Single-payer: a healthy start

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Working people in the U.S. have long demanded changes to a medical system that places private profit before their health needs. But now that the failing capitalist economy itself is requiring more and more life support, cries for healthcare reform are getting louder even from the big corporations themselves.

What big business wants and what working people need, however, are diametrically opposed.

Big business wants to improve profit margins by unloading its obligations to pay for employee health insurance and transferring this cost to workers. But with rising unemployment and the economy in a tailspin, workers are already strapped to make ends meet. They need better healthcare, without economic hardship.

With both labor and big business calling for an overhaul of the U.S. healthcare system, it is no wonder that President Obama has promised reform. Yet the form that this will take is not a foregone conclusion. The battle between workers and big business will determine the final outcome.

The Single-Payer Proposal.

A bill before the House of Representatives calls for universal healthcare as a right, regardless of ability to pay. Every U.S. resident, citizen or not, would be entitled to receive standard-of-care medical coverage, including in-patient, out-patient, and long-term care, mental health, vision, dental and chiropractic treatment. There are no co-pays or out-of-pocket expenses.

H.R. 676, the United States National Healthcare Act, was introduced by Democratic Congressperson John Conyers Jr. of Michigan. It would prohibit any private insurance company from selling coverage for the same items covered under the bill. In other words, companies could not use their resources to sabotage the national plan. Though free to sell coverage for items like cosmetic surgery, private insurers would essentially be put out of business.

Most of the funds needed to pay for the program would be realized through the wholesale elimination of the current administrative bureaucracies of the private insurers. Their insanely irrational paperwork, duplicated from one insurer to the next, is geared fundamentally toward diverting healthcare premiums from actual care to the pockets of private investors and their CEOs. It amounts to about 31 percent of the available revenue.

Medicare, on the other hand, the non-profit national health plan for the elderly, with no CEOs drawing salaries in the tens of millions or investors expecting big returns, has an administration that consumes only about 3 percent of its revenue.

Funding for the national health plan would come from payroll taxes on both individuals and employers. However, the estimated cost to workers would be substantially less than what they currently pay. Additional money would come from health surtaxes on the top five percent of income earners and closing corporate tax loopholes.

Pros and Cons of H.R. 676.

The biggest advantage of H.R. 676 for working people is that it establishes healthcare as a right, not a privilege. This means that a portion of society’s wealth, all of which is produced by working people anyway, comes back in the form of guaranteed universal high quality medical care.

H.R. 676 would also reduce healthcare’s economic burden on working people by eliminating the current massive diversion of healthcare dollars into private pockets. What workers currently purchase from the insurance industry is a reduced financial risk if they should become ill. This risk would be taken on by society as a whole.

For these reasons, H.R. 676 should be given critical support.

However, because the bill leaves crucial components of the healthcare industry in private hands, its prognosis for success remains guarded.

Pharmaceutical companies, private hospitals, and HMOs all have an interest in diverting healthcare dollars to their own CEOs and private investors. Yet H.R. 676 seeks to negotiate with the drug industry, and has a complex scheme for reimbursing private providers. As long as it must feed the profits of these private interests, its resources remain at risk.

Ultimately, for universal healthcare to succeed, every single private component of the industry must be nationalized under the control of workers and patients, especially those least served today – women, people of color, youth, the elderly, the unemployed and under employed. H.R. 676 is a good start, but further struggles will still be necessary.

Don’t Count on the Democrats.

The Democratic Party is one of the two main parties of big business. It cannot be trusted to fight for a bill that substantially improves the social rights of working people at the expense of private enterprise.

Conyers can’t be trusted to fight for his own bill. His allegiance is first and foremost to private profit.

In a February 19, 2009 letter to General Motors CEO Richard Wagoner, Conyers and Ohio Democrat Dennis Kucinich urged the automaker to endorse H.R. 676, arguing that it would improve GM’s “cost control” and “competitive advantage.” They praised GM’s recent “Voluntary Employee Beneficiary Association agreement with the United Auto workers” in obtaining “relief of health care costs,” since this agreement allowed GM to “relinquish financial responsibility for retiree care.”

In other words, Conyers and Kucinich endorsed takeaways from workers, naively hoping that would convince General Motors to sacrifice one of its class allies – the health insurance industry.

General Motors is a member of the Business Roundtable, a highly influential coalition of CEOs of the nation’s largest corporations. This group also includes health insurance companies. The Business Roundtable’s health reform plan calls for “creating a more competitive private health insurance marketplace while maintaining a strong, stable public safety net.” That is, quality healthcare for the rich, mediocre healthcare for those with some means, and a minimal “safety net” for everyone else.

The New York Times reported that the Business Roundtable has been meeting behind closed doors with Democratic Senator Edward Kennedy of Massachusetts to hammer out healthcare policy. They are joined by America’s Health Insurance Plans, the Pharmaceutical Research and Manufacturers of America, and bureaucrats from the AFL-CIO labor federation. H.R. 676 is not on their agenda.

Nor can we expect much from Democratic President Obama. His campaign accepted $19 million dollars from the healthcare industry. Far from saving billions by eliminating any part of it, Obama wants to negotiate a deal whereby no one can be denied coverage, and a new government-run insurance program is set up along side the private plans. Companies would still gain more customers because low-income parents would be required to buy insurance for their children, with some aid from government subsidies.

Obama is hardly a friend of H.R. 676. Indeed, at his March 5 healthcare summit, supporters of H.R. 676 had to threaten a demonstration outside the White House in order to obtain a last-minute invitation.

For quality healthcare!

The U.S. healthcare system is an unmitigated disaster. But it does not have to be like this. Only the system of private profit stands in the way of meaningful improvement for workers.

Achieving universal, high quality, guaranteed healthcare will take a determined struggle by organized labor, pushed by the rank and file. And labor must build coalitions with the communities which are the least served today.

We can win by mobilizing support for H.R. 676 and demanding nationalization of the whole medical industry, including especially the drug companies, under workers’ control.

Dr. Steven Strauss is a Baltimore neurologist. He can be contacted at fspbaltimore@

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