• Submitted Tue, 06/16/2009 – 9:15am.Dave Lindorff

If you want to fix the disaster that is called the American healthcare system, the first thing to do is to clearly point out what its major failings are, and there are two of these.

The first is cost.  America is the most expensive or one of the most expensive places in the world to get sick or injured. The corollary of that is that it is one of the best places to make a killing if you are in the medical business, whether as a doctor, a hospital company, a pharmaceutical firm, or a nursing home owner.

The second is access.  One in six Americans — a total of 50 million people at latest count — have no way to pay for that care. Too young for Medicare, too “well off” for Medicaid, but too poor to buy private health insurance or too sick to be admitted into a plan, or employed by a company that doesn’t provide health benefits, these people get no medical care until they get so sick that they are brought into a hospital emergency room where they get treated (often too late) at public expense, or at the hospital’s expense, with the cost shifted onto taxpayers or onto insured patients’ premiums.

Any reform of this atrocious “system” must address these two major failings or it is no reform at all.

And that’s where all the various versions of Obamacare fall flat.

Simply put, you cannot solve either of these problems by leaving the payment system for medical care in the hands of the private insurance industry, since the whole paradigm of insurance is to make money by keeping high-risk people out of the insured pool, and by keeping reimbursements and coverage for premium payers as low as possible.

Having a so-called “public option” plan working in competition with private insurance plans will not solve this problem. Either the public option will become like the private options — trimming benefits and rejecting some applicants — or it will become a dumping ground for all the high-cost, high-risk people that the private sector insurance industry doesn’t want.  At that point, the public plan will become a huge cost burden on the taxpayer, who will begin demanding that it cut back in the benefits it provides, taking us right back to where we started.

The fact that the Obama Administration and the Democratic Congress are both raising the issue of the high cost of health care “reform,” and are talking about ways to raise revenues to pay for it tells us all we need to know about the alleged “reform” schemes they are contemplating. They are doomed and, even if implemented, will not work.

Real reform of the American health care system would not cost money. It would save money.

There is a level of dishonesty in what passes for the debate over health care “reform” in both Congress and the media that is stunning in its brazenness and/or venality.

Of course, real reform would cost more in government spending.  But that is because real reform would remove the cost of medical care from both employers and from workers (who over the last 20 years have been shouldering an increasing share of their own medical care).  And that shift would mean more profits for U.S. companies, which would free up more money for wages, and it would mean less money deducted from paychecks, meaning higher incomes for workers.

If President Obama had any political courage at all, he’d simply get on TV and say this: I will create a plan that will cover everyone, lift the burden of paying for healthcare from individuals and employers, and have the government pay for it all. You the taxpayer will pay for this plan with higher taxes, but you will no longer have any significant medical bills, you will no longer have health insurance premiums deducted from your paycheck, your employer will no longer be paying for employee medical coverage, and you will never have to worry about losing health benefits again, even if you are laid off. (Incidentally, eliminating employer-funded health insurance would go a long way towards allowing workers to fight to have unions, and to strike for contracts, by ending the threat that they would lose their benefits.)

Of course, to do that the president would have to be talking about what is variously known as national health care or a single-payer plan, in which the government is the insurer of health care for all.

This option isn’t even being discussed in this so-called debate. As I’ve written earlier, even though there is an excellent single-payer system in place that has been running for a third of a century just to the north in Canada — a system where patients have absolute freedom to choose their doctor, get instant access to a hospital and to expert specialist care in emergencies, and have a healthier society by every statistical measure — all at a fraction of the staggering cost of healthcare in the U.S., not one Canadian expert working in that system has been invited down to discuss its workings with the White House or with members of Congress.

There has been a lot of negative propaganda spread about Canada’s single-payer system, by right-wing, business-funded “no-think” tanks, and by medical industry lobbies from the American Medical Association to the pharmaceutical industry, but no government committee or agency has bothered, or dared, to bring in Canadian experts to respond to and debunk that propaganda.  The corporate liars talk about waiting lists and lack of access to CAT-scan or MRI machines. But all we really need to know about the Canadian, and other similar single-payer systems, is that nowhere that they have been instituted have they been later terminated, even when, as in Canada, right-wing governments have been elected to power.  The public, whether in Canada, or France, or England, or Taiwan or elsewhere, loves their public health insurance system, whatever flaws or problems with underfunding those systems may have at certain times.  Trying to eliminate such systems would be political suicide for a conservative government, as even arch-free-marketer British Prime Minister Margaret Thatcher, who never met a government activity that she didn’t want to privatize, learned.

Right now, with half of all Americans reportedly fearing that they could lose their jobs, and with one in five Americans reportedly either unemployed, or involuntarily working part-time, we have a situation where a majority of Americans either have no health insurance, have lost their health insurance, or are in danger of losing their employer-funded health insurance.  It is a unique moment when a bold president and Congress could act to end private health insurance and establish a public single-payer insurance plan to insure and provide access to affordable medical care to all Americans.

Instead of this, we are being offered half measures or no measures at all by leaders who are shamelessly in hock to the health care industry or who are afraid of its power.

In 1993, the Clintons had a similar opportunity to grab the health care industry by the neck, strangle it, and produce a single-payer alternative. They blew that chance by trying to keep the health care greed-heads happy. Now, almost a generation later, we have another shot at it, and Obama and his Democratic Congress are doing the same thing again.  There is a strong likelihood that they will fail, like the Clintons before them. If they succeed in coming up with some kind of hybrid public-private Frankenstein of a system that includes a public insurance option, it will simply delay the inevitable disaster, as medical costs, already 20 percent of GDP — the highest share of any economy in the world — continue to soar, and as the cost of the public plan, which will inevitably become a dumping ground for high-cost patients, becomes politically untenable. In the end, we will have even more expensive and inaccessible healthcare than we have today.

It doesn’t have to be this way, but only if Americans rip their eyes away from their crisp new digital-image TV screens and start demanding real health care reform will we get honest reform.  A good place to begin would be to start writing and phoning your local media outlets to ask why they are not reporting on single-payer, and in particular on the single-payer bill sponsored by Rep. John Conyers (D-MI), which is being silently blocked and killed by his colleagues in the Democratic congressional leadership and by the White House. A good place to begin would also be to start calling your elected representatives to demand that they support Rep. Conyers’ single-payer bill.

DAVE LINDORFF is a Philadelphia-based journalist. His is author of the critically acclaimed book “Marketplace Medicine: The Rise of the For-Profit Hospital Companies” (Bantam Books, 1992). His latest book is “The Case for Impeachment” (St. Martin’s Press, 2006). His work can be found at www.thiscantbehappening.net.

Dateline Mon, 08/17/2009 Dave Lindorff [print_link]

Bill Clinton was the worst thing to happen to the Democratic Party and to progressives since that racist warmonger Woodrow Wilson won the presidency and dragged the U.S. into the utterly pointless and incredibly bloody First World War.

Clinton and Carter in 1978. Clinton was very good at sucking up to established politicians. But the man defines opportunism.

Clinton, by posing as a progressive, confused and undermined, and ultimately betrayed the liberal/progressive wing of the party, shattering what was left of the New Deal coalition and leaving the American left adrift and riven by the conflict between those who thought the Democratic Party was the only viable vehicle for progressive reform and those who thought it was hopelessly in the grip of corporate interests.

Barack Obama offers the hope of bringing that era of debilitating confusion to an end.

Not because he is the Great Black Hope of progressives, but because he has taken the concept of selling out to corporate interests and compromising with Republicans to such remarkable heights that progressives hopefully can no longer be confused about the irretrievably corrupted nature of the Democratic Party.

On virtually every issue of importance, President Obama has sided with corporate interests and the wealthy.

On the issue of war and peace, he has sided with the military-industrial complex, with a policy of permanent occupation of Iraq and endless war in Afghanistan, as well as continued funding of the country’s colossal armory of death, from strategic missiles and submarines to aircraft-carrier-group armadas to high-tech fighter squadrons and space weaponry.

On civil liberties, he has sided with the police state, supporting continuation of the Bush/Cheney administration’s insidious National Security Agency spying program, defended military spying within the U.S., and refused to prosecute obvious abuses by the prior administration.

On torture, the Obama Administration is continuing the imprisonment and torture of captives in Afghanistan and elsewhere around the world at Bagram Air Base and, probably, at other secret sites, and instead of closing Guantanamo as promised, is looking into transferring that hellhole of torture and abuse to one or several sites in the mainland U.S.

Health care reform has become a sad joke, with the emerging “reform” bill looking for all the world like the Rube Goldberg creation of the Clinton era that properly went down in flames. Instead of taking on the insurance industry, the hospital companies and the pharmaceutical industry and other parts of the profit-making medical-industrial complex, Obama cut deals with all of them behind closed doors, assuring that their profits would be left untouched, and that they could essentially write their own “reform” bill through the offices of bought-and-paid members of Congress such as Senator Max Baucus. Obama and his congressional allies carefully kept any discussion of the single-payer idea — essentially Medicare for all, and the approach that even Obama himself admits would be cheaper and more universal — out of sight and off the table.

Climate change action, too, has been sold out, with Obama adopting the approach favored by the energy industry — “cap and trade.” That concept is a gold mine for Wall Street trading firms, which will be doing trades next in pollution credits instead of subprime mortgages, and for energy companies that will get free credits to sell, courtesy of the taxpayer. And because it’s a system so easy to game, it will do nothing or next to nothing to reduce greenhouse gases.

Finally, there’s economy and banking reform. Here Obama didn’t even make a pretense of taking a progressive approach. There is a stimulus program, but half of it was in the form of tax cuts — token for the poor and middle class and significant for the rich and for businesses, and half in the form of federal grants, often for unneeded projects such as roads and road repair that go to some of the higher paid members of the working class, leaving the poor and the nonunionized with no job help. Meanwhile, bankers were the recipients of trillions of dollars in bailout assistance, while nothing was done to break up the huge mega-bank holding companies that brought on the financial and economic crisis in the first place. Instead of picking economic advisers and bank regulators from the many talented system critics such as Nobelists Joseph Stiglitz and Paul Krugman, Obama picked veterans of the Bush/Cheney administration, and Wall Street shills such as Larry Summers and Timothy Geithner.

Last fall, I and many progressives urged voters to elect Obama, not because we thought he was a progressive, but because we hoped that his background — community organizer, raised by a single mother, experience living in a third world country (Indonesia), multi-racial — would lead him to make at least some right decisions. We, or certainly I, hoped too that the energized young and working class electorate that came out for him in the fall would continue to press him aggressively to do the right thing on war, environment, civil liberties, and the economy.

I was wrong on the first count: Obama has been a corporatist through and through on all the major issues that matter. And I was wrong on the second. Most of the left in the U.S., from the labor movement to the environmentalist movement to the anti-war movement, has to date remained glumly quiescent as Obama has sold them out on each of their key issues.

But here is the silver lining: The sellout this time is so much more blatant, and so much more serious, than it was with Clinton, and for all the talk about Obama’s ability to string words together, he is so much less of a charismatic figure than the gregarious Bill Clinton, that he is unlikely to hang on to the ardent support that propelled him to his victory last November. The disappointment and sense of betrayal among progressives this time is palpable, especially because, while Clinton, by 1994, had the excuse that he was working with a Republican, or partially Republican Congress, Obama has solid control of both houses, but refuses to use it. If, as I expect, the recession continues to deepen, with more and more people losing jobs and homes, if, as I predict, health care continues to be unaffordable and inaccessible, if, as I know will happen, evidence of deadly climate change continues to pile up, and if, as I am equally certain, Iraq explodes and the war in Afghanistan continue to worsen, the left is going to see Obama and the Democrats in Congress as the failures and corrupt frauds they are, and will abandon them.

That leaves the question of what to do, and where those frustrated progressives will turn.

I don’t claim to have the answer to that. Clearly the labor movement needs to recognize that hitching its fortunes to the Democratic Party has been and will continue to be a dismal failure. It needs to pull all its political money back and only support those who are 100% allies in the struggle for the rights of workers. No money for the party as a whole. It should also go back to the pioneering work of people such as the late Tony Mazzocchi of the Oil and Chemical and Atomic Workers Union, who before his death was tirelessly working to establish an American labor party.

Other third parties on the left need to drop their individual agendas and work towards unity, especially with the labor movement, in order to create a broad-based left party that doesn’t have litmus tests for inclusion — just broad principles such as steeply progressive taxation, an end to NAFTA and the WTO, democratization of the Federal Reserve Bank, national health care, a wholesale slashing of the military budget, by perhaps two-thirds or more, free education through four years of college for all, and a crisis plan to attack climate change.

If the ever fractious U.S. left, and the somnolent labor movement, cannot come together as one, there is little hope of political change in America. At that point, the alternative would be an increasing militancy over these critical issues, outside of the electoral arena — something that has to happen anyhow, regardless of whether a real third party force can be put together. We know that simply organizing occasional polite marches in Washington, or in key cities, accomplishes nothing. We have learned that e-mail campaigns to deluge members of Congress with canned opinions don’t work. What has worked, and will always work, is massive campaigns of civil disobedience, tent cities in Washington, organized disruption of war preparations, and door-to-door organizing. The corrupt hacks who inhabit the halls of Congress and the White House will not do the right thing just because it is the right thing, or because we ask them nicely. They may, if we make them fear that they will actually lose our votes in the next election. For the most part, incumbent Democrats know that the people who peacefully march down Connecticut Avenue are still likely to vote for them come the next election. They’re not going to be so sure about people who are being hit by tear gas and water cannons and who are being hauled off en masse to jail at protests.

We may need to start sending that stronger message.

DAVE LINDORFF is a Philadelphia-based journalist. His latest book is “The Case for Impeachment” (St. Martin’s Press, 2006). His work is available at www.thiscantbehappening.net.