Health Care in Crisis

Do the Democrats have a solution?

It’s the deadly calculus of health care in America: Billions of dollars are spent in the name of caring for the sick, yet millions go without the health care they need.

Widespread recognition of this fact has pushed health care reform to the center stage of the battle over who will be the Democratic Party presidential nominee. Hillary Clinton accuses Barack Obama’s plan of “leaving out” 15 million people from “universal coverage,” and Obama charges that by mandating that everyone have insurance, Clinton’s plan penalizes those who can’t afford it.

Angry rhetoric aside–“Shame on you, Barack Obama!” Clinton chastised after Obama supposedly misrepresented her plan in campaign literature–both Democratic candidates are far from proposing the kind of changes necessary to guarantee people the health care they need.

In fact, in important ways, the two Democrats’ plans could make matters worse for people desperate to get quality health coverage, but left with no alternative but a private insurance industry bent on making more profits.

But in the meantime, the debate between Obama and Clinton has created an opportunity for opponents of health care business-as-usual to put their case forward–for a truly universal, single-payer health care plan.

Obama’s and Clinton’s plans do share some long-needed and welcome proposals, including bans on insurance companies using the excuse of “pre-existing conditions” to keep people from obtaining insurance, and requirements for insurance companies to charge the same premiums, regardless of clients’ age or health.

Beyond these, however, Obama and Clinton disagree on who will be insured and how.

Clinton promises a federal mandate that would require everyone to have insurance, but it is unclear about how the mandate would work. Clinton says there would be some sort of help, likely a tax credit, for people who make too much money to apply for Medicaid, but can’t afford high insurance costs. Beyond that, her proposal has been vague on the details.

Though she denies it, Clinton’s plan resembles the 2006 health care law passed by Massachusetts that requires everyone in the state get insurance.

Under the law, people who make up to three times the poverty line–$30,630 for individuals and $41,880 for couples–get a subsidy to help them with purchasing insurance. More than that, and they pay the full price of insurance–which can be anywhere from $1,464 a year for young adults to $9,600 a year for those over 55.

It’s no wonder that, despite the threat of fines that are set to increase to $2,000 in 2008, only 7 percent of the 244,000 people who are uninsured in Massachusetts had bought insurance by December 1, 2007.

In response, the Obama campaign has argued that Clinton’s universal mandate will penalize the middle class. His plan limits mandated insurance to coverage for children alone.

“The only difference between Sen. Clinton’s plan and mine is that she thinks the problem for people without health care is that nobody has forced them to get health care,” Obama said at a Democratic debate in Las Vegas last year. “What I see are people who would love to have health care and can’t afford it.”

But if Obama wanted everyone to have access to affordable health care, he’d support a national single-payer health care plan that covers everyone. Five years ago, he said he supported such a plan.

In 2003, Obama told an audience at an AFL-CIO conference: “I happen to be a proponent of a single-payer 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…

“[E]verybody in, nobody out–a single-payer health care plan, a universal health care plan. That’s what I’d like to see. But as all of you know, we may not get there immediately. Because, first we’ve got to take back the White House, and we’ve got to take back the Senate, and we’ve got to take back the House.”

Now, however, Obama claims he would only support single-payer if he were “starting from scratch”–and, as he told the New Yorker in May 2007, “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.”

Obama’s talks like he’s ready for substantive change, but the truth is that he’s holding it back.

“Obama references two papers by PNHP co-founders Dr. David Himmelstein and Dr. Steffie Woolhandler: Their seminal paper on medical bills as a contributor to bankruptcy (Health Affairs, 2005) and their groundbreaking study on the 31 percent administrative overhead in the U.S. health system (New England Journal of Medicine, 2003),” Physicians for a National Health Program (PNHP) Executive Director Dr. Ida Hellander wrote last May.

“Unfortunately, he doesn’t show any understanding of the implications of either.

“For example, he continues to rely on private health insurance (75 percent of people bankrupted by medical bills had insurance) and insists (like Hillary Clinton) that computers can reduce administrative burdens in the health system (only a single payer can do that, as demonstrated in their research).”

Obama said one thing when faced with a trade union audience in favor of single-payer health care. Now, on the presidential campaign trail, he says he’d do another.

Without pressure forcing him to take up single-payer, Obama is bound to opt for what is seen by the Democratic Party establishment as the more reasonable, “not-so-disruptive” solution.

That dynamic should be familiar to followers of Hillary Clinton. During her campaign, she regularly invokes her record of fighting for health care reform during the administration of her husband, Bill Clinton.

Hillary Clinton claims she learned a valuable Washington lesson at the time about tempering her demands for reform. However, health care activists who met with her learned a different lesson–the old bait and switch.

In early 1993, Hillary Clinton met with health care rights activists like the PNHP’s Quentin Young and David Himmelstein. They were told outright that a single-payer plan didn’t have a prayer with the Clinton White House. The eventual proposal from the White House trumpeted toothless “universal” coverage, but even that was too much to get past the health care industry and its mouthpieces in Congress.

In the end, the feeble “Health Security Act,” centered largely on private health maintenance organizations (HMOs), withered and died before even coming to a vote in Congress. Thus, even in the context of widespread public expectations that the Clintons would win health care coverage for every working and poor American, the administration covered for the health care industry’s bottom line instead.

For this reason, a better way to figure out how committed the candidates are to far-reaching change in health care would be to follow the trail of campaign contributors.

According to the Center for Responsive Politics (CRP), Clinton so far tops the list of presidential candidates to receive donations from the health care industry with $3.9 million. But Obama isn’t far behind with $3.2 million. John McCain came in at $1.2 million–but former Republican candidates Mitt Romney and Rudolph Giuliani each attracted almost twice as much as McCain.

Even more telling is the fact that campaign money from the health sector is going to Democrats ahead of Republicans this year–donations to Democrats are beating out Republicans by about $4 million. This is in contrast to previous election years, when the Republicans roundly beat Democrats.

Among the top 10 health-sector donors is Pfizer Pharmaceuticals, which lobbied fiercely against prescription drugs benefits coming under Medicare and opposed attempts to get more generic drugs on the market. So far this election cycle, Pfizer has split its money evenly between Democrats and Republicans–a big departure from its typical heavy lean toward the Republicans.

Figures for the drug giants Eli Lilly and GlaxoSmithKline are similar. Meanwhile, among Obama’s campaign team is Moses Mercado, a lobbyist with Ogilvy Government Relations, whose client list includes Pfizer and United Health Group, a managed health care company.

Meanwhile, ordinary people continue to suffer the consequences of a for-profit health care system. Some 47 million people–roughly one in every six Americans–goes without health insurance. According to the U.S. Census Bureau, 2.2 million people were added to ranks of the uninsured in 2006 alone.

Last year, Michael Moore’s film Sicko corroborated what so many people experience firsthand–that even if you have insurance, it doesn’t mean that you are guaranteed health care.

The reality of the “health insurance plan” in the U.S. is that it is none of these things–it isn’t healthy, no one is actually ensured care, and there doesn’t appear to be a plan.

In the long run, Clinton and Obama’s health care plans share more than the candidates would like us to think. Both leave out undocumented immigrants, whether they are children or adults. Neither requires insurance companies to cover abortion or a range of other reproductive health issues for women.

Both plans rely primarily on employers to provide insurance to their workers, which too few actually offer–and when they do, employees usually have to pay a significant amount, and the coverage is a far cry from complete.

While their plans may offer some coverage for people to buy if they aren’t covered at work, it will be based on the private, for-profit insurance industry. The heads of these giant companies will still call the shots, and undoubtedly, millions of people will remain unable to afford medical care, and will therefore go without.

Rather than representing an incremental step toward winning affordable health care for everyone, these plans go in the opposite direction.

“The leading Democrats’ health care plans, if enacted, are a prescription for failure by giving the private insurance industry another bonanza: a carte blanche opportunity to sell more limited-benefit policies to healthy people and prevent a structural health care fix,” Dr. John Geyman wrote in Tikkun magazine.

“They would further raise costs, increase bureaucracy, enrich market stakeholders at the expense of patients, families and taxpayers, and perpetuate markets treating health care as just another commodity to be bought and sold. Wall Street would prosper as Main Street hurts.”

Elizabeth Schulte is a correspondent for Socialist Worker, where this article first appeared. Read other articles by Elizabeth, or visit Elizabeth's website.

4 comments on this article so far ...

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  1. Arch Stanton said on March 6th, 2008 at 1:26pm #

    I think the end of this article got chopped off. I was expecting some kind of statement advising people that the crypto-rebulicans, aka the democratic party, are useless and beyond redemption, and that a wiser alternative is a socialist-based third party. On the other hand, if the US wants to gut its infrastructure and play national Russian roulette by leaving itself vulnerable to pestilence, who are we to kick? After all, we’re only the national constituency.

  2. rosemarie jackowski said on March 6th, 2008 at 2:34pm #

    Ralph Nader supports a Universal Single Payer system. If he was president 18,000+ lives would be saved in the U$A every year.

  3. dan e said on March 6th, 2008 at 5:15pm #

    It’s very simple: If the California Democrat Party was serious about wanting to implement Singlepayer universal coverage, they’d be breaking their collective behinds to push the California Health Security Initiative & see that it’s on the ballot in November. If passed by the voters it would be Arnold-proof Singlepayer for everybody.

    Even if the Dem-controlled Legislature passes a Singlepayer bill, Arnold has guaranteed to veto it. So all the to-d0 about SB this & HB that is just more Dumbock-rat fakery, puttin on a show for The Folks.

    If they were serious, they’d have soundtrucks rolling through the hood: “Sign the Petition! Singlepayer Healthcare Initiative! Free Healthcare for everybody! Put it on the Ballot!” And paid signature-collectors at every supermarket, section 8 office, outside churches on Sunday: “Thank you, glad you enjoyed the sermon, come again next Sunday — and please take a sec to sign the Healthcare Petition? Thanks, bless you.”

    Hehe, I sure can cook up fantasies, can’t I?

    Oh yeah. Hallelujah. Helpmegeezuzz. Oh yeah.

    m@&%*k#g Dumbosuckers, one born every minit. Hallelujah.

  4. Dan said on July 18th, 2009 at 10:37am #

    What follows are believed to be facts that are believed to exist regarding the present U.S. Health Care System. This may be why about 80 percent of U.S. citizens understandably want our health care system overhauled desperately due to the inadequate health care they receive and access:

    The U.S. is ranked rather low in regards to life expectancy and infant mortality, compared with the Western world.

    However, the U.S. is ranked number one in the world for spending the most for health care- as well as being number one for those with chronic diseases. About 125 million people have such diseases. This is about 70 percent of the Medicare budget that is spent treating these terrible illnesses.

    Health Care costs are now well over 2 trillion dollars of our gross domestic product. This is three times the amount nearly 20 years ago- and 8 times the amount it was about 30 years ago. Most is spent with medical institutions, as far as health expenditures are concerned. Some believe that perhaps one third of these costs are for care given to patients by health care providers that is not necessary.

    About another third of that amount is nothing more than administrative toxic waste that does not involve the restoration of the health of others. This illustrates how absurd the U.S. Health Care System is presently. Nearly 7000 dollars is spent on every citizen for health care every year, and that, too, is more than anyone else in the world.

    We have around 50 million citizens without any health insurance, which may cause about 20 thousand deaths per year. This includes millions of children without health care, which is added to the planned or implemented cuts in the government SCHIP program for children, which alone covers about 7 million kids.

    Our children.

    Nearly half of the states in the U.S. are planning on or have made cuts to Medicaid, which covers about 60 million people, and those on Medicaid are in need of this coverage is largely due to unemployment. With these Medicaid cuts, over a million people will lose their health care coverage and benefits to a damaging degree.

    About 70 percent of citizens have some form of health insurance, and the premiums for their insurance have increased nearly 90 percent in the past 8 years. About 45 percent of health care is provided by our government- which is predicted to experience a severe financial crisis in the near future with some government health care programs, it has been reported.

    Half of all patients do not receive proper treatment to restore their health, it has been stated. Medical errors desperately need to be reduced as well, it has been reported, which should be addressed as well.

    Most doctors want a single payer health care system, which would save about 400 billion dollars a year- about 20 percent less than what we are paying now. The American College of Physicians, second in size only to the American Medical Association, supports a single payer health care system.

    The AMA, historically opposed to a single payer health care system, has close to half of its members in favor of this system. Less than 20 percent of all practicing physicians in the United States are members of the AMA, according to others. The membership of the AMA has progressively declined over the years for a variety of authentic reasons.

    Our health care we offer citizens is the present system is sort of a hybrid of a national and private health care system that has obviously mutated to a degree that is incapable of being fully functional due to perhaps copious amounts and levels of individual and legal entities.

    Health Care must be the priority immediately by the new administration and congress. Challenges include the 700 billion dollars that have been pledged with the financial bailout that will occur, since the proposed health care plan of the next administration is projected to cost over a trillion dollars within the first year or so of the proposed plan to recalibrate health care for all of us in the U.S.

    Likely, hundreds of billions of dollars that are speculated to be saved with a reform of the country’s health care system. Health policy analysts should not be greatly concerned on the health care corporate shareholders who may be affected by this reform of our health care system that is desperately needed.

    It is estimated that the U.S. needs presently tens of thousands more primary care physicians to fully satisfy the necessities of those members of the public health. This specialty makes possibly less than 100 thousand dollars annually in income, compared with other physician specialties, yet they are and have been the backbone of the U.S. health care system.

    The American College of Physicians believes that a patient centered national health care workforce policy is needed to address these issues that would ideally restructure the payment policies that exist presently with primary care physicians.

    Further vexing is that it is quite apparent that we have some greedy health care corporations that take advantage of our health care system. Over a billion dollars was recovered for Medicare and Medicaid fraud last year through settlements paid to the department of Justice because some organizations who deliberately ripped off taxpayers.

    These are the taxpayers in the U.S. who have a fragmented health care system with substantial components and different levels of government- composed of several legal entities and individuals, which has resulted in medical anarchy, so it seems.

    Thanks to various corporations infecting our Health Care System in the United States, the following variables sum up this system as it exists today. Perhaps the United States National Health Insurance Act (H.R. 676) is the best solution to meet our health care needs as citizens, it appears.

    We would finally have, as with most other countries, a Universal Health Care system that will allow free choice of doctors and hospitals, potentially, and health care for all completely. It should and likely will be funded by a combination of payroll taxes and general tax revenue which is realistically possible. Because the following seems to be in need of repair regarding the U.S. Health Care System:

    Access- citizens do not have the right or ability to make use of this system as we should.

    Efficiency- this system strives on creating much waste and expense as it possibly can.

    Quality- the standard of excellence we deserve as citizens with our health care is missing in action.

    Sustainability- We as citizens cannot continue to keep our health care system in as it is designed at this time- as it exists today.

    Dan Abshear