socialized medicine is on the table, let’s debate it. It’s not, and neither is single-payer. For every knowledgeable activist (right or left) pushing for reform, there is another totally ill-informed voter calling their rep(s) with the wrong info.
My biggest concern is that some analysts are correct in that Obama is trying to please every major player (insurers, doctors, hospital chains, business, some unions, etc.). Finding a real solution that is best for citizens and residents alike means big health insurers have to lose (or at least, god forbid, face a public option that would make them lower costs. Should we shut down the Postal Service so FedEx, UPS, DSL, etc. can have less competition?).
The greatest tragedy of this is what Chris wrote about. The final outcome will be costly, leave people out, and leave single-payer even further out of reach for another 15 years.
Obama is about to cave on his support of a public option in “reform” legislation: “in an interview with CNBC and The New York Times, Mr. Obama expressed a willingness to compromise on his call for a new public insurance plan to compete with private insurers…“We’re open-minded,” Mr. Obama said. “If, for example, the cooperative idea that Kent Conrad has put forward, if that is a better way to reduce costs and help families and businesses with their health care, I’m more than happy to accept those good ideas.”
Conrad’s cooperatives idea is total garbage that will do absolutely nothing to lower healthcare costs because they won’t be big enough to have any leverage in the healthcare market. They’ll just be drowned by the big insurance companies.
http://www.nytimes.com/2009/06/17/us/politics/17health.html?ref=politics
“The private insurers can’t be “brought to the table.” They must disappear, and the only way to do that is through the mobilization of public opinion (which clearly supports single-payer) and through conflict, something that Obama seems congenitally allergic to. ”
I’m not going to debate the issue of public opinion, but do you really think “conflict” and trying to make companies “go away” is going to end in anything but failure or extremely nasty failure (no matter who is running things)? Seems like this isn’t dealing with the world as it is, rather as you would like it to be.
Just having a public option that forces the companies to lower costs, gives the uninsured an option, and likely draws in most people from private insurers anyway (in essence causing people to choose a single payer, since it will be affordable, and causing more companies to go under naturally), would go a long way in my opinion.
Any single payer serves the role of diminishing the insurers, but it seems like you’d rather create a head-on conflict that isn’t necessary for the purpose of creating some sort of class struggle, which isn’t necessary in my opinion. If that’s you’re cup of tea, that’s great. We’re allowed to differ on our perspective of socialism/social democracy here.
Picking up on David’s point, it’s hard to even bring up and defend the single payer solution when misinformed people are railing against “socialized medicine” (which is different and mostly unrelated to insurance reform) or demanding to know why Mr. Obama wants to send their physicians to labor camps in his homeland, Saudi Arabia.
I suspect these red herrings and non-issues are being deliberately injected into the debate by the industry lobbies and their friends in the hack tanks. They work because they force us to waste a lot of time and energy picking through the heaps of bullshit.
Any bill that does anything will be met by opposition from the health insurance companies. Any progressive reform in general will be met by the concerted opposition of groups like the Chamber of Commerce, right-wing think tanks, lobbyists, etc.
These are all class organizations that have been created and are wielded for the purpose of class warfare (very successfully at that). So mobilization from even the most timid of mainstream labor unions for meaningful health care reform is class warfare as well. It just happens to be that segments of the bourgeoisie stand to benefit from and support health care reform (shifting direct burden from employers onto the state).
Any reform we get is the manifestation of class struggle whether you want to acknowledge it or not. Any socialism that doesn’t not only acknowledge, but places paramount, class struggle cannot really be socialism and can at best I guess be considered liberal philanthropy.
“Any reform we get is the manifestation of class struggle whether you want to acknowledge it or not. Any socialism that doesn’t not only acknowledge, but places paramount, class struggle cannot really be socialism and can at best I guess be considered liberal philanthropy.”
It depends on what you see as the defining foundation of socialism. Would you deny that there have been non-Marxist socialist movements within the umbrella of what we would call “socialism”. There is such a thing as a reformist socialism, despite what some insist.
I’m not arguing whether a reformist socialist agenda is possible right now (though I see potential for something similar in the Progressive Caucus), but I would argue that a revolutionary perspective based on class struggle isn’t possible when class consciousness is so helter-skelter in the US (for example, among the conservative poor or the bootstrap-obsessed middle class).
If you don’t agree with that, I at least hope that you can respect why someone might be hesitant to dive into the class struggle perspective, no matter how many quotes from Marxist intellectuals and others you can cite about it being “everything”.
I don’t think Andrew understands what class struggle is. You don’t have to consider yourself a revolutionary to acknowledge that the interests of workers and capitalists are different. John L. Lewis, the driving force behind the founding of the CIO, was no revolutionary, but he understood quite well what class struggle was. Most of the trade unionists in the Labor Notes network aren’t revolutionaries but they understand that their interests differ from those of their bosses. Etc. If you want reforms, you need a critically organized working class ready to fight against corporate power — and corporate politicians — to get reforms. No way around it.
Sorry, I’m getting off track. That’s another discussion for another time.
With regards to HC reform, unfortunately I think that the goodwill of the left has long been squandered by moderate and conservative Democrats who insist on writing as inoffensive a bill as possible. The worst example of this was the shutting out of the single-payer advocates by Max Baucus. That, I think, was a slap in the face to the left by the Democrats, and I doubt that fence can be mended. The best we can hope for now is a plan where a public option with lower costs is so attractive that everyone chooses it and eventually it turns into a sort of backdoor “medicare for all”.
“I don’t think Andrew understands what class struggle is. You don’t have to consider yourself a revolutionary to acknowledge that the interests of workers and capitalists are different. John L. Lewis, the driving force behind the founding of the CIO, was no revolutionary, but he understood quite well what class struggle was. Most of the trade unionists in the Labor Notes network aren’t revolutionaries but they understand that their interests differ from those of their bosses. Etc. If you want reforms, you need a critically organized working class ready to fight against corporate power — and corporate politicians — to get reforms. No way around it.”
Well you could have engaged me in this without the condescending “you dont understand, here let me enlighten you” stuff, but alright.
I, like many other historians, have another view of Marxism, mostly, in my opinion, as a convenient way of viewing history. It’s just not important to me to use this perspective so I just tend to avoid it, but I am aware that there’s a thing called class which does factor into any movement. Maybe I go to far in trying to separate the struggles of classes of people against other classes from the deterministic Marxist perspective which many socialists hold much stock in. I probably do. But I see it as an interesting lens through which to view history, not a blueprint for political success.
Of course, a lot of this is probably just my tendency to deflect any “revolutionary” talk, which stems from having to deal with ISO folks pretty regularly at school.
Andrew, thanks for responding to my piece. Here’s a quick response.
Any sort of legitimate reform of the healthcare system threatens the profits and power of the private insurance companies. They will never willingly accept reform that cuts into those interests. Because of that, it’s going to be necessary to take the industry head on and to engage in political struggle to establish even an effective public option short of full-blown single-payer. Single-payer is probably not politically attainable in the short term, but if you don’t organize for it and demand it forcefully regardless of the current balance of political forces, you’ll be forced to compromise for less than you would want to otherwise. Because single-payer advocates have not been successful in getting it onto the political agenda (largely because of resistance from politicians in the pocket of the insurance industry), any sort of “public option” that comes out of this process is going to watered down to the point that it doesn’t threaten the insurance companies at all. And Obama is already showing signs that he’s backing away from his previous support for a public option, as I pointed out above.
As Frederick Douglass said, “Power concedes nothing without a demand.” And the demand for single-payer health insurance implies a struggle against the insurance companies. You don’t have to be a Marxist or a revolutionary to accept that reality.
@Andrew.
ISO has basically turned me into a liberal.
I don’t see how acknowledging that class struggle exists is Marxist or intellectual. The Chamber of Commerce and the AFL-CIO both engage in it pretty openly and I’m sure they haven’t read “Capital.”
“Just having a public option that forces the companies to lower costs, gives the uninsured an option, and likely draws in most people from private insurers anyway”
That’s why we’re not going to get a serious public option, because those interests are better organized and committed to maximizing their profits.
It’s not really a theory of history or anything, it’s the reason why unions exist, it’s the reason why socialist organizations and labor parties the world over exist.
When the SEIU sends 100 lobbyists to Washington to campaign for a new safety regulation, that’s class struggle. Class struggle isn’t something that socialists create — it happens constantly. It’s the way governments and societies operate. This balance of forces between opposing interests obviously results in agreements and compromise, but that doesn’t mean that their wasn’t struggle.
Maybe I’m misinterpreting your point, and I would be glad to hear it, I’m just actually unaware of any theories that disavow that conflict occurs in society and yields change — that doesn’t seem all that different then contesting the existence of oxygen.
“It’s not really a theory of history or anything”
I’m talking about the Marxist view of history and the deterministic beliefs included in it, not simply a view of history that recognizes that there are classes of people with conflicting interests. Sorry, it’s sorta unclear from what I said.
I’m feeling very pessimistic about reform now. If I had to venture to guess, we’re probably going to get a mandate and not a public option. Perhaps David, being a Mass. resident, can weigh in on how that’s working out up there. I can’t say I’m happy at all.
I misunderstood you then, never mind. I think if the Progressive Caucus stands firm enough we’re going to get a public option, but it may be watered down to the point of uselessness. Your pessimism is unfortunately grounded in reality. The Massachusetts system by all accounts is wholly ineffective.