A showdown is looming between Trump loyalists determined to scrap Obama’s Affordable Care Act (ACA) and its supporters.
The Republican plan is as everyone predicted. It will cut federal support for low income people, shift wealth to those already better off, and enrich the private sector.
But is Obama’s act one that working people should fight for? A contradictory combination of public assistance and for-profit medicine, it too leaves the big health insurers and drug companies calling the shots. That’s why it cannot stop rising costs to workers or provide truly high quality care to everyone.
Working people need our own plan, one that works for us by taking the profit drive out of the waiting room and beyond. We need socialized medicine, and we should fight for it now.
The truth about Obama’s plan. The Affordable Care Act is anything but. It is primarily about increasing the profits of the health insurance industry. That’s why their corporate bigwigs helped write the bill and signed onto it.
Since the Supreme Court upheld the act in 2012, the five biggest health insurers have made staggering profits. From 2013 to 2015, stockholders of United Health, Anthem, Aetna, Humana, and Cigna took in $30 billion, money which could have been used for healthcare.
Workers are experiencing rising costs and shrinking coverage. According to Washington’s own reports, those purchasing existing midlevel plans will pay 25 percent more for them in 2017. Those covered by their employers will see a 9 percent rise in their deductibles. Overall, premiums are rising faster than wages.
Why is this? Because Affordable Care is a business deal between the health insurance industry and Washington. The Obama administration dangled 50 million new customers — the number of Americans without coverage — before the drooling faces of the insurers. Because of the requirement that everyone not already covered purchase private insurance or face penalties, the industry was willing to concede on some of its discriminatory practices, like excluding pre-existing conditions.
Trump and private healthcare. But if private profit is the bill’s key ingredient, why does Trump rail against it?
Because Obama’s plan does provide some relief. It directed federal assistance to families with incomes under four times the official poverty level. It expanded Medicaid eligibility and, though states were allowed to opt out, increased those covered to 74 million people.
Medicaid health assistance to poor families, along with Medicare, was won in 1965 as part of the great civil rights struggle. It was not a gift from the Democrats or Republicans.
But Tom Price, Trump’s head of Health and Human Services, and the majority of congressional Republicans pretend that the private sector can solve people’s healthcare needs. They aim to replace inadequate Medicaid funding with even more inadequate block grants to states, which may not even spend the money on healthcare. They’ll provide “tax credits,” a deduction on income taxes for those able to afford healthcare up front. This will only transfer workers’ hard earned social wealth to the already privileged. Millions will lose coverage.
Medicare and Medicaid need to be expanded, not contracted. Indeed, polls have shown that what U.S. workers like in the Affordable Care Act are its anti-corporate features. And a 2016 Gallop Poll found that fully 58 percent of Americans supported “Replacing the ACA with a federally funded healthcare program providing insurance for all Americans.”
Such a program should include full coverage for reproductive rights, not found, by the way, in Obama’s plan.
Problems with a private system. Among advanced capitalist countries, the U.S. possesses the most profit-driven healthcare system. Not surprisingly, it consistently ranks lowest in every important measure of success.
Per capita, the U.S. spends more on healthcare, and peddles more prescription drugs, than other developed countries, all of which have some type of national health plan. Yet Americans live on average two years less. They have the lowest life expectancy at birth, the highest infant mortality, and the highest rate of chronic disease.
Within the USA, wealth discrepancies translate into distinct health outcomes. The richest Americans live fifteen years longer than the poorest. A 2013 study by healthcare provider Kaiser revealed that financial obstacles lead more women than men to miss recommended tests and treatment, avoid filling prescriptions, and neglect needed mental-health care.
Apart from providing greater access, non-profit systems, including Medicare in the U.S. and national plans in Europe, cost less to run than private systems. Non-profit systems typically require three percent of their revenues for administration. The rest goes to actual care. For-profit systems consume 33 percent of revenues for bureaucratic management, including paying multimillion dollar salaries to CEOs.
Solution: socialized medicine. The U.S. is wealthy enough to provide quality healthcare to everyone as a fundamental human right. Only private profit stands in the way.
A forward step is single payer. The government, as the sole insurer, is obligated to pay for everyone’s medical needs, no matter how healthy or ill, young or old, black or white, male or female.
Even better is fully nationalized healthcare, provided directly by government. No private insurers, pharmaceuticals, hospitals or health clinics.
How to pay for it? Tax Wall Street, large corporations and the rich, for a change. Or expropriate big health insurers and drug companies.
We need a working class solution urgently. Bernie Sanders has called for defending Obama’s plan today and fighting for single-payer in the distant future. But the future is now, because working people are suffering today. Why fight for a plan that enriches the already rich and leaves the real wealth creators still in need?
Trump has made it abundantly clear that as long as capitalism exists, any progress for workers can be withdrawn as quickly as the president can sign an executive order. For permanent gains, we need nationalized medicine in a socialist society, one run by workers, not corporations, and which therefore puts human needs first.
Steven Strauss, M.D., is a Baltimore neurologist. Send feedback to him at email@example.com.
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