Since his days in the Illinois state legislature Barack Obama’s position on health care has consistently devolved. Once a bold champion of medical care as a human right, Obama has become an advocate of “market-based” health care solutions – which do not serve public health, but line the pockets of insurance and Big Pharma executives. Taking his lead from the private health insurance industry, Obama is unwilling or unable to expose even the most fraudulent policies and claims perpetrated on behalf of his campaign contributors.
If there’s one thing America’s political and media elite have proved, it’s their willingness to lie. A law designed to gut and dismantle public education is named “No Child Left Behind.” An act to let energy companies burn more coal is the Clear Skies Initiative. Legislation to shield giant corporations from lawsuits by consumers and the public is “tort reform,” and the proposed privatization of Social Security is “social security reform.”
Rather than educating us, American political campaigns run on themes, images, and messages which evocative, with content-free sound bytes. Think of Bush’s “war on terrorism.” In a political culture suffused with lies, where legislators win elections based on corporate campaign donations, and bait-and-switch is the norm, the only sane response is a big dose of skepticism toward whatever elite media and politicians tell us.
On the domestic front, sound bytes of this political season are variants of “universal health care” and “national health care.” Though Republicans and Democrats alike favor the label, there are devils in the details which are far too complicated for ordinary mortals to understand. For their part, our media, utterly fails to examine the workings of supposed “health care for all” plans like those in Massachusetts, California and several more to be considered.
Congressional Democrats and Republicans have spoken highly of plans in Massachusetts and California. These progressive Blue states have solved the problem of the millions uninsured by requiring the poor to buy health insurance from private vendors. If the poor don’t subsidize the insurance industry, they face draconian fines and tax penalties amounting to thousands of dollars a year per person, including the loss of one’s personal exemption on state income tax.
What Is Going On Here?
On a January 11, 2007, interview on Doug Henwood’s Behind the News (WBAI, Pacifica Radio in New York), Steffie Woolhandler, MD, a practicing physician in Boston and co-founder of Physicians For a National Health Care Plan said the following:
“The core idea is [that] the uninsured are going to have to buy their way out of their predicament. The bills contain a so-called individual mandate which says to uninsured families ‘you must go buy health insurance, and if you make more than a certain amount of money [the state will not] subsidize you’….
“We’re talking about someone who earns $25,000/year being mandated, forced by law to go
out and purchase private health insurance. The average individual policy in … Massachusetts is about $6,000 per person, in California it’s at least $5,000.
“It’s a little like Marie Antoinette. The poor have no health insurance. So let them buy health insurance. People simply don’t have the money. That’s why they’re uninsured in the first place. … People are not uninsured by choice … But these plans have tremendous appeal to Republican types because they use the language of individual responsibility. [The plans also place] a big tax on the uninsured people themselves. … if you say to someone earning $30,000 ‘you didn’t buy health insurance, we’re taxing you $3,000,’ you’re penalizing them $3000. That’s new tax revenue [that hurts] middle income families who can’t afford insurance.
“..it’s called an individual mandate, but in order to enforce the mandate the government is using the tax code … to place huge tax penalties on people unless they hand over their money to a private, often investor owned, profit seeking entity.”
Many poor and middle class families will pay more than the average cost, the uninsured with chronic illnesses, those with children, those in their forties and fifties. Unsurprisingly, this car insurance approach to health care reform is touted with a straight face as innovative and a giant step toward “universal health care” by a large number of establishment politicians including Ted Kennedy (D-MA) and Barack Obama.
Obama Means Status Quo?
Last week, the media breathlessly announced that Obama delivered the first significant health care speech of his campaign, one in which he endorsed the principle of universal health care for all. This is what he had to say about the car insurance model of health care reform.
“..we have to start looking at some of the interesting ideas on comprehensive reform that are coming out of states like Maine and Illinois and California, to see what we can replicate on a national scale and what will move us toward that goal of universal coverage for all.”
To be fair, Obama didn’t specifically endorse the car insurance model, he only pronounced it “interesting.” But it speaks volumes about the “leadership” style of this elite politician that he made no attempt to educate the public on this “interesting” stuff or to denounce it as a bad idea. Though short on elucidations of proposed and actual policies, Obama was long and strong on rhetoric. Summoning the ghosts of Harry Truman and Lyndon Baines Johnson to his side, candidate Obama thundered that it was “time to act” on health care. But aside from putting all medical records online, he brought forth no new suggestions, and recommended no precise action.
“…one out of every four health care dollars – is spent on non-medical costs; mostly bills and paperwork. And we also know that this is completely unnecessary. Almost every other industry in the world has saved billions on these administrative costs by doing it all online ….
“But because we haven’t updated technology in the rest of the health care industry, a single transaction still costs up to twenty-five dollars – not one dime of which goes toward improving the quality of our health care …
“… if we brought our entire health care system online, something everyone from Ted Kennedy to Newt Gingrich believes we should do, we’d already be saving over $600 million a year on health care costs.”
Rather than ‘moving the conversation’ on health care toward any practical solution, Senator Obama seems intent on keeping it vague and unfocused.
In the realm of public policy, this kind of pap is to advocacy is like the fistful of meat-flavored bread enclosing the postage-stamp burgers at White Castle: lots of flavor concealing a lack of substance. Obama’s suggestion if that computers do away with the “paperwork” the savings will show up in more health care is inane and misleading. Obama’s neighbor, Dr. Quentin Young, an eminent Chicago physician, a past president of the American Public Health Association, and another co-founder of Physicians For a National Health Care Plan offers a more honest and complete assessment of where health care dollars go. Young has pointed out many times that a quarter of every U.S. medical care dollar ends up as the administrative overhead, including billing, advertising, shareholder returns and profit for the private insurance industry.
Computerizing the records won’t remove corporate greed and graft and Obama knows it. Only a “single payer” system of national health insurance, under which a governmental or quasi-governmental agency takes the place profit-driven insurers and then dispenses medical care as a human right instead of a commodity, can do that. But an honest national debate on the merits of single payer is the last thing candidate Obama and his financial backers want.
What Is National Health Care? Why Do We Need It?
“We need national health insurance,” explained Dr. Woolhandler in her interview with Henwood. “Every other developed country has some form of national health insurance and every other developed country spends less [per capita on health care] than we do. The average, among developed nations, is that they only spend about half as much as we do, despite having universal coverage. So the national health insurance is a much more efficient way of covering everyone. You do get rid of all of the insurance overhead. Typical private insurance overhead in the U.S. is about 13%, but some of the HMOs take 20 to 25% overhead. Twenty-five percent overhead means that the [policy holder] puts in a dollar, but only 75 cents would ever come out for doctors, nurses, hospitals medications, the rest stays with the HMO….”
What neither Barack Obama nor the mainstream media tell us is that most of the “paperwork” burden in U.S. medical care is generated by the for-profit insurance industry. By comparison, single-payer systems in Canada, Australia, and Europe, as well as Medicare in the U.S., generate only 1% to 3% administrative overhead.
Woolhandler argues that, “One of the reasons we don’t have national health insurance here is because the opponents of national health insurance keep it off the agenda with piles of misinformation, by suppressing debate … The foes are the private insurance industry and the pharmaceutical industries. They use their immense political and monetary power to try to prevent debate.”
What the Public Wants, What Obama Wants
Whenever the outlines of various health care schemes are explained to voters, the single payer or Medicare-for-all solution emerges as the favored choice. Consider the findings of Frank Russo in a recent California poll from the Public Policy Institute of California:
“…by a two-to-one margin, most prefer a universal health insurance program … like Medicare that is run by the government and financed by the taxpayers’ nationally to the current [system] in which most people get their health insurance from private employers, but some people have no insurance. … what is known as single payer.”
Barack Obama is quite familiar with the concepts and the specific merits of single payer. Back in the 1990s, as an Illinois State Senator representing a mostly Black district in Chicago, Obama took pains to identify himself with his neighbor Dr. Quentin Young. Obama co-sponsored the Bernardin Amendment, named after Chicago’s late Catholic Archbishop, who championed the idea that medical care was a human right, not a commodity. At that time, when it was to his political advantage, Obama didn’t mind at all being perceived as an advocate of single payer.
By June 2003, when Obama was a candidate for his current job in the Illinois Democrat primary, we were impolite enough to ask him a direct question about whether he’d support single payer legislation if elected to the U.S. Senate. We asked him:
“Do you favor the adoption of a single payer system of universal health care to extend the availability of quality health care to all persons in this country? Will you in the Senate introduce or sponsor legislation toward that end?”
Obama’s answer was:
“I favor universal health care for all Americans, and intend to introduce or sponsor legislation toward that end in the U.S. Senate, just as I have at the state level.”
Already Obama’s position on health care had returned to a pro-corporate, anti-public stance. By 2004, Obama was newly elected to the U.S. Senate, and in an interview with Glen Ford, Obama was asked whether he planned to sponsor the kind of single payer legislation he’d been identified with as a state senator.
Glen Ford: “Are you going to introduce single payer legislation?”
Barack Obama: “No, I am not. Which isn’t to say that I’m not interested in the conversation about moving in a direction that expands affordability and accessibility. … along that spectrum there are many points that people may arrive at, all of whom affirm the notion that we have a health care crisis that hits our communities much harder than anybody’s, but it’s everybody’s crisis, and we’ve got to have an agenda in terms of both general health care issues as well as issues like AIDS that are ravaging the African American community.”
George Bush would never sign a single payer bill, even if it did pass the House and Senate. Change rarely comes from the top. In Canada, the first single-payer health care law was enacted in Saskatchewan, which had a left-wing local government. With millions of people benefiting from it, Big Pharma and Big Insurance were no longer able to suppress critical examination of the success of single-payer in delivering health care to all citizens. The following year, the neighboring province of British Columbia, with a conservative government, adopted a similar plan. The year after that, single-payer became law nationwide in Canada.
Rather than “moving the conversation” on health care forward, Obama seems intent on keeping it vague and unfocused. Just as he won’t denounce the “interesting” car insurance model, Obama refuses to discuss the merits of single-payer anyplace voters might hear it. He has no plans to introduce a Senate version of HR 697, the single-payer bill introduced in the House by John Conyers (D-MI) and Dennis Kucinich (D-OH). Obama’s silence on the issue lets him take full advantage of mainstream media’s purposeful silence on single-payer, despite widespread public support for it. Thus, candidate Obama affords himself maximal weasel room in which to pose as a media-anointed leader endorsing “universal health care” without having to discuss or advocate the only proven method of delivering real universal health care in an industrial society.
During his days in the Illinois State Senate, Obama was an advocate of universal medical coverage as a human right. But as U.S. senator and presidential candidate Obama has devolved into the timid, dissembling, and calculating creature we see today: a man who dares not criticize clearly fraudulent measures offered in the name of health care for all. Obama is a candidate who studiously avoids discussion of single payer, and who summons the ghosts of dead presidents to sell us “market-based” health care reform.
Bruce Dixon, Managing Editor of the Black Agenda Report (BAR) can be reached at Bruce.Dixon@BlackAgendaReport.com.