Barack Obama's health care plan coddles the corporations that profit from the misery and illnesses of tens of millions of Americans. The plan is naive, at best, and probably disingenuous when it insists that we can coax these corporations, which are listed on the stock exchange and exist to maximize profit, to transform themselves into social service agencies that will provide adequate health care for all Americans. I wish we lived in such a rosy world. I know, and I suspect Obama knows, that we do not. 

"Obama offers a false hope," said Dr. John Geyman, the former chair of family medicine at the University of Washington and author of "Do Not Resuscitate: Why the Health Insurance Industry Is Dying, and How We Must Replace It." "We cannot build on or tweak the present system. Different states have tried this. The problem is the private insurance industry itself. It is not as efficient as a publicly financed system. It fragments risk pools, skimming off the healthier part of the population and leaving the rest uninsured or underinsured. Its administrative and overhead costs are five to eight times higher than public financing through Medicare. It cares more about its shareholders than its enrollees or patients. A family of four now pays about $12,000 a year just in premiums, which have gone up by 87 percent from 2000 to 2006. The insurance industry is pricing itself out of the market for an ever larger part of the population. The industry resists regulation. It is unsustainable by present trends."

We face a health crisis. The Democratic and Republican parties, awash in campaign contributions from the beasts they should be slaying on our behalf, have no interest in addressing it. A report in the journal Health Affairs estimates that, if the system is left unchanged, one of every five dollars spent by Americans in 2017 will go to health coverage. Half of all bankruptcies in America are because families are unable to pay their medical bills. There are some 46 million Americans without coverage and tens of millions more with inadequate policies that severely limit what kinds of procedures and treatments they can receive. 

"There are at least 25 million Americans who are underinsured," said Dr. Geyman. "Whatever coverage they have does not come close to covering the actual cost of a major illness or accident."

Obama, like John McCain, did not support HR 676, the single-payer legislation. The corporations that run our for-profit health care industry, which would be shut down if the bill was enacted, have vigorously fought it through campaign contributions and armies of lobbyists. A study by Harvard Medical School found that national health insurance would save the country $350 billion a year. But Medicare does not make campaign contributions. The private health care industries do. They have lavished money on Obama. He received $708,000 from medical and insurance interests between 2001 and 2006, according to the Center for Responsive Politics. And Michelle Obama is a vice president for community and external affairs at the University of Chicago Hospitals, a position that paid her $316,962 annually.

"The private health insurance companies and the pharmaceutical industry completely and totally oppose national health insurance," said Dr. Stephanie Woolhandler, one of the founders of Physicians for a National Health Program. "The private health insurance companies would go out of business. The pharmaceutical companies are afraid that a national health program will, as in Canada, be able to negotiate lower drug prices. Canadians pay 40 percent less for their drugs. We see this on a smaller scale in the United States, where the Department of Defense is able to negotiate pharmaceutical prices that are 40 percent lower."

Sen. Obama argues that we can improve the system by expanding government oversight. The government, he says, should require doctors and hospitals to prove they provide quality care. His plan links payment with reported quality. This would mean that health care providers would have to hire even larger staffs to collect and report this data to the government. There would be a $10-billion federal investment in health care information technology over five years under the Obama plan, in essence turning record keeping from paper to electronic data. 

Obama's plan, said Dr. Don McCanne, who writes on health care issues, would actually make health plans "more expensive, which compounds the problem."

Obama says he would require insurance companies to use more income from premiums for patient care.

"There isn't an enforcement mechanism," Geyman said bluntly. "Most states have been unable to control rates or set a cap on rates."

Obama's plan would also not cover all Americans. Unlike in Canada, citizens would not be enrolled in a plan automatically. Americans would have to go looking for one they could afford. And if they could not find one they would remain uninsured. Dr. Woolhandler, who is also a professor at Harvard Medical School, estimates that "tens of millions" of Americans would remain uninsured under Obama's plan. These numbers would swell as employers, who provide plans for 59 percent of those who are employed, continue to reduce coverage.

"The only way everyone will get insurance is with national health insurance," she said from Boston in a phone interview. "There is nothing in the Obama plan that will change the bitter reality that working-class families face when their breadwinner gets sick. People with catastrophic illnesses usually lose their jobs and lose their insurance. They often cannot afford the high premiums for the insurance they can get when they are unable to work. Most families that file for bankruptcy because of medical costs had insurance before they got sick. They either lost the insurance because they lost their jobs or faced gaps in coverage that meant they could not afford medical care."

Obama has borrowed John Kerry's idea to have the government absorb certain severe costs, although again the details are not spelled out. Insurers, he says, would no longer be able to discriminate based on preexisting conditions. All children would have health coverage. He would, he says, expand Medicare and Medicare-like coverage to protect the very young and the elderly. This is laudable, if he can make it happen. But the fundamental problem is a health industry run for profit. Our health system costs nearly twice as much as national programs in countries such as Switzerland. The overhead for traditional Medicare is 3 percent, and the overhead for the investment-owned companies is 26.5 percent. A staggering 31 percent of our health care expenditures is spent on administrative costs. Look what we get in return.

We on the left, those who should be out there fighting for universal health care and total and immediate withdrawal from Iraq and Afghanistan, sit like lap dogs on the short leashes of our Democratic (read corporate) masters. We yap now and then, but we have forgotten how to snarl and bite. We have been domesticated. And until we punish the two main parties the way big corporations do, by withdrawing support and funding when our issues are ignored, we will remain irrelevant and impotent. I detest Bill O'Reilly, but he is right on one thing-we liberals are a spineless lot. 

Labor unions don't negotiate with corporations on the basis of good will. They negotiate carrying the threat of a strike. What power do we have as long as we cave on every issue we stand for, from opposition to the death penalty to battling back against the military-industrial complex? 

It is not about liking or not liking Obama. It is not about race or class or gender. It is not about growing up poor or a member of the working class. There is no shortage of greasy politicians who, once in power, sold out their own. Look at Bill Clinton. It is about fighting back. It is about confronting a system that belittles us, what we stand for and what is best for the majority of Americans. We need to throw our support behind alternative candidates who champion what we care about, whether Cynthia McKinney or Ralph Nader. Bob Barr's health care plan, like John McCain's, is even worse than Obama's tepid proposal. We need to begin to actively and militantly defy the corporate state, and this means stepping outside of the two-party system. Universal health insurance is one issue. There are others. Nothing we care about will change until we do.

The Democrats, who promise to end the war in Iraq, create jobs and provide universal health care, ignore these promises once election cycles are over. And we never make them pay. They gave us NAFTA, the destruction of welfare and increased military spending, and we gave them our vote. This is the party that took back Congress in 2006 on an anti-war platform and then increased troop levels and funding for the Iraq war. This is a party that talks about the crushing weight of debt carried by Americans and then refuses to cap predatory interest rates as high as 30 percent imposed by credit card companies. This is a party that promises to protect our constitutional rights and then passes the FISA bill to protect the telecommunications companies. The list goes on.  These politicians, including Obama, must begin to feel heat. They must learn that there is a cost to be paid for working on behalf of corporations and disempowering citizens.

Chris Hedges writes a regular column for Truthdig.com. Hedges graduated from Harvard Divinity School and was for nearly two decades a foreign correspondent for The New York Times. He is the author of many books, including: War Is A Force That Gives Us Meaning, What Every Person Should Know About War, and American Fascists: The Christian Right and the War on America.  His most recent book is Empire of Illusion: The End of Literacy and the Triumph of Spectacle.

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