An attack on health care in the guise of reform

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An attack on health care in the guise of reform
22 March 2010

The vote Sunday night by the US House of Representatives to approve
Obama’s health care overhaul was accompanied by declarations that the
measure represents the greatest social reform in generations.

With predictable demagogy, Obama, in a statement following passage of
the bill, hailed the measure as a historic reform a century in the
making, a vindication of the “American dream” and proof that
“government of the people and by the people still works for the people.”

After months of closed-door negotiations with insurance CEOs and
pharmaceutical executives, Obama made the absurd claim that the
measure came “from the bottom up.” In fact, the legislation was
entirely dictated from the top. It represents the opening shot in a
sweeping attack on health care for working people.

A staggering level of cynicism has been exhibited throughout the
so-called health care “debate.” Evasions and outright lies have been
utilized to conceal the real content of the bill. With its final
passage, a media-led orgy of self-congratulation will no doubt follow.

In the end, what decided the bill’s passage was pressure brought to
bear by the White House, acting on behalf of the most powerful
sections of the financial elite.

There has always been a stark difference between the public appeal
made by the Obama administration, accompanied by phony populist
attacks on the insurance companies, and the fundamental strategic aims
guiding the health care overhaul, which were worked out by Washington
think tanks behind the backs of the American people.

Details on what is actually included in the legislation have
deliberately been left vague. The public presentation by the
administration and congressional Democrats is designed to conceal far
more than what it reveals. Through no fault of their own, most people
are largely in the dark as to what the implementation of the bill’s
provisions will mean for them and their families. For all of Obama’s
talk of the great debate over health care, there has been no serious
or honest public discussion.

The main features of the bill include hundreds of billions of dollars
in cuts to Medicare, and the requirement that individuals and families
obtain insurance or pay a fine, thus providing a new influx of
cash-paying customers for private insurance companies. Businesses are
under no obligation to provide their workers with insurance, paying
only minimal fines if they do not.

The government and the corporations are to a large extent absolved of
any responsibility for funding health care, and the working population
made to foot the bill.

Those elements of the overhaul which, within the framework of American
liberal politics, were proclaimed to be absolutely essential—such as
the public option—were abandoned long ago. They were initially
included as a fig leaf, to make it easier for Obama’s liberal
supporters to sell the scheme to the American people.

Concession after concession to the Republican Party was said to be
necessary in order to obtain bipartisan support. But after it became
clear that no Republican support would be forthcoming, rather than
restoring the discarded provisions, new regressive measures were added.

A shameful agreement was reached with the most right-wing sections of
the Democratic Party itself to further restrict abortion coverage.
Final passage was secured through a deal with Democratic
Representative Bart Stupak, an anti-abortion advocate from Michigan.
Obama agreed to sign a last-minute executive order confirming that no
federal funds would be used for abortions under the terms of the bill.

The executive order, as well as language in the bill itself, means
that individuals receiving government subsidies—that is, the working
class and the poorest layers of society—will be prevented from
purchasing insurance that covers abortion.

This testifies to the political bankruptcy of the liberal and
so-called “left” supporters of Obama. What they claimed for decades
was the central issue necessitating support for the Democratic
Party—the right to an abortion—was abandoned without a protest.

Comparisons to the passage of Social Security (in 1935) and Medicare
(in 1965) proliferate in the media and in statements from the White
House and congressional Democrats. When these landmark reforms became
law, however, people were clear on their implications.

Enactment of Social Security meant that retirees would receive a
monthly check in the mail. With Medicare, people knew that when they
reached the age of 65 they would receive medical coverage under the
government-run program. With this so-called “reform,” by contrast,
nobody knows what to expect.

The earlier measures, like every social reform wrested from the
American ruling class, were connected to broad social struggles.
Enactment of Social Security came as a response to the mass movement
of the working class for industrial unions. Medicare coincided with
the civil rights movement, a wave of militant strikes, urban
uprisings, and the initial stirrings of popular opposition to the war
in Vietnam.

This measure has been drafted and imposed from above. It is entirely
in line with the overall policy of the Obama administration.

The White House and Congress have responded with indifference and
contempt as millions have been made jobless, lost their homes, and
struggled to pay their rent and utility bills. While trillions of
dollars have been allocated to bail out Wall Street, no meaningful
measures have been taken to alleviate the catastrophe facing working
class families.

All of Obama’s policies have been geared toward increasing social
inequality. School closures and privatizations and mass teacher
firings have been endorsed by his administration. General Motors and
Chrysler were driven into bankruptcy in order to create conditions
where the wages, working conditions and health benefits of auto
workers could be savagely attacked.

The claim that the health care overhaul is an oasis of progress in
this desert of social reaction is simply a lie. The experiences of
millions of people—who have seen no sign that the government is in any
way responding to their needs—have fueled well-deserved skepticism and
outright opposition to the health care legislation within wide layers
of the population.

The bill aims to deal with what is seen as a pressing problem for the
ruling elite. While corporations, with the collaboration of the
unions, have been able to drive down wages and increase productivity,
they have not been able to put a brake on spiraling medical costs.
These come in the form of increased costs for employee insurance
coverage, as well as care for the poor and uninsured who seek medical
treatment at emergency rooms and public clinics, thus driving up costs
overall.

A solution to this problem for big business—one which is addressed by
Obama’s health care restructuring—is to dump these more vulnerable
sections of the population into bare-bones plans, where limitations
are placed on more expensive and “unnecessary” tests, treatments and
drugs. These will include stripped-down Medicaid plans, a gutted
Medicare program where care is rationed according to “cost
effectiveness,” and substandard plans available for purchase on
insurance “exchanges.”

The health care legislation sets a dangerous precedent for a far
broader assault on social programs, elements of which have already
been put in motion by the administration. Last month, Obama
established by executive order a bipartisan commission on deficits,
which will propose measures to slash government spending on Medicare,
Medicaid and Social Security.

In the coming period, when millions become clearer on the real
implications of the health care bill, the brutal reality will
inevitably provoke an enormous sense of betrayal and anger. This will
set the stage for the emergence of new forms of struggle as people
begin to consider the alternative to a corporate-controlled health
care system—that is, one based on a socialist program that begins with
basic human needs rather than corporate profit.

Kate Randall

http://wsws.org/articles/2010/mar2010/pers-m22.shtml

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