A close reading of the new health care legislation, which will conveniently take effect in 2014 after the next presidential election, is deeply depressing. The legislation not only mocks the lofty promises made by President Barack Obama, exposing most as lies, but sadly reconfirms that our nation is hostage to unchecked corporate greed and abuse. The simple truth, that single-payer nonprofit health care for all Americans would dramatically reduce costs and save lives, that the for-profit health care system is the problem and must be destroyed, is censored out of the public debate by a media that relies on these corporations as major advertisers and sponsors, as well as a morally bankrupt Democratic Party that is as bought off by corporations as the Republicans.
The 2,000-page piece of legislation, according to figures compiled by Physicians for a National Health Plan (PNHP), will leave at least 23 million people without insurance, a figure that translates into an estimated 23,000 unnecessary deaths a year among people who cannot afford care. It will permit prices to climb so that many of us will soon be paying close to 10 percent of our annual income to buy commercial health insurance, although this coverage will only pay for about 70 percent of our medical expenses. Those who become seriously ill, lose their incomes and cannot pay skyrocketing premiums will be denied coverage. And at least $447 billion in taxpayer subsidies will now be handed to insurance firms. We will be forced by law to buy their defective products. There is no check in the new legislation to halt rising health care costs. The elderly can be charged three times the rates provided to the young. Companies with predominantly female work forces can be charged higher gender-based rates. The dizzying array of technical loopholes in the bill-written in by armies of insurance and pharmaceutical lobbyists-means that these companies, which profit off human sickness, suffering and death, can continue their grim game of trading away human life for money.
"They named this legislation the Patient Protection and Affordable Care Act, and as the tradition of this nation goes, any words they put into the name of a piece of legislation means the opposite," said single-payer activist Dr. Margaret Flowers when I heard her and Helen Redmond dissect the legislation in Chicago at the Socialism 2010 Conference last month. "It neither protects patients nor leads to affordable care."
"This legislation moves us further in the direction of the commodification of health care," Flowers went on. "It requires people to purchase health insurance. It takes public dollars to subsidize the purchase of that private insurance. It not only forces people to purchase this private product, but uses public dollars and gives them directly to these corporations. In return, there are no caps on premiums. Insurance companies can continue to raise premiums. We estimate that because they are required to cover people with pre-existing conditions, although we will see if this happens, they will argue that they will have to raise premiums."
The legislation included a few tiny improvements that have been used as bait to sell it to the public. The bill promises, for example, to expand community health centers and increase access to primary-care doctors. It allows children to stay on their parent's plan until they turn 26. It will include those with pre-existing conditions in insurance plans, although Flowers warns that many technicalities and loopholes make it easy for insurance companies to drop patients. Most of the more than 30 million people currently without insurance, and the 45,000 who die each year because they lack medical care, essentially remain left out in the cold, and things will not get better for the rest of us.
"We are still a nation full of health care hostages," Redmond said. "We live in fear of losing our health care. Millions of people have lost their health care. We fear bankruptcy. The inability to pay medical bills is the No. 1 cause of bankruptcy. We fear not being able to afford medications. Millions of people skip medications. They skip these medications to the detriment of their health. We are not free. And we won't be free until health care is a human right, until health care is not tied to a job, because we still have an employment-based system, and until health care has nothing to do with immigration status. We don't care if you are documented or undocumented. It should not matter what your health care status is, if you have a disease or you don't. It should not matter how much money you have or don't, because many of our programs are based on income eligibility rules. Until we abolish the private, for-profit health insurance industry in this county we are not free. Until we take the profit motive out of health care we cannot live in the way we want to live. This legislation doesn't do any of that. It doesn't change those basic facts of our health care system."
Redmond held up a syringe.
"I take a medication that costs $1,700 every single month," she said. "I inject this medication. It costs $425 a week for 50 milligrams of medication. I would do almost anything to get this medication because without it I don't have much of a life. The pharmaceutical industry knows this. They price these drugs accordingly to the level of desperation that people feel. Billy Tauzin, the former CEO of [the trade organization of] Big Pharma, negotiated a secret deal with President Obama to extend the patents of biologics, this new revolutionary class of drugs, for 12 years. And Obama also promised in this deal that he would not negotiate drug prices for Medicare."
Obama's numerous betrayals-from his failure to implement serious environmental reform at Copenhagen, to his expansion of the current wars, to his refusal to create jobs for our desperate class of unemployed and underemployed, to his gutting of public education, to his callous disregard for the rights of workers and funneling of trillions in taxpayer money to banks-is a shameful list. Passing universal, single-payer nonprofit health care for all Americans might have delivered to Obama, who may well be a one-term president, at least one worthwhile achievement. Single-payer nonprofit health care has widespread popular support, with nearly two-thirds of the public behind it. It is backed by 59 percent of doctors. And it would have helped roll back, at least a bit, the corporate assault on the citizenry.
Medical bills lead to 62 percent of personal bankruptcies, and nearly 80 percent of these people had insurance. The U.S. spends twice as much as other industrialized nations on health care, $8,160 per capita. Private insurance bureaucracy and paperwork consume 31 percent of every health care dollar. Streamlining payment through a single nonprofit payer would save more than $400 billion per year-enough, PNHP estimates, to provide comprehensive, high-quality coverage for all Americans.
Candidate Obama promised to protect women's rights under Roe. v. Wade, something this legislation does not do. He told voters he would create a public option and then refused to consider it. The health care reform bill, to quote a statement released by PNHP, has instead "saddled Americans with an expensive package of onerous individual mandates, new taxes on workers' health plans, countless sweetheart deals with the insurers and Big Pharma, and a perpetuation of the fragmented, dysfunctional, and unsustainable system that is taking such a heavy toll on our health and economy today."
"Obama said he was going to have everybody at the table," Redmond said, "but that was a lie. Our voice was not allowed to be there. There was a blackout on our movement. We did not get media attention. We did actions all over the country but we could not get coverage. We had the ‘Mad as Hell Doctors' go across the country in a caravan, and they had rallies and meetings. If that had been a bunch of AMA Republican doctors, Cooper Anderson would have been on the caravan reporting live. NPR would have done a series. Instead, they did not get much coverage. And neither did the sit-ins and arrests at insurance companies, although we have never seen that level of activity. They turned us into a fringe movement, although poll after poll shows that the majority of people want some kind of single-payer system."
Our for-profit health system is driven by insurance companies whose goal is to avoid covering the elderly and the sick. These groups, most in need of medical care, diminish profits. Medicare, paid for by the government, removes responsibility for many of the old. Medicaid, also paid for by the government, removes the poor people, who have a greater tendency to have chronic health problems. Hefty premiums, which those who are seriously ill and lose their jobs often cannot pay, remove the very sick. If you are healthy and employed, which means you are less likely to need expensive or complex treatment, the insurance companies swoop down like birds of prey. These corporations need to control our perceptions of health care. Patients must be viewed as consumers. Doctors, identified as "health care providers," must be seen as salespeople.
Insurance companies, which will soon be able to use billions in taxpayer dollars to bolster their lobbying efforts and campaign contributions, know that single-payer nonprofit insurance means their extinction. And they will employ considerable resources to make sure single-payer nonprofit coverage is denied to the public. They correctly see this as a battle for their lives. And if human beings have to die so they can survive, they are willing to make us pay this price.
The for-profit health care industry, along with the Democratic Party, consciously set out to confuse the public debate. It created Health Care for America NOW! in 2008 and provided it with tens of millions of dollars to supposedly build a public campaign for a public option. But the organization had no intention of permitting a public option. The organization was, as Dr. Flowers said, "a very clever way to distract members of the single-payer movement and co-op some of them. They told them that the public option would become single payer, that it was a back door to single payer, although there was no evidence that was true."
Physicians for a National Health Plan attempted to fight back. It worked with a number of organizations under a coalition called the Leadership Conference for Guaranteed Health Care. The group, which included the National Nurse's Union and Health Care Now, sought meetings with members of Congress. Flowers and other advocates asked Congress members to include them in committee debates about the health care bill. But when the first debate on the health care reform took place in the Senate Finance Committee, chaired by Sen. Max Baucus, a politician who gets over 80 percent of his campaign contributions from outside his home state of Montana, they were locked out. Baucus invited 41 people to testify. None backed single payer.
The Leadership Conference, which represents more than 20 million people, again requested that one of their members testify. Baucus again refused. When the second committee meeting took place, Flowers and seven other activists stood one by one in the room and asked why the voices of the patients and the health care providers were not being heard. The eight were arrested and removed from the committee hearing.
Single-payer advocates were eventually heard on a few of the House and Senate committees. But the hearings were a charade, part of Washington's cynical political theater. It was the insurance and pharmaceutical lobbyists who were in charge. They dominated the public debate. They wrote the legislation. They determined who received lavish campaign contributions and who did not. And they won.
"We are talking about life and death, about the difference between living your life and dying," Redmond said. "And once again it came down to the Democratic Party trumping the needs of the people."