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The Health Care Debate Has Only Just Begun

Mark T. Harris

Now that the era of “change” is upon us, in the form of health care reform, it's enlightening to watch the process unfold.

Actually, enlightening may not exactly be the right word. How about excruciating? Or infuriating? Or, how about we just admit we are not graced to live in an era when the words substantive, progress, and health care are ever likely to be inked with anything Washington's elected representatives manage to accomplish.

As Obama's health reform initiative confronts the reality of the beltway culture that is Washington, it's clear that real health care justice will not come easy to the United States.  But why should this be a surprise? In contrast to the 1960s when Medicare and Medicaid were first introduced, U.S. health care today is primarily less a social service than just another investor-driven sector of America's hyper-capitalist culture. The days when religious non-profits, stand-alone community hospitals, and independent physician offices were the norm are long gone. In most major markets, two or three hospital organizations dominate the local health care scene. The nation's largest hospital corporation, HCA, for example, owns 278 hospitals and freestanding surgery centers. In turn, Wall Street equity firms lurk behind the scenes of most large hospital corporations.

Likewise, select health insurance companies now dominate most major markets. WellPoint and UnitedHealth Group, for example, alone sell insurance to some 67 million Americans, according to recent Senate hearings. It's well established that such private insurers have dumped enormous administrative waste into the system. They also take out a lot lavishing hundreds of millions of dollars in pay, bonuses, and stock options on high-paid executives.

But how many more times do we have to go over all this before things change? How many more tragic stories have to be told about sick people denied care by insurance giants? Or great arguments made about the value of single-payer? How much injustice exactly do we as a nation have to endure before our health care system lives and breathes in service to the universal right of every person to the best care possible? But then the resistance to health care reform has never been about rational argument or even ideology. It's about entrenched financial interests who cannot be expected to give up a good thing without a fight. No doubt Congress’s ability to parse even the mildest vision of reform shows they’ve got that fight covered.

That's not to say the insurance industry is opposed to all health reforms, especially if under new legislation tens of millions of uninsured Americans become legally compelled to buy some form of insurance. In return, the industry might go along with new restrictions on their ability to deny coverage for “preexisting conditions” or medical history. Still, they continue to oppose any form of “public option” insurance. It’s debatable now whether this component of “universal coverage” will even survive in the final legislation, or offer coverage worth anything if it does.

Of course, none of this has stopped the cuckoo right from portraying Obama's health reforms as "socialistic." But if conservative ideologues want to envision Bolsheviks manning the HMO help line next time they call to make a doctor's appointment, let them. The more daunting reality is that it is going to take an extraordinary mass political campaign if the American health care system is ever going to catch up with an industrialized world that has long recognized health care as a public resource similar to education or fire protection.

What makes such a humanitarian goal especially daunting in the United States is not just the crazy talk resistance of far-right Republicans. The other obstacle to progress is the endless genuflecting before corporate power on the part of the Democratic Party leadership. Tellingly, Obama has admitted single-payer health care would probably be the best health care system, if we were starting from scratch. Instead, Obama wants to promote a more socially palatable version of the existing health care system while preserving the industry's profits. This is another way of saying the President is not about to risk his political career on some “wild plan” to root out the scourge of private insurers and investment firms who are ruining health care.

In place of the current wheeling and dealing among Washington lawmakers that now defines health care reform, imagine instead if Obama called upon the roughly 13 million voters who enlisted as the grassroots base of his presidential campaign to rally on the steps of Congress and demand comprehensive universal health care reform. Unfortunately, despite the grassroots vigor of his presidential campaign, a mass action campaign for health care justice does not appear to be on Obama's to do list for anytime soon.

In contrast, right-wing zealots appear more than ready for mass action, as Democratic supporters of health reform recently learned when confronted by shouting mobs opposing “socialized medicine” at town hall meetings. MSNBC's Rachel Maddow, Sen. Dick Durbin (D-IL), and others have accused health insurance lobbyists and GOP activists of orchestrating these hooligan hootenannies.

Whatever the dismal particulars of the legislation to emerge from Congress, there is growing public recognition that health care should be a universal human right. Indeed, support for single-payer is far greater now than during the early 1990s when President Clinton pushed his version of reform. There's also far more healthy grassroots activism and discussion taking place.

Accordingly, it is safe to say that the debate over the future of health care justice in the United States has only just begun.

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Mark T. Harris has written for Utne, Z, and other magazines. He is a former senior editor for the Joint Commission on Accreditation of Healthcare Organizations. Website:

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