What could ‘fix’ the U.S. health care system?

The writer is a Registered Nurse working in the Los Angeles area. The following is based on a presentation at a meeting of the Party for Socialism and Liberation in Los Angeles July 17.

A large majority of health care professionals supports single-payer health care.

After decades of attempts to reform and get control of the chaotic monster we know as the U.S. health care system, the Obama administration is pushing ahead for a bill in Congress aimed at health care reform. Previous attempts by the Clinton administration in the 1990s were defeated by a political assault launched by the insurance companies, pharmaceutical giants and the banks.

Corporate campaigns and millions in spending crushed a California ballot proposal for single-payer health care in 1994. Now we are seeing President Obama’s initiative advancing somewhat in both the House and Senate, with the president calling on Congress to pass a bill before the August recess.

While the debate is becoming fierce, it does appear that some kind of deal could be reached between the big players—health maintenance organizations, big insurance, the giant pharmaceuticals, the American Medical Association and so on.

What is in the works right now is a hybrid combination of the same old cartel of insurance companies and pharmaceuticals, blended in with a government-devised public plan that workers would pay for based on some kind of sliding scale. The “public option,” as it is called, would be funded by a tax surcharge on individuals who make more than $350,000 a year. This is all still open for debate, of course, so even much of this plan is probably doomed.

Attempts by individual states to combine government with private plans have not lowered costs by much and still leave many without protection.

‘Fixing the system’

If the capitalists really wanted to fix the system, their only real reform option is single-payer health care. Many capitalist countries, like Canada, Britain, France and others, have had this for decades in response to the power and class consciousness of workers in those countries.

Cuban doctors provide free care not only in Cuba but also abroad. Here, a Cuban doctor cares for a patient in Haiti.

Things would be different under socialism, different even from single-payer care. The first step in building socialism is to end the profit system and seize control of the wealth to provide food, housing and health care to all. The results of what can happen in a planned economy, even one that is surrounded by imperialism, such as Cuba, are astounding.

Unlike the competition that prevails among researchers in opposing think tanks and universities in the United States, under socialism all knowledge is shared, as are all the resources for providing comfort and care, as well as cures and hope for all who are facing catastrophic illnesses.

The achievements of the Cuban health care model have stunned and thrilled millions of people around the world. Because Cuba provides free education to all, it has built up a great reserve of health care providers. Tens of thousands of Cuban doctors and health care workers have gone all over the world to help set up clinics, from Africa to South America and beyond. Medical students from around the world, including the United States, receive free training in Cuba so they can provide services to communities in need in their home countries. In Cuba, every neighborhood has a clinic with a doctor and nurses to take care of everyone. All of this is free and of the best quality.

Capitalist health care, on the other hand, denies the right of every person to full medical prevention and care, all the while exploiting millions of health care workers. These workers struggle day in and day out to provide the support their patients and clients so desperately need—in the clinics, hospitals, patients’ homes and mobile care units. Nurses, aides, doctors, housekeepers, lab technicians, unit secretaries, intake coordinators and so many others are the workers who should be running the health care system for the benefit of the entire working class.

Yet these workers are the ones being left out of the discussion—the workers who truly understand why single-payer health care is so necessary.

Recent polls have shown clearly that the majority of people in the United States support single-payer health care, including polls in the New York Times, ABC News and other mass media outlets. These polls show that 60 percent support and prefer single-payer health care. Single payer also counts among its supporters a solid 59 percent majority of all doctors. That figure rises to 80 percent among general family doctors and pediatricians.

At a May 2009 meeting of the Senate Finance Committee on Health Care Reform, convened by Senator Max Baucus (D-Mont.), all the moneyed players were there: HMOs, the AMA, and big insurance and pharmaceutical corporations. No one was allowed to represent advocates of single-payer health care reform.

An organized group of doctors, nurses and other workers effectively disrupted the event, however. One after another stood up to support single-payer reform, each standing to speak after the speaker before them was removed and arrested.

This outrageous exclusion of health care workers is not a big surprise considering Sen. Baucus’s record. As a point man for health care reform, he has received more campaign money from health and insurance industry interests than any other member of Congress. In fact, over 30 members of Congress have significant holdings in health care corporations with their spouses and family members sitting on the boards of directors of such giants as Cigna, Blue Cross and others. These include Democratic leaders like Harry Reid, Jane Harmon and Christopher Dodd.

Worst coverage in the capitalist world

For the workers in the United States, the status of health care is the worst in the industrialized capitalist world. Despite being the richest country, more than 47 million people are uninsured, and millions more are underinsured.

Health insurance companies are in business for one reason alone: profits.

The capitalist economic crisis has made the situation even worse. People with catastrophic diseases are losing their coverage while others with pre-existing conditions are being denied insurance. More than 200 million working-class people in the United States have no dental insurance. Every day, you hear about more and more nightmares—of patients suffering and dying on the floors of emergency rooms, or of being dumped onto the streets by big hospitals that are “losing money” on patients.

Case managers for big HMOs are receiving lavish bonuses for finding ways to deny coverage of crucial, potentially life-saving procedures and plans of care. This is a crime!

According to a recent study by the Harvard Medical Review, 62.1 percent of bankruptcies are due to medical expenses, not just for uninsured workers but even more so for underinsured workers. Health care in the United States—the self-proclaimed great leader of the capitalist world—is nothing more than a commodity that you buy if you can afford it, and denied to all as a basic human right.

Meanwhile, the insurance companies are raking in mega profits. Corporate CEOs are receiving millions in salaries and bonuses.

Without a doubt, health care reform is more necessary now than ever before. While proclaiming that “all options are on the table,” it has become clear that the one option that would solve the problem—single-payer health care—has been rejected by the Obama administration and their congressional allies.

So what does Obama’s and the Democrats’ plan look like? Their concern is to lower the soaring costs of health care and at the same time protect the profits of the capitalist interests that are making billions while millions are deprived of even basic care. Call it a kinder, gentler health care system that maintains profits, and that also puts health care spending on the backs of the working class. Under Obama’s plan, health care would remain a commodity that is bought and sold for profit.

Predictably, Obama’s proposal for a mélange of private and public options is being attacked by the same right-wing and pro-corporate forces that have kept reform off the table for decades. These interests spend tens of millions of dollars to scare workers and undermine support for any kind of reform, no matter how small.

At the same time, racist groupings led by the anti-immigrant Barbara Coe are diverting attention away from the struggle by trying to blame the health care system’s failures on undocumented immigrants. Coe and her neo-fascist friends claim that undocumented workers are responsible for draining the public coffers. This is a racist lie. It is another attempt to stoke the fires of racism and violence toward immigrants, who pay taxes and contribute billions to the economy. But instead of scapegoating immigrants, the truth must be told: Affordable, quality health care must be available to all, regardless of immigration status.

Even though study after study has shown that a streamlined, planned, single-payer, government-funded program would cost by far less than any other proposal, the capitalists under Obama and the Democrats have killed the idea. Why? To push it through would mean getting rid of the HMOs and giant insurance companies, along with sharply regulating the profits of the pharmaceuticals. There is no other way, and they are not about to go there.

The U.S. government, whether it is Obama and the Democrats, or Bush and the Republicans, is there to serve the capitalist class. What is needed is to shut down the predatory, parasitical insurance companies, which contribute nothing to society and act only to maximize profits and deny coverage wherever possible. But to do so would undermine the supremacy of the capitalist class the politicians represent. Washington will never do that unless the politicians are forced to by a mass movement of people—unions, doctors, nurses and working-class organizations—that are united to fight for it. This is an important struggle that needs to involve broader layers of the working class.