Every year in the United States, 45,000 people die from one eminently treatable condition — healthcare coverage that’s nonexistent or inadequate. That’s more than die from automobile accidents or breast cancer.
On the other hand, over 50 countries, both wealthy and not, guarantee medical services to all. They include Rwanda, Thailand, and Mexico.
The U.S. leads in medical technology, but has disparities in care the size of the Grand Canyon. These are created by race, gender, language, and immigration status. But, above all, they are due to lack of money to pay for healthcare — which, under capitalism, is a commodity like any other.
The shocking truth. About twice as much is spent per person in the U.S. as in any other industrialized country. Yet, in overall health quality, the U.S. ranks 37th, just ahead of Slovenia. It is 30th in life expectancy, and 39th in infant mortality.
Why is the U.S. medical care dollar getting so little bang for the buck?
Conventional wisdom is that Americans are driving up costs by getting fatter and older. But the real culprit is private insurance corporations. On average, they claim 14 percent for administrative costs and a whopping 17 percent for profits, leaving only 69 cents on the dollar spent on actual health needs.
By contrast, Medicaid and Medicare hold their overhead to about 3 percent, with 97 cents of every dollar paying for hospital stays, lab tests, medications, etc.
The government pays 60.5 percent of all health costs through its subsidies and programs, including medical coverage for its employees. A basic problem is that its dollars flow mostly into the private pockets of healthcare profiteers like drug companies and insurers.
The result? Pfizer and United Healthcare are in blooming health — poor and working people not so much.
Evolving history. Some federally guaranteed medical care has existed in the U.S. since its founding, when it provided services to soldiers; later, veterans were included.
Federal services were temporarily provided for slaves freed during the Civil War, when four and a half million became refugees in their own country. Hundreds of thousands fell prey to exposure, starvation and epidemics. The Freedmen’s Bureau established 30 medical facilities before being stripped of support with the dismantling of Reconstruction.
Healthcare was promised to Native Americans in many treaties and executive orders, but long amounted to little more than counting the dead from epidemics and starvation. The medical system developed side by side with Indian schools designed to “assimilate” Native American children. Appalling conditions improved only gradually, in response to activism. Today the Indian Health Service provides care to just over half of Native Americans and Alaskans.
The movement for a national health plan, backed by the labor movement and Left, grew in the 1930s during an upswing in the class struggle. Franklin Delano Roosevelt responded with the New Deal. It was meant to provide jobs and improve conditions during the Great Depression, thus forestalling the very real threat of revolution.
Legislation for a national plan was considered by Congress as extensions of the Social Security Act in 1934, 1938 and 1940, only to be sabotaged by presidential maneuvering.
During the labor shortages of World War II, employers began providing healthcare as an incentive. Wage controls were in place, but benefits weren’t counted.
Not until Lyndon Johnson’s War on Poverty was a significant healthcare reform won. Pressured by massive civil rights and anti-war movements, and funded by a guns-and-butter economy during the Vietnam War, the federal government adopted Medicare and Medicaid. These provided coverage for the elderly, the disabled, and a segment of the impoverished, over half of them children.
As the social movements retreated, so too did healthcare coverage. Bill Clinton promised reform as a top priority but did not deliver (although he did manage to decimate welfare).
Obama also made campaign promises, but convened a healthcare committee that kept universal care off the table. In the end, he brought the leaders of major unions to heel behind the monumentally flawed Affordable Care Act (ACA).
Obamacare no solution. Even if fully implemented, which is unlikely, the ACA would leave between 20 and 30 million people not covered.
A key ACA component is its expansion of Medicare eligibility to nearly all low-income adults. However, as a concession to the right wing, it leaves individual states with the decision to accept or reject the federal aid to implement this expansion. Half have refused, leaving 86 percent of adults who are poor but not elderly uninsured: covered neither by Medicare nor Medicaid, and too poor for Obamacare!
Those who make a little more aren’t much better off. The percentage of people with the least adequate plans, including deductibles greater than their savings, has risen five-fold since 2006. The percentage of health coverage paid by employers is dropping like a rock. The ACA favors individual rather than employer-funded healthcare, and taxes higher quality plans that used to be exempt.
Obamacare is not about providing comprehensive care. It’s about guaranteeing that private insurers and medical megabucksters can continue to profiteer from human misery, taking money from working people and enlarging the bank accounts of the already rich.
In other words, the healthcare industry isn’t much different from the rest of the economy. The “recovery” from the 2008 economic crash is thanks to a massive transfer of wealth to corporate pockets through wage freezes, layoffs, service cuts, lowered corporate taxes, and rampant privatization.
The road to universal care. What options are there to the current dismal hodgepodge? The most talked-about is a single-payer system: the government is the insurer, a la Medicare, or the national programs of Canada and France. In this vein, the Expanded and Improved Medicare for All Act (HR 676), first introduced by Rep. John Conyers in 2003, has won broad support from unions.
As attempts to win single-payer on the national level have repeatedly gone down in flames, dozens of campaigns for state plans have been launched. Only one succeeded, in Vermont.
A step above single-payer is socialized medicine: doctors and health facilities are paid directly by government. This is the model for the military, Department of Veterans Affairs, and Indian Health Service, as well as Great Britain and Spain.
But this still leaves the production of medications, health equipment, and hospital supplies in the grasping hands of the profit system. The best answer is nationalization of the whole healthcare industry: public ownership, controlled by workers and consumers, of drug companies, hospitals, and every facet of medical services.
Nationalization is what it will take to make healthcare truly universal — and free. With no economic triage, no multi-tiered levels of quality depending on ability to “co-pay.” And no exclusion of undocumented workers or elimination of reproductive services!
Universal healthcare should be a right. It’s logical, cost-effective and humane. And, when the working class realizes its power to stop being robbed, it’s winnable.
Dr. Williams works and teaches at Metropolitan Hospital in East Harlem. Email her at firstname.lastname@example.org.