26.08.2009

Obama’s reforms -inadequate and unfair

Healthcare is a long-running sore on the US body politic, writes Eddie Ford

Some facts just speak for themselves. In the United States, the richest country by far on the planet, 46.7 million people (15.3% of the population) - and disproportionately Hispanic - have absolutely no healthcare insurance at all.¹ While for another 25 million, though they have some sort of basic cover, it is grossly inadequate - and even for many of the ‘lucky ones’ with a more comprehensive insurance plan illness still represents a daunting financial risk. This leads to the truly grotesque situation where millions of Americans are terrified by the prospect of going to the hospital in case of an emergency, as they do not want to saddle either themselves or their families with potentially crippling levels of debt.

Or to put it another way. When you lose your job in America, your health insurance goes with it. Leaving you deep in the shit. And with millions of American workers now finding themselves out of work thanks to the global financial meltdown, the old leftwing adage - ‘capitalism kills’ - takes on a whole new relevancy.

Furthermore, in the land of the free and the brave trying to actually claim for health insurance is a legal-bureaucratic nightmare. Naturally, many if not most insurance companies deploy a diabolical array of delaying tactics and tricks in order to wear down and eventually demoralise the claimant - knowing full well that a profitably high percentage will just not possess the patience, means or ability to fight their way through the seemingly endless layers of red tape in order to get the money rightfully and legally owed to them. No wonder that anyone foolish enough to get ill in the Unites States is strongly advised to get a lawyer first - if they can afford one, of course.

Yet, topsy-turvy style, it costs the country a fortune to fund this utterly wasteful and obscenely inefficient health system - if you can dignify such a dog-eats-dog free-for-all with the term ‘system’. So healthcare costs amount to some 16% of GDP, almost twice the Organisation for Economic Cooperation and Development average. But, of course, the parasitic lawyers and private insurers have grown fat and rich on it.

With healthcare a long-running sore on the US body politic, it is hardly surprising that at periodic intervals the more intelligent - or less irrational - sections of the ruling class start talking about ‘reforming’ the current dysfunctional set-up. Hence Barack Obama has given a series of speeches, some of them bordering on the rousing, about his “commitment” to healthcare reform. Indeed, in Colorado he engaged in leftish-sounding rhetoric (to American ears) about how his “faith” in the “public option” was “strong”. Fine words. But, as always with Obama and his ilk, the windy semi-evangelising talk serves to disguise the fact that he has no effective strategy with which to achieve genuine reforms to the US healthcare system. Rather, being in reality a defender of the establishment, he wants to preserve an essentially privatised American healthcare system but ‘with a human face’.

Thus Obama has declared that his prime goal is to “simplify” the entire system, making it “fair for everyone” and in the process “reduce” healthcare costs “across the board”. To this apparent end, it has been widely reported that the Democrats in the House of Representatives are busily brokering a deal that would mandate all Americans to take out health insurance - with subsidies for the less well-off paid for by a tax on families earning over $350,000 a year. This putative bill, now allegedly being fine-tuned by the Senate finance committee, would also offer Americans who do not get adequate coverage through their boss the chance to join a government-run scheme.

Naturally, the mere thought of even the most partial, tentative, half-step towards a less privatised health system has brought the loony right out in a rash - better ill or terminally dead than ‘red’. For many of them - the sort of worrying people who believe that Obama is simultaneously a Kenyan Muslim and a Manchurian Candidate sent to destroy all personal liberty in the US - such reformist proposals are ‘Orwellian’ and ‘totalitarian’ - indeed, most dreaded of all, have the smack of ‘socialism’ and ‘communism’ about them. It has even been debated in all earnestness on the Rupert Murdoch-owned Fox News whether the British National Health Service is a “breeding ground for terrorism” - therefore the freedom-loving US should avoid at all costs any sort of NHS-type universal healthcare system.²

Predictably, almost reassuringly, the distinctly oddball former Republican vice-presidential candidate, Sarah Palin - supporter of Alaskan independence, a creationist Young Earther, hater of abortion rights and enthusiastic butcher of wildlife and the environment - has stepped into the healthcare breech. She luridly fulminated about Obama setting up “death panels” of government officials endowed with the power to decide whether disabled or elderly Americans are “worthy of healthcare”. That is, under Obama’s proposals there would be panels of ‘medical experts’ who would be charged with the task of making decisions about the “appropriate levels” of health expenditure for specific medical/health conditions - like, for example, Down’s Syndrome (which affects Palin’s son).

In a similar vein, and possibly most craziest of all, are the comments from the Executive Intelligence Review - founded and run by Lyndon LaRouche, ex-Trotskyist and former US Labor Party presidential candidate. The EIR, which clearly exists in a world of its own, writes about Obama appearing to “crumble under the pressure of an angry popular revolt against his Nazi healthcare reform” and even ventured the idea that we were witnessing a “revival of Hitler’s euthanasia killing programme”.³

There is nothing particularly new in such accusations, of course. In January 1946 a notable of the British Medical Association, Dr Alfred Cox, said the healthcare plan being put forward by Clement Attlee and Nye Bevan “looks uncommonly like the first step, and a big one, towards national socialism as practised in Germany”. And in April of that year - backed by rightwing rags like the Evening Standard - the BMA’s annual conference passed a motion denouncing the proto-NHS as a “clearing of the ground for the erection of that glittering ediface of a socialist dream, a whole-time state-salaried service”.⁴

Now, of course, everyone in the UK loves the NHS - including the Tories, who like the BMA instinctively loathed it upon creation, and then very quickly learned that it would be expedient to quickly fall in love with it once it was firmly established - after all, who would vote for a return to the pre-World War II past?

However, there has always been a sizeable contingent of Tory, and other, malcontents who have never felt comfortable with the idea of a universal healthcare system - it is too “bureaucratic”, “impersonal”, a product of the “nanny state”, and so on. Accordingly, the rightwing pin-up wonder boy, Tory MEP Daniel Hannan, recently completed a tour of the US media - where he launched scathing attacks on the NHS, especially on Fox News. There he described it as “outdated and unfair”, a “60-year mistake” which he “wouldn’t wish on anyone” and called for it to be “scrapped”.⁵ If that was not enough, he told the Washington Army and Navy Club that the NHS is “exactly a Marxist system” where you are “treated as a supplicant”.⁶

Unsurprisingly, with a general election on the horizon - and scenting the invigorating aroma of governmental power - David Cameron could not distance himself from Hannan fast enough. The Tory leader labelled Hannan an “eccentric” and proclaimed his own undying faith in the UK healthcare system, stridently telling the BBC: “The Conservative Party stands four-square behind the NHS. We are the party of the NHS. We back it, we are going to expand it, we have ring-fenced it and said that it will get more money under a Conservative government, and it is our number one mission to improve it.”

But Hannan’s views are hardly a bolt from the Tory blue. Michael Howard, the former Tory leader, told the Commons in 2001 that the NHS was a “Stalinist creation” - and Hannan’s fellow Tory MEP, Roger Helmer, promptly went on record to say that “Dan has done us a service by raising these issues which need to be looked at”. And the rightwing think-tank, Social Market Foundation, has proposed a £20 fee for each visit to the doctor. Another pressure group, Doctors for Reform, also advocates a greater injection of market forces into the NHS - though under the sweet-sounding guise of being valiant defenders of ‘patient power’. It argues: “The campaign aims to help patients who have been prevented from paying extra towards their NHS care in order to receive new drugs and treatments.”⁷

In response to Hannan’s anti-NHS attacks, health secretary Andy Burnham accused the Tory MEP of being “unpatriotic” - on the grounds that he was “talking in the foreign media” and not representing the “views of the vast majority of British people”. In fact, Hannan’s opinions were an “insult” to the 1.4 million NHS workers. Piling in behind Burnham, former deputy prime minister John Prescott recorded a video message to the American people accusing Hannan of “misrepresentation of the NHS” and Gordon Brown did his patriotic duty as well by adding his voice to the ‘We love the NHS’ Twitter campaign - set up almost overnight by the creator of Father Ted, Graham Linehan, specifically in order defend the health service from US attacks. Brown posted the message that the NHS “makes the difference between pain and comfort, despair and hope, life and death”.

Communists unequivocally and militantly defend the NHS from the attacks launched upon it by Hannan and other such reactionary wretches. Yet we do so not out of misty-eyed social democratic sentimentality, least of all out of a sense of patriotic duty. Rather because communists recognise that the creation of the NHS, no matter how imperfect, was a gain for the working class movement as a whole.

But, on the other hand, we are also fully aware that there is an obvious kernel of truth to what the various critics of the NHS say - that it is increasingly bureaucratic and inefficient, impersonal and alienating, penny-pinching and prone to managerial pettiness, etc. Anyone who has experienced the NHS in recent years will easily recognise this picture.

However, the increasing bureaucratisation of the NHS suffered by both patients and NHS workers is directly proportional to the creeping and relentless marketisation to which it has been exposed - that is, the entirely artificial introduction of the so-called ‘internal market’. I say ‘increasing’ because, of course, the NHS was never democratically controlled by its workers and users - which, by the way, would be the only way to achieve an efficient system as well as one that really meets our needs. But workers’ control cannot even be mentioned, let alone contemplated, by the establishment for obvious reasons.

Instead marketisation and part-privatisation were supposed to be the cure for NHS bureaucracy. Hence the damaging roll call of healthcare ‘reforms’ pioneered first under Thatcher and then dutifully continued, and indeed ramped up, under New Labour. Like the ‘internal market’, the private finance initiative, and now the department of health’s latest “enabling guidance” measures, Transforming community services, enabling new patterns of provision - supposedly “intended to help primary care trust providers of community services to move their relationship with their commissioners to a purely contractual one, consider what type(s) of organisations would best meet the future needs of patients and local communities, and how change can be managed to support the transformation of services to patients”.⁸ The NHS patient needs all these ‘cures’ like it needs a hole in the head.

Communists fight not only to defend the NHS as it exists, but to broaden and extend the principles of socialised healthcare, which logically requires both the abolition of the market in medicine and the democratic control of the NHS by its workers and users. That would really make the “Orwellian” nightmares of Daniel Hannan and Sarah Palin come true.