Go to source
all the forms of inequality, injustice in health care is the most shocking and
Is it not painfully obvious to everyone now that the Affordable Care
Act (ACA) is a complicated failure of a contraption, from a healthcare and a
political point of view? Answer: Yes!
Even Michael Moore now admits
that "Obamacare is
Indeed, I contend that:
- Obamacare is not a public program,
but a government-assisted private boondoggle. Its main purpose is not to ensure
public health, but to insure the profitability of private health insurance
companies and the private pharmaceutical and hospital industries.
- It is the product of a now
thoroughly corrupt political culture in which capital openly buys politicians,
elections, and laws.
- It is failing politically at every
level, and is even likely to fail in its actual socio-economic goal of
perpetuating the profitability of the private health insurance industry.
- It cannot be "tweaked" into
becoming a real public healthcare program, and every syllable of every argument
for fine-tuning it does nothing but waste time and stand in the way of ever
getting the single-payer, universal coverage, Medicare-for-all that we need.
Unfortunately, it was Democratic
Obama cheerleaders like Moore -- who refused four years ago to oppose
the program and insist, as they
should have (and promised they would!), on a public system -- who helped to
create the terrible situation we now have. (And Moore still seems to think
Obamacare is "a godsend" that can be tweaked into perfection. See Shamus
's wonderful takedown of Moore's
put it, with their "disingenuous sales pitches four years ago, President Obama and his
Democratic acolytes did a lot to create the current political mess engulfing
Obamacare -- exaggerating its virtues while pulling out the stops to normalize
denial about its real drawbacks.
That was a bad approach in 2009.
It remains a bad approach today."
The result has been a situation in
which healthcare has become more
and the possibility of a single-payer
Medicare-for-all system -- the cheaper
, more effective, already-proven and undeniably popular
by two-thirds of the public in 2009
solution -- has become deferred even further, and made harder even to see or
To fully understand how phony the
whole ACA discourse is -- both that of
free-market "Tea Party" fundamentalists and that of Democratic-Party/Obamican
free-market neo-liberals -- and why Obamacare should be understood as "a fraud
on the public" (Glen
), and "the biggest insurance scam in history" (Kevin
Zeese and Margaret Flowers
we have to look at what the real purpose of the law is, and what it is not.
That's really quite obvious if you look at the forest the legislation creates,
and don't let yourself get diverted by the deceptive and confusing debate over
the prettiness of this or that tree.
Obamacare is not a healthcare
program. It -- and, importantly, the government through it -- does not provide
healthcare to anyone. Obamacare does not give a penny to healthcare providers.
In fact, as an
posted by Paul Craig Roberts puts
it: "Hundreds of billions of dollars are siphoned from Medicare to help pay the
cost of Obamacare." In order to budget for the ACA, Obama has reduced Medicare
payments to doctors and hospitals, actually taking public money that is
directly paid for medical services and shifting it into the pockets of private
health insurance middlemen.
It is not even a health insurance
program. It, and the government through it, does not provide health insurance
to anyone (although it kinda, sorta, partly pays
for some of it, for some people). Obamacare is a publicly-funded marketing
program for private insurance companies, a program through which a compliant
capitalist government functions as a super-broker that forces the public to
buy, and funnels public money into, private health insurance companies, which
retain complete management and control of healthcare delivery behind the
It's a boondoggle, designed, by
Obama and the health insurance lobbyists who wrote it, to prevent
movement toward the only reasonable and effective
alternative -- some form of Medicare for all, which people are literally dying
for -- and to save
insurance companies by forcing people to buy their products, which people
rightfully despise. Obamacare does for the despised health insurance companies
what Quantitative Easing is doing for the despised banks -- concocting a way to
pour public money into them to keep them afloat, and keep their CEOs'
plutocratic incomes flowing. Like $21
to $47 million for the top five
as much as $106 Million.
Like the highest average of all
percent higher than chief executives at financial services companies.
That's the money drain out of real healthcare that Obamacare
sustains. Liberals who think Obamacare
is some kind of some kind of "step in the right direction," rather
than a new obstacle to moving forward, are no less deluded than Tea Partiers
who think it's some kind of "socialism."
To put it in a way that right and
left might understand: Obamacare is no more a public healthcare plan than the
Federal Reserve is a public bank. It's a simulacrum of a public institution
that stands in for, and in the way of, a real one. Fundamentally, Obamacare is
another element -- a particularly nasty one because of what it's screwing with
(healthcare) -- in the three-decades-long right-wing/neo-liberal denial of the social.
For the contemporary right-wing,
"society" is nothing more than the net sum of individual, private transactions.
Margaret Thatcher gave the tagline for this movement, with her famous
insistence that "there is no such thing as society." Following her -- and their
other socio-economic mentor, Ayn -- American Randian Republicans have been the
loudest and most aggressive promoters of the crude "greed is good" ideology
that bashes any attempt to think socially with the fist of triumphant
Right-wingers are not wrong to see
the ability to think socially as the basis for "socialism," as something which,
if thought through consistently, would lead in that direction. Reactionary whiskers
are fine-tuned to twitch excitedly when the tiniest molecule of such an
attitude brushes by. A fine, concise definition of "communism" was given by Edgar Speer, Chairman of the Board of United States Steel,
when, in 1978, he explained
why it would be such a terrible idea to sell
Youngstown's abandoned steel mills to the workers: "The whole concept of
community-owned facilities is the same as communism -- particularly where the
profit of the facility will go for the social benefit of the people. This is
communism." Well-said, comrade Edgar.
But, as Democratic liberals and less-dogmatic
capitalists since FDR have understood, it is quite possible to craft policies
and programs embodying incipient forms of social solidarity that will be
comfortably absorbed within the capitalism system. Social Security was not, and
socialized health insurance will not be, the death-knell of capitalism. These
programs are threats in the sense that they both provide examples of how well
things can work when democratically run "for the social benefit of the people,"
and they empower ordinary people to organize for greater control of society by
freeing them from constant fears of sickness and penury. But we are far away
from reaching a tipping-point in the security and militancy of working people that
would endanger capitalist hegemony.
These reformist social programs
are also sometimes politically and
economically necessary. When the leaders of the $2.6
consortium of for-profit health-insurance,
pharmaceutical, and hospital industries sat down with Obama, their favorite
candidate by far
, to write the ACA,
this is what they all understood. They were trying to save their capitalist
industry, the source of their personal wealth, from being shut down (as it should
be) by a perfect storm of popular rage and threatening economic tendencies. They,
including Obama, were also following the anti-social imperative to reject the
possibility of taking public responsibility for the common good, in favor of
insisting on a program of dispersed, "mandated," individual private purchases.
Candidates: Selected Industry Totals, 2008 Cycle
So, in the shadows of this
right-wing hoopla, it is Democratic Party neo-liberalism from Clinton to Obama,
posing as a kinder gentler alternative, that
has been most effective in undermining, by co-opting, the policies and political
thinking that represent effective forms of social solidarity. Democratic Party
neo-liberalism has been a most effective force in turning the American and
global social economy into a privatized, financialized playground for
plutocracy, and in promoting austerity and immiseration for ordinary working
people. Barack Obama has been a most effective agent of that effort, and
Obamacare is one of the most effective and pernicious tools of that project.
Would you buy a used car from this man?
To highlight this most fundamental
point, I'll begin with this observation
of Noam Chomsky on "solidarity." As
opposed to the alienating, competitive individualism that serves capitalist
interests, "solidarity" is the fundament of the logic and ethic of social
thought, indispensable to common action for the public good. Which is why it's been undergoing an enforced
post offices, Social Security, and public schools all have to be dismantled
because they are seen as being based on a principle that is regarded as
care about other people, that's now a very dangerous idea. If you care about
other people, you might try to organize to undermine power and authority.
That's not going to happen if you care only about yourself. Maybe you
can become rich, but you don't care whether other people's kids can go to
school, or can afford food to eat, or things like that. "
That's why unions had the slogan, "solidarity," even though they may not
have lived up to it. " And it's really important for power systems to undermine
that ideologically, so huge efforts go into it. Even trying to stimulate
consumerism is an effort to undermine it. Having a market society
automatically carries with it an undermining of solidarity. For example, in the market system you have a choice: You
can buy a Toyota or you can buy a Ford, but you can't buy a subway because that's not offered. Market systems don't
offer common goods; they offer private consumption. If you want a subway, you're going to have
to get together with other people and make a collective decision. Otherwise,
it's simply not an option within the market system, and as democracy is increasingly
undermined, it's less and less of an option within the public system. All of
these things converge, and they're all part of general class war.
Let's pretend we're in a society
where people are clamoring for a decent public transportation system. They are fed up with having to buy overpriced
and unreliable cars from unscrupulous dealers on onerous financial terms in
order to be able to get to work every day.
They are at a boil over this.
Along comes a smart, mellifluous, "progressive" politician, who says, to
the public and to the thousands of activists who've been working on this issue
for decades: "I'm absolutely with you on this. We need a first class, effective
public transportation system. I promise you I will not settle for anything
less." He is elected, with a mandate to solve this problem and many others like
Now imagine that, after months of
negotiation with auto dealers and manufacturers, from which the best public
transportation advocates have been excluded, he proposes the following solution:
To make sure that everyone has some
transportation, I am going to force everyone, under the threat of a tax
penalty, to buy a car -- a Ford or a Lexus or whatever, you choose -- from the
same network of dealers that's been gouging you all along. But Don't
worry, he says. I'm going to make sure that every car you buy has brakes, seat belts,
and turn signals. What's more, I'm going to make sure (kinda, sorta, maybe, for
some of you) that you are offered an affordable monthly payment. I'll even help you make the payment if you're
really strapped, by giving public money to those car dealers. Now, a steering wheel, that'll cost you a deductible.
A heater? Copayment. But, for the poorest of you, we'll cap your
total yearly payment at $6000 or so, over and above your monthly payments.1
Would anybody think that this was
a solution to the need for a public transportation system? Any of the public that had demanded such a
system? Any of the thousands of activists
who had been working for it? Would
anybody -- especially any one of those activists -- think or say that this was a
"step in the direction" of the public transportation system? One would have to be an utter fool.
Such a program would be the opposite of a public transportation
system. It would clearly be designed not to satisfy the public's needs for a
transportation system, but to strengthen and perpetuate the same system of selling
cars, and further enrich car dealers. And this would be the case even if the politician were opposed by right-wing
groups who objected to "the government" forcing dealers to include brakes and
turn signals in their cars, and called that "socialism." No serious public
transportation advocate would take those right-wing complaints to mean that the
program really was a public transportation system, or even a "step toward" one.
Try repeating the analogy: Public water supply? We'll help you buy
bottles of Dasani and Poland Spring. You can repeat it, because this is exactly the sort of
government-assisted privatization that is the order of the day, around the
world. This kind of thing has nothing to do with, is the opposite of, a public
program, structured for the public interest, let alone "socialism."
This is what Obamacare is. Once
you see that -- and really, how could you not? -- you see that it is, indeed,
If you're tempted to say: "But
isn't it better that cars have seat belts?" you are missing the point, and
demonstrating the hold that capitalist, individualist ideology has on our
minds, and how it diverts us from thinking
socially. The private car market can be better or worse, well- or
ill-regulated, with lousy products or quality ones, but none of those
differences will make it a public transportation system, or a "step in the
direction" of one. It does not have the same purpose.
Consider this, for example: In order to keep the for-profit private
health insurers in the game, Obama has to make the pitch that healthy young
people should consider it their civic duty to be forced to give money to a
private health insurance company, since that company has agreed to things like
not excluding pre-existing conditions. Really? It's your civic duty to make car payments to a private auto dealer even
when you don't need the car, so that the
dealer can maintain his profitability? No, it is not. This is nothing like the civic duty one would
have to pay taxes into a social fund that pays directly for your and everyone
public transportation healthcare. Nothing like it. Not to
understand that distinction is to be trapped in a straitjacket of anti-social
It's not that there are no good
features of Obamacare; it's that the positive features, like not excluding
pre-existing conditions (but there are loopholes for that2) are
"loss leaders" to get you into the showroom, buy a nice upgrade package, and
sign on the dotted line for those easy monthly payments. They are all hedged in
by a framework whose primary purpose is profitability. The private for-profit health
insurance industry remains in charge, and it will chip away and undermine, or
(same thing) try to monetize, any of the positive discrete features that were
used to lure progressives into defending one more crappy piece of right-wing
In a for-profit health insurance
system, "a company that sells
insurance, no matter what for, does it for one reason and one reason only- to
make money." The insurance company becomes "a third party that needs to extract
profit from the relationship between a doctor and his or her patient." For-profit
health insurers, who require profitability, and
continual growth in profitability
, are impelled to put up barriers to
providing actual healthcare: "On top of the expensive monthly premiums, there
are co-pays and deductibles that are huge barriers to getting treatments. We
have in-network providers, out-of-network providers, and a book full of
policies and percentages that gets changed every year." (Graeme Anfinson "The
Democratic Enemies of Medicare for All
Since it is premised on perpetuating
the private, for-profit, health insurance system, Obamacare "further entrenches
this mess into our lives." Obamacare
will not provide healthcare, or even health insurance to every American, and its purpose is not that
. Its purpose is
to ensure ongoing sufficient profitability for the health insurance industry
that fashioned and controls it:
The ACA was not selflessly designed with the intent
of providing affordable and equitable medical services to those in need, but
rather to acquire taxpayer money for the private insurance companies under the
seemingly helpful guise of health care and the ideological excuse of personal
responsibility. It takes money from ordinary people and gives it to a medical
insurance industry that profits handsomely from this legally-enforced corporate
welfare -- all while keeping Americans locked in the same broken system that
puts profit before patients. The law was essentially written by business
executives from the industry so that special interests would not be upset and
profits assured. [Anfinson again. My
The Swedish Way
"assuring profits" is Obamacare's purpose. Don't take my word for it. Read the New York Times
story, wonderfully titled "The President Wants You to Get Rich on Obamacare
." It's about a business seminar at the "21"
Club, given by Tom Scully of "the Potomac Research Group, a Beltway firm that
advises large investors on government policy (tag line: "Washington to Wall
Street"). Tom schooled his colleagues about how Obamacare is "actually
more, not less, capitalistic than anything that came before." He detailed
how it will provide, and was designed to
("It's exactly the kind of competition that Elizabeth Fowler,
and the Baucus team, intended the law to encourage."), myriad
opportunities for new parasites to make money off your sickness:
Scully finally began his speech, he noted that the prevailing narrative among
Republicans -- assuming that many in the room were, like him, Republican -- was
incorrect. 'It's not a government takeover of medicine,' he told the crowd.
'It's the privatization of health care.' In fact, Obamacare, he said, was
largely based on past Republican initiatives. 'If you took George H. W. Bush's
health plan and removed the label, you'd think it was Obamacare.' [Yup. See also:
"Why Obamacare is a Conservative's Dream")
Scully then segued to his main point, one he has been making in similarly
handsome dining rooms across the country: No matter what investors thought
about Obamacare politically -- and surely many there did not think much of it --
the law was going to make some people very
rich. [emphasis in original]
a look at "Despite
Glitches, Obamacare Profit Windfall To Insurers Well Underway
," from Forbes
citing "Health plan CEOs like
Wellpoint's Joe Swedish," who -- taking in a $1.25 million salary, plus
possible $3.75 million bonus, plus
$8 million stock options, plus
$3.56 million "compensation" for leaving his last job (Must have been a hell of a job!
) -- knows
While politicians and pundits alike inside the
beltway beat up the White House over computer system glitches, health insurance
companies still project robust revenue growth and profits from a boom in
business from newly insured Americans under the Affordable Care Act.
Republican Tea Partiers delude themselves that it's "socialism," and Democratic
liberals delude themselves that it's some kind of real humanitarian initiative
for the public good, shrewd businessmen and the business press know exactly
what Obamacare is about: a profit windfall.
thought I was going to talk about healthcare in Sweden? OK, I will.
I have family living in Sweden. The adults cannot pay more than $500 a
year each for healthcare -- for everything: doctors, tests, surgeries. (Not,
alas, dental.) For the kids (up to 18), it's all free (including dental,
not including eyewear). They have pretty good doctors, too, last I heard. Tell
me about what a hard sell that would be. And Sweden is not
a socialist country
, although it is a social
The Path Not Taken
I cannot insist enough on the
demonstrated falsity of the argument that defending Obamacare was then (or is
now) the only politically "realistic" strategy.
First of all, particularly in
early 2009, in the midst of a severe crisis of capitalist legitimacy, it was not
politically impossible to make the case for Medicare-for-all. I
chose this image
of Newsweek's February 2009 cover as my blog avatar precisely to indicate the radical ideological and political
possibilities that had opened as a result of the near-collapse of the American
capitalist economy. These were the possibilities that candidate Obama so
craftily surfed on to his election in 2008, and that gave Democrats control of both
houses of Congress. In that context, there was absolutely no reason to presume
that it would be politically more difficult to make the case for an expanded
version of the enormously popular Medicare program than for some complicated
scheme to force people to buy private health insurance.
Obama did not refuse to make that
case because he could not, but
because he would not. He did not want
to, because -- despite the other impressions he loves to give gullible
progressives -- he is a free-market neo-liberal by conviction, and favors the
private healthcare system. He wanted
the deal that would save and strengthen private insurance companies, not the public social fund. When he
said otherwise, he was lyi", er, triangulating. Not telling the truth.
The details of how Obama locked
himself up with insurance, hospital, and pharmaceutical lobbyists to write the
ACA, and ordered Democratic legislators to drop any "public option" are well
known, and were well known at the time -- although they were at the time, and
still are, ignored by delusional Democratic constituents who want to believe
that their party leaders only produce such monstrous policies because they're
hogtied by Republicans.
Back in 2010, Glenn Greenwald pointed
that: " [T]here was already ample evidence that the White
House had, in fact, secretly negotiated away the public option early on in the
process, including confirmation from a New York Times reporter of the existence of such a deal
, as well the fact that Russ Feingold said as clearly as he could
that the reason there was no public option in the final
bill was because the White House never pushed for it, because the final bill --
without the public option -- was the " legislation that the president wanted in the first place
The White house "secretly bargained away the public option with corporate
interests early in the negotiation process," and then "spent months after that
assuring their supporters that they were doing everything they could do have a
public option in the bill." In another
wrote that the Democratic Party leadership: "pretended
in public to "demand' that the public option be included via reconciliation
with a letter that many of them signed (and thus placate their base: see,
we really are for it !
), while conspiring in
private with the White House (which expressed "sharp resistance'
to the public option) to
make sure it wouldn't really happen." (See also Miles Mogulescu at Huffington
, and David Dayen at Firedoglake
, and a David D. Kirkpatrick in the NYT
Hogtied? Hogwash. The Republicans
did not stop the Democrats from doing anything. The Democratic politicians did exactly what they wanted (and what their constituents did not want).
The ACA passed with no Republican votes.
Didn't need "em. Another world of healthcare was possible. People were clamoring
for it. America had voted for, and expected it.
It was Democratic Party health industry stooges, with Max Baucus and
Barack Obama in the lead, who stood in the way, insisting that nothing else was
possible. The progressive constituency, and the people of America, were betrayed
by Obama and conservative Democratic legislators, who never wanted any public
plan, and by compliant progressive Democratic legislators who reneged on their
sworn and signed promise not to vote for exactly the kind of capitulation to
the insurance companies the ACA is. Prominent liberal groups and personalities
-- MoveOn, the unions, and the Michael Moores -- collaborated in this betrayal en masse.
It was the progressive
constituency, not the Republicans, that was being fought and played by the Obama
and the Democratic Party, and it was Obama and the Democratic Party who should
have been the targets of progressives' relentless pressure for a single-payer
system. Bruce A. Dixon of Black Agenda Report nailed
it back in 2010
health care fight waged by the Obama administration has not been against
Republicans, who never had the votes to stop, let alone dictate or pass
administration's effort all along has been to pass the worst bill possible,
with the greatest amounts of corporate welfare and loopholes, and the fewest
protections for patients, while silencing, neutering and coercing the voices of
most Democrats, who have favored some form of single payer, or Medicare For All
from the beginning.
There is no good feature of
Obamacare that could not be handled better in a public, single-payer system. It
is not as if the American private health insurance market functions in a way
that satisfies anybody but the insurance companies. People were at a boil about
it. It is absolutely not the case
that there is no better public alternative. We have one that's been working for
going on 50 years. All we have to do is let everyone in it. This is not a hard
argument to make, for those who might actually want to make it.
Not only was it politically
possible to make the case for single-payer Medicare-for-all, it would have been
more politically/electorally advantageous to do so. If they had made the case
forcefully for such a clear and simple solution, Obama and the supposedly
progressive Democrats would have put the Republicans in the rhetorical position
of arguing against Medicare. Even if,
because of resistance by reactionary
Democrats, they had failed to pass the legislation at first try, they would
have laid the ideological and political groundwork for continuing the debate,
and strengthening their electoral position. That is serious politics.3
Instead, unable to generate any
logic or passion for a complicated program involving forced purchases, new
taxes, and hidden confusions -- which, to this day, no one understands -- Obama
and the Democrats gave the Republicans a chance to pose as defenders of free
Medicare, and to
re-constitute a newly aggressive, revanchist, laissez-faire ideology. In the
context, it was an enormous defeat, with horrible long-, or at least mid-term
consequences for the Democrats electorally, and for the country ideologically.
As Norman Solomon says:
little helpers, dutifully reciting White House talking points in 2009 and early
2010, were helping right-wing bogus populism to gather steam. Claiming that the
Obama presidency would sink without signing into law its "landmark" healthcare
bill, many a progressive worked to throw the president a rope; while ostensibly
attached to a political life preserver, the rope was actually fastened to a
huge deadweight anvil.
The Democrats avoided fighting for
single-payer Medicare-for-all, not because of electoral opportunism, or even
stupidity, but because, in principle, it is not
what they wanted, or want, to do.
They left the politico-ideological initiative to reactionary
Republicanism because the Democratic Party, as an institution, prefers a politico-ideological field
where laissez-faire capitalist ideology aggressively dominates to one where a
more cooperative social ideology militantly challenges. They neither want, nor
know what to do with, the latter. Until progressives understand this, they will
continue to be the victims of the same scam without end.
As Shamus Cooke points out, for
four years since the ACA was passed, the whole Democratic Party, and
liberal and labor groups " frittered away their group's resources--and integrity-- to sell a crappy
product to the American people.".adding
crucial political support to a project that deserved none.
"Obamacare was always more barrier than progress: we've
wasted the last several years planning, debating, and reconstructing the
national health care system, all the while going in the wrong direction -- into
the pockets of the insurance mega corporations.
A true public and progressive
system will not be an adjustment to, but a total replacement of, Obamacare.
Obamacare is failing politically, and may very well fail in other ways, as
analyzed below, and that is an opportunity.
The task for progressives is not to conjure new means of life support for this
political zombie, but to put it out of its misery. It has to be replaced by a
vibrant social program, a public, single-payer system in which the criteria of
success is not profitability, but universal coverage and the health of all our
citizens -- because that's what we as a society think is the right thing to do.
This means unapologetically
putting an end to a mulit-trillion-dollar business that is the source of millions
in campaign contributions, that is the income stream for the lifestyle of
scores of plutocrats who are also politicians' friends, and that is a
destination sinecure for many politicians themselves.
This is also a demand to reverse
the tide of austerity, and expanding and strengthening social programs, instead
of destroying them, may also require a complete reform of tax policy. Programs
like Medicare and Social Security should be funded from the general tax
revenue, with a simplified and truly progressive tax code that eliminates
loopholes and treats capital gains the same as wages.
Sure, this will require a militant
political movement based on an ethic of social solidarity, as opposed to
private enrichment, that both major political parties have effectively
abandoned. That's what's needed to address all the problems we face. It's that, or waste another four years
defending Obama, and chatting up the next Democratic shill.
Lost in the Woods
The debacle with the website was a
canary in the mine. It was a secondary, but not insignificant problem. It was significant in itself, because it was,
in its own right, a failure of the Obama administration, which had four years
to prepare something that actually worked. But it also indicates how a
liberal concession to a complicated, semi-hidden complicity with private
capital ended up in a failure that feeds capitalist ideology itself.
Let's see: First, the
Canadian company that had been fired by the Ontario government for missing
three years of deadlines. Then, it's clear that Administration officials did
not understand the difference between a "webpage" and a complex programming and
database architecture. It's also clear that they thought that adopting the pose
of some hard-nosed politician from House
and ordering that everything must
be done on time was the way to get that complex programming architecture built.
It's clear that the contractor yes-manned
its way to the bank.
It's clear that both the Administration and the contractor ignored
, and generally thought they could
cover up any flaws on the fly. It's a classic tale of incompetence and
arrogance over four years,
nobody but the Obama administration is responsible, and for which nobody has
is secondary, most obviously because it will be fixed. They'll get enough
competent programmers to make it work. But it's also secondary in the sense that the
complexities of the programming task are a secondary effect of the complexity
of trying to digitally coordinate hundreds of independent systems of for-profit
companies and government agencies, even though it's "the government" that will
get all the blame for it. As Zeese and Flowers point out "in 1965 when Medicare
started, everyone 65 and over was enrolled within six months - using index cards."
By "the government." It wouldn't have
been a hundredth as difficult to add everyone to the Medicare rolls.
I had my own experience that
indicates the layers of public-private complexity. I helped someone who had to sign
up for a new Empire health insurance plan by January 1st. We could
not get signed up, even provisionally, until December 11th, and
could not actually pay the premium (which is the real confirmation of coverage)
until December 31st, after three hours on the phone. She still does
not have a new ID card or any plan documentation, and she is still not sure she
is covered for the same doctors and hospitals as before, which are
indispensable for her ongoing condition (though it's likely she is).
This was not an Obamacare website problem. This was a current Empire
policyholder trying to get an off-exchange
plan directly from Empire, at their website, and through their phone centers, using
her existing account. Empire Blue Cross,
which is also Anthem, which also seems to be Wellpoint, which had personnel in
Virginia and New York trying to figure out a New York plan, was pretty
clueless. Yes, they had a zillion new customers (poor them), and, yes, they also
had four years to prepare.
So, although our current
ideological discourse will place the blame in this way, these problems are not
the fault of "the government" per se.
There is no "government" in the abstract. The more precise way to put it is
that this is not the fault of a government truly acting as a representative of
the people, in the public interest, for the common good. It definitely is the
fault of a government that makes itself the coordinating salesman of a
consortium of private profit-making enterprises, a government acting in the
interests of perpetuating their profitability. That's the government we have.
One has to appreciate the
perfection of the ideology: by implicating itself in ensuring the profitability
of private sector enterprises, this
government actually feeds the discourse that "government" in general,
understood as any form of common social action outside the sphere of profitability, is to blame. This is now a
well-implanted ideology. You cannot defeat it by sidestepping it.
If you're looking for the fish at
the poker table, you're it. The liberal constituency -- Michael Moore
personifies it -- goes along with an awful program like Obamacare, which it
knows cedes too much (the essential substance!) to the right, because the
liberal constituency thinks it's an effort by "their" shrewd leader and Party to
defeat reactionary ideology by evading it.
What's actually happening -- you'd think they might notice this, when
they're losing hand after hand, while reactionary ideology keeps winning all
the chips -- is just the opposite: the party being played, evaded, and defeated
is the liberal constituency itself.
the Democratic Party strategy as
"If we lose, we capitulate because we must; if we win, we capitulate because
it's the right, bipartisan, thing to do."
Liberals who support what they
know to be "awful" Obamacare, because it's always necessary to cede to the
discourse of the right, shouldn't be surprised when the only "tweaks" to the
program we're now likely to see are those from the right itself.
And whaddaya know, they have
already begun. Here's the
of what happened to the the
public subsidies to private health insurance companies through Medicare Part D.
These are subsidies from which "U.S. drug manufacturers are reaping a
windfall from taxpayers because Medicare's privately administered prescription
drug benefit program pays more than other government programs for the same
medicines." These subsidies were gifts to private insurers that Bush introduced
as a way of getting private insurers' noses into the Medicare tent at the
public's expense. Obama promised to cut them to help pay for the ACA. You know,
the way he actually did cut direct Medicare payments to healthcare providers:
a reversal that followed intense lobbying from the health insurance
industry," the CMS "said on Monday it will increase the rate by 3.3
percent in 2014, reversing a 2.3 percent cut announced in February." The many "free market" fans of
increasing this Republican federal subsidy to big businesses were applauding.
At fool.com, Sean Williams bannered "The Insurance Industry Shows
Obamacare Who's Boss," and exulted "The insurance industry
effectively dictated itself a raise."
Robert C. Townsend, a successful
business executive and management guru who ran Avis in the 70s, is reputed to
is run largely by and for about five thousand people who are actively supported
by 50,000 beavers eager to take their places. I arrive at the round figure in
this way: maybe 2500 megacorporation executives, 500 politicians, lobbyists and
Congressional committee chairmen, 500 investment bankers, 500 commercial bankers,
500 partners in major accounting firms, 500 labor brokers. If you don't like my
figures, make up your own. We won't be far apart in the context of a country
with 210 million people. The five thousand appoint their own successors and are
responsible to nobody. They treat the nation as an exclusive whorehouse designed
for their comfort and kicks. The President of these United States, in their private
view, is head towel boy.
Adjust for the new, generous, tipping
etiquette, which gives towel boys and pool girls a path to junior membership. Adjust
for the resulting political system that "is not only run by plutocrats, it's
become a system for making plutocrats," with, for the first time, more
than half of our legislators now millionaires
-- as I've
government of millionaires hired by billionaires." Adjust the ratio of
investment bankers, in an aggressively financialized economy. Adjust any way
you want: In a population of 316 million people, it's a tiny group that
controls the country, and it's capital who's the boss.
(Mark Leibovich chronicles how
thoroughly this culture of corruption saturates our polity in his book, This Town
. For a good précis, take a look at his appearance
on Bill Moyers
As with the national electoral
process, behind the distracting public facade, the national legislative process
is almost (?) completely controlled by this corrupt coterie of Serious People,
and Obamacare was their production.
The specifics of how Obamacare
will work need some attention, because they help to indicate the extent to
which this plan is designed for private profit as
opposed to public good. Devilish
details, and all. But it is ludicrous, a fool's game, falling into the trap, to
try and tote up how many people will do better vs how many people will do
worse. That is precisely the anti-social exercise of calculating the net sum of
Frankly, I suspect that most
people who think Obamacare is some kind of "progressive" achievement just do
not know much about it beyond the PR slogans on MSNBC. How could anybody know
much about it? It is incredibly complicated. No, really, incredibly
complicated. The very best single document I have read, which delves into all
the details of this program, was published by Paul Craig Roberts, and can be
. I know that I did not understand what the ACA
actually was, did not know what I was talking about, until I read that piece. Take a look at it -- it's very detailed, you
may not go through all of it, but pick a section -- and the slogans will
disappear. You will never again be fooled into thinking that this is anything
but a scam to force-feed profits to the private health-insurance industry.
We know that a lot of people who
could not buy health insurance will now be able to -- though at complicated
rates, and with varying levels of actual healthcare. We know that some people
who had health insurance will now pay more, some less. Some will get better
policies, some worse. And we don't need to know much more than that. These inconsistencies are themselves a
sufficient indictment of the whole awful concoction, because they derive
from no healthcare logic, but only from the profit demands of particular
companies. It's ridiculous that an American citizen who lives in county x
should have different healthcare coverage than one who lives in county y.
Period. No tweaking.
But there's more: Everyone is now
aware that Obamacare will leave millions of people without health insurance
(But did you know that figure is 26-27
in 2016, according to the Congressional
?), and millions of others with
health insurance they cannot afford to use. We also know, since it keeps all
the insurance companies in the game, that it's not going to reduce the paperwork
for doctors, and it's not going to stop the kind of insulting demand on their
time, and total diversion from real medical care we see in stories like this: Doctor's Office Spends 2 Hours On Hold With Health
Insurer For Patient's Surgery Authorization
. We know, too, that the
insurance companies are going to limit the doctors and hospitals they cover,
especially in the cheaper plans (Insurers Push Plans That Limit Health Choices
and we're rightly afraid that doctors themselves are going to hate it and opt
out of it. Di d you also know that the ACA will
actually force people into and out of Medicaid without their consent? That it will force doctors to use HMO-type
"productivity" criteria that will incentivize them to avoid sick patients and
rush through all the others as cheaply as possible?
The ACA is a stew of ludicrous
contradictions, exceptions, and regulations that are unrelated to any real
healthcare needs, and only made necessary by the profit imperative underlying
the whole mess.
Go for the shirts
Let's take a look at this from
another angle: the likelihood that the insurance companies will get what they
want from Obamacarre. This requires a
little case study.
We'll use my locale, New York
City. New York state and city had a number of insurers (good "competition"), a
lot of good regulations, and very
high rates. An individual policy cost nearly $24,000 a year. That is not a typo.
Here's the letter with the last rate increase for a couple (and it was not the
most expensive policy available, and it was the same for all ages):
The rate for what seems to be a
comparable policy now will be about 60% cheaper.
[Disclosure: I went on Medicare in
2013, so I'm out of that onerous burden. But this savings is a great personal
and family benefit. There are going to be very few people in the United States
who save more from Obamacare than those close to me. That's not the point,
though, is it? It's not working out as well for these
in Summit County, Colorado, or these employees
of a car dealership [couldn't resist
] in Michigan. The way to judge an ostensible public
health plan is not by this or that private cost, or the net sum of private costs,
but by the social benefit it actually provides. Healthcare has to become a
social right, not an individual purchase.]
We should carefully remark, in the
Empire letter above, the phrase: "Rates have been approved by the New York
State Department of Financial Services." This was, as I said, a regulated
market, and the DFS was supposedly looking out for consumer interests. Fifteen
years ago, the individual rate was around $500. It increased inexorably, year
after year. The regulators were driven by the insurance companies, who really
made the decisions. Obamacare "oversight" will be no more rigorous, managed by
the insurance companies, with, again, a mandate to maintain their
This means that premiums (not, by
far, the full cost of the insurance) will continually go up. How fast and far they rise will depend on
whether Empire gets enough healthy young people, who certainly were not buying
at the above rates, to buy into their cheaper plans. Empire will have to get enough healthy new
customers who won't be making much use of their product, to make up for what's
about $1200 a month they are losing on their legacy higher-paying customers. This
is the kind of bet that hundreds of companies across the country are making,
and it's no sure thing. The point of this program is to allow the private
health insurance companies to make more profits. If they don't, it fails, in its own real capitalistic
(as opposed to its ostensible humanitarian) terms.
Let's take an example:
Say you're a 40-year-old,
non-smoking single adult living in Brooklyn, and make $46,000/yr (for
simplicity, above the cut-off for subsidy, but definitely not living large).
You're paying at least $15K a year for rent (a share at this price), utilities,
metrocards, basic cell phone (no cable or netflix) -- whatever you need to get
to work, before you buy a loaf of bread or a shirt. You gotta have some food
and shirts. Let's say another $2400/yr for other necessities. This is New York:
these are very conservative figures.
You're paying about $3200 in income and payroll taxes. You're down to $25,400/yr ($2116/mo) for
everything else. You've got a clean
shirt for work, but still not one movie ticket or beer for yourself. No diapers
for the kids. No visits to the parents. You're perfectly healthy. You have this
- You buy
the cheapest Empire Bronze plan. You pay $4320 ($360/mo) in premiums plus $5800
in deductibles before the plan starts paying benefits, with a $6350 out-of-pocket
maximum if you actually use the plan.
- You don't buy insurance, save that $4320, and pay a tax penalty. In 2014 that would be a
maximum of $460 (1% of MAGI), rising in 2014 to a maximum of $1150 (2.5% of
AGI). (The penalty will actually be less than these figures, since I calculatesd
assuming the gross salary equals Modified Adjusted Gross Income, when MAGI is
actually always less. Don't ask about that "Modified." Incredibly complicated.)
Any way you look at it, you save
over three grand by not buying the insurance. That's real shirts, beers, and
diapers. And, guess what? You can always go and buy the insurance if you get
sick. And guess what else? According
to the law
: "taxpayers shall not be subject
to any criminal prosecution or penalty, tax liens, seizure of bank accounts or
garnishment of wages for failure to pay [the penalty] and no accumulation of
interest on the unpaid balance." Yes, the IRS will deduct the penalty from any
tax refund that you get it, but no penalty of any kind, they can't bug you for
it, and you're still $3K in the black. So what's the downside for you in
forgoing the insurance?
Now there may be some people who
will remember that the President, that nice man they voted for, who struggled
mightily against those Republican ogres to give us all the gift of Obamacare,
says that it's their civic duty to pay that extra $3000 per year to make sure
Joe Swedish is well-enough compensated for leaving his last eight-figure job.
There may even be a few who,
starting down that path of thought, remember the argument that "polemicist" guy
made about what is and isn't civic duty, which suddenly seems worth
But there are certainly going to
be a lot of healthy young people -- I'm guessing millions -- who are just going
to do the math and go for the shirts.
Why the hell not?
In other words, millions of people will remain uninsured,
and end up paying more taxes for that honor.
Wasn't it sooo much shrewder
politically to fight for this than Medicare-for-all?
This is, first of all, absolutely
ridiculous. Should people not be pissed off about this? Why
shouldn't any extra tax you pay end up buying actual health insurance? Because the minute you ask that question, and
think about it for more than three seconds, you end up with some form of
Medicare-for-all, paid for by a progressively-structured tax, as the only
But this also means trouble for
Empire, and Joe Swedish, and the whole contraption. A Reuters article
emphasizes the concerns
that "the market won't attract enough young people to keep it financially
viable, putting more pressure on government
funds to compensate for any insurer losses
." So far, according to
preliminary and incomplete data, 22% of 18-34 year-olds have en enrolled, as
opposed to the 38% the administration hopes for in 2014. As one "actuarial consultant" emphasized: "The
whole insurance relationship is counting on them signing up".Otherwise rates
will have to increase." And as another academic noted: "If the
demographics come in poorly, insurers are going to lose money."
Which is why we have made-for-mockery
amusements like the "brosurance
" appeal that Jon Stewart and
Aasif Mandvi lampoon so well. The reluctance of healthy young people, combined
with one of the best provisions of Obamacare -- the requirement
that health insurance companies spend 80% of the
consumers' premium dollars they collect on actual medical care rather than
overhead and profit -- is going to make it harder for health insurance companies
to get the kind of profitability they think they need.
Watch for more Democratic and
Republican "tweaks" to fix the profitability problem! But, if they try to "save Obamacare" by
waiving that 80% requirement and/or stiffening the tax penalties and their
enforcement, there will be more political hell to pay, and they know it.
This all means that, as we are
seeing Obamacare failing politically, there is a very good chance that it will
fail in its actual socio-economic goal of maintaining the profitability of the
private health insurance industry -- in other words, failing the capitalist
interests it intends, as much as the people it pretends, to serve.
Here, from Christopher
, is another little thing about
the penalty tax for progressive defenders of Obamacare to look at.
the penalty-tax that the individual mandate imposes will soon constitute one of
the most regressive taxes in the United States. " [It] inherently disadvantages
low income earners who, in effect, pay proportionally more on fewer dollars.
Taxes imposed here are uncannily akin to the regression rates of sales and
social security taxes. Take a look at the scatter chart below:
Regarding the famous premium
subsidy -- officially the "premium assistance tax credit" -- we should be aware
that millions of people are going to owe
premium subsidy money back to the government. Any premium subsidy the government pays to
the for-profit health insurance company on the taxpayer's behalf is only a
provisional tax credit, subject to being re-billed to the taxpayer if his or
her actual income exceeds the estimate on which the subsidy was calculated. The
"premium assistance tax credit" is not a gift to the taxpayer, but to the
Other subsidies, to reduce the
burden of deductibles, co-insurance, etc., are only available to those with
incomes between 100% and 250% of the federal poverty level, and only
if they buy a Silver plan (higher premiums, more public money to the insurance
There's a pernicious, and I think deliberate, side-effect to
this subsidy policy. The jumble of regulations,
penalties, and subsidies is another contraption for reproducing class,
really intra-class, resentment and division.
People like my Brooklyn exemplar, whose income is a bit too
high for any kind of subsidy, will probably have to choose the plan with the
lowest premium, and will also have to pay for every penny of deductible and
co-insurance out of his her own pocket. S/he is going to see some folks with
less income getting bumped into better plans because, in a given venue (Different
everywhere!), a family that qualifies for all
the subsidies may be find it cheaper to opt for a Silver plan with a nominally
higher premium. Brooklyn Jack or Jill may not feel so great about that. This is
the kind of intra-class resentment that these kinds of means-tested, particularized
purchase plans (as opposed to a simple universal-coverage plan) foment -- and it is exactly what they are intended to
The idea is to get Camden Mary and Brooklyn Jill, two people
whose incomes are an inch apart -- and not in the same galaxy as Joe Swedish -- fighting
over who gets one dime more from "the government." The idea is to keep them
clueless about the fact that it's Joe Swedish who is getting all
the money from the government, and to prevent them from ever thinking about how
everyone can get healthcare coverage that's equally good, if we'd just leave
Joe out in the cold.
The Humane Physician
Bottom line: Obamacare is a system
that's fundamentally irrational and unjust. It's a system that won't work well for anybody
it pretends to serve, and will perpetuate enormous social inequalities in the
access to healthcare.
The sole focus of healthcare
progressives now must be to promote a true single-payer, universal coverage,
Medicare-for-all system, which means -- There's no avoiding it! -- quickly and thoroughly
ending Obamacare, along with the parasitical $2.6 trillion profit machine that
produced it, and that it sustains.
It's a common mistake to think
that Karl Marx conceived of the term "cash nexus" to describe
the alienating structure of relations in capitalist society. He and Friedrich Engels certainly did appreciate the
point, and expand on it, b ut it was
the nineteenth-century British conservative
writer, Thomas Carlyle, in his tract, "Past and Present," who first insisted that " Cash
payment is not the sole nexus of man with man." He was railing against the
ethic of "S upply-and-demand, Laissez-faire
and such like" that was associated for him with the "liberal"4 faction of the day . In the same
text, he recounted the following story, which, like MLK's quote above, still
strikes the heart of the matter -- the utter folly of a privatized, capitalist market
approach to something (the health of the people!) that is an
unavoidably social problem:
A poor Irish Widow, her husband
having died in one of the Lanes of Edinburgh, went forth with her three
children, bare of all resource, to solicit help from the Charitable
Establishments of that City"referred from one to the other, helped by none;"You are no sister of ours;
what shadow of proof is there? Here are our parchments, our padlocks, proving
indisputably our money-safes to be ours, and you to have no business with them.
Depart! It is impossible!"
--till she had exhausted them all;
till her strength and heart failed her: she sank down in typhus-fever; died,
and infected her Lane with fever, so that 'seventeen other persons' died of
fever there in consequence. The humane Physician asks thereupon, as with a
heart too full for speaking, Would it not have been economy to help this poor Widow? She took typhus-fever, and killed
seventeen of you " she proves her sisterhood; her typhus-fever kills them: they
actually were her brothers, though denying it!
Had human creature ever to go lower for a proof? [Slightly rearranged. Carlyle's emphasis.]
Let's not go any lower.
The last word to Glen
of Black Agenda Report
fatal flaw in Obamacare can't be fixed. The best thing that could happen would
be a quick and total collapse. Large majorities of Americans still support
Medicare for All, but Obamacare stands in the way of a real national health
plan -- just as the Republican right-wingers that invented Obamacare back in
Notes and Links
1The cheapest New
York State individual "Bronze" plan has a $360/mo premium, a $5800 deductible,
a 50% coinsurance after that deductible, and a $6350 out-of-pocket limit.
Double the deductible and coinsurance for families. (Empireblue.com)
But a loophole in the law allows insurers to rescind (cancel) your policy if you intentionally put false or incomplete information on your application. The ACA says you must be given at least 30 days' notice before your coverage can be rescinded, giving you time to appeal the decision or find new coverage. So, if your care becomes costly for the insurer and you didn't mention you had a rash on your arm when you were 15, that'll work. How can you prove if leaving this out was intentional or not? It's them against you.
One of the great selling points of the ACA con is that those with pre-existing illnesses will not be denied coverage. This is true, but insurers have many ways to avoid the ill. "
One way to avoid the sick was mentioned above: excluding hospitals where people with serious health problems go, like major medical centers. Another way is by providing poor service to people who have a lot of claims so they change insurers. And a third has to do with the fact that insurance companies are allowed to charge more in geographical areas where health costs are higher. If a plan in a particular area is not making enough profit, the insurance company can simply stop selling in that area.
Insurance companies also can charge three times as much based on age. Because most pre-existing illness comes with age, this greatly undermines the protection of those with pre-existing illness. Insurance companies are excellent at gaming laws and regulations, so we can expect more creative avoidance of people who actually need health care.
3Consider even what might have been a "compromise"
proposal: Would it have been "impossible" to get an extension of Medicare to
cover everyone older than 54 and younger than 25, with others having the
possibility of buying into Medicare? That would have been a real step in the
right direction, because it would have preserved, strengthened, and extended
the public social fund that serves the common good. It would also have grabbed
all the boomers, all the students, and every parent, and brought a lot of new
money into Medicare. Can anybody seriously think this would have been a harder
sell, than the incomprehensible hodgepodge of the ACA?
A well-connected Democratic source
swore to me that the Democratic congressional leadership, working with Howard
Dean, was ready to introduce some kind of Medicare expansion like that, but was
ordered by the White House to drop it, which they dutifully did.
4Thus our use of the
term "neo-liberalism." And therein lies
another long story about the convoluted trajectory of political words.