The case of Massachusetts: A failed model for health care reform

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Obama and Clinton: Cut from the same "meliorist" cloth


NOW THAT THE OBAMA administration is touting ever louder the need to provide healthcare “for all Americans,” it’s time to put on our doubting caps and subject his proposal to detailed scrutiny, lest the public end up with the short end of the stick, as usual. Citizens concerned about Barack Obama’s true political objectives and, in particular, the fixing, once and for all, of the disgraceful American style of privatized health care controlled by grasping insurers and Big Pharma, should pay attention to the vastly superior plans and critiques put forth by physicians working to take the profit motive out of health care. 

For years now, qualified observers such as Drs. Rachel Nardin, David Himmelstein, and Steffie Woolhandler—all educated and operating out of the nation’s premier medical schools—have called for a public health system based on universal access and no restrictions based on ability to pay. Aside from its myriad redundancies and irreducible waste, they find it immoral and grotesque that the American nation, which has already given so much to its ruthless billionaire class, should continue to allow capitalist logic to dominate access to health care.

Times may be a’changin

As it is, since the late 1990s, and despite the nonstop equivocating coverage given the issue in the mainstream media, more people may be paying attention to what critics have to say. The scandal of privatized US medicine, highlighted in Michael Moore’s SiCKO, put the topic on the national consciousness, and now even some powerful sectors of business are lining up to support a vastly more egalitarian and economical approach to health care distribution. This shift is noteworthy in its own right. While the integration of ruling class money and individuals into the same capitalist matrix in today’s capitalism makes it difficult to sort out interest according to industry origin, this represents in some respects an intramural struggle between capitalist groups in the finance and insurance sector (in dominant position) and the older manufacturing segments, whose relative power is on the wane, and which have fallen into a de facto alliance with small business, and—and at least in this case— a substantive portion of the public. [The enormous disparity in treatment recently accorded the Wall Street financiers and the auto company executives by the Obama administration and Congress—the latter publicly rebuked and denied a pittance while the scoundrels from high finance were given trillions with few questions asked—underscores this split in perceived power, or, as cynics might say, who was more successful in bribing the political class and usurping the powers of the state.)

In any case, it’s clear that the private health insurance racquet (and its lobbying sidekick, the pharmaceutical industry) have finally burnt their bridges even with brother capitalists, and talk of reform is again in the air. The nation’s health bill has cut so deep into the competitiveness of large and small firms, including giants like GM, GE, etc.,  formerly somewhat immune to such predicaments, that now the political class is mobilizing to provide some solution—or the illusion of one.  So the Obamites are moving forward with some kind of plan, but, true to form, craven captives of the free market ideology, their plan —as prefigured—is not likely to breathe fire, which it must do if a real solution is to be implemented. In this, Obama, like Bill Clinton, Hillary, Harry Reid, Pelosi and fellow DLC Democrats, follows the same old “Third Way” nostrum of foisting a timid, meliorist, and therefore obscenely inadequate centrist formula to the great crises created precisely by capitalism’s own dynamics. Alone among developed nations, this type of highhanded political fraud continues to thrive in America without much challenge thanks to the great power of corporate media propaganda.

As previously mentioned, Dr. Nardin’s critique of this approach, the Massachusetts’ Plan: A Failed Model for Health Care Reform [ February 18, 2009 ] is an eye-opener on the type of plan that Obama aims to impose nationally. The report is an alarm that should be heeded. 

Why the Obama approach is worse than wrong-headed: it’s hypocritical

So much has happened in the truculent history of American health care reform, that it’s dishonest at this point on the part of Obama supporters—especially after the almost intentionally botched attempt by Hillary Clinton—to pretend confusion in the face of their hero’s sheer audacity —maybe the term is impudence—in proclaiming his true allegiances while chanting “change”.  Who among those who still use their brains can believe that Obama is not beholden to the plutocratic class that pulled him out of obscurity less than six years ago?  Leaving aside the mounting evidence signaling that Obama fits snugly in the continuist imperialist project,  Obama cultists (legions at this point) should read what Obama and his advisers are really proposing to “fix health care”.  It’s all right there, in big bold type on their misleadingly named “Change We Need” website. The passages marked in red are eloquent for those unafraid to recognize reality. The conclusions are inescapable. Proclaims his website:

  • Barack Obama will make health insurance affordable and accessible to all:

    The Obama-Biden plan provides affordable, accessible health care for all Americans, builds on the existing healthcare system, and uses existing providers, doctors and plans to implement the plan.

    Obama and Biden will require coverage of preventive services, including cancer screenings, and will increase state and local preparedness for terrorist attacks and natural disasters.

There it is. No breaks with the old system. What’s this if not a centrist, Clintonian position of allowing insurers and Big Pharma to keep calling the shots at the expense of the American people?  The tipoff is “affordability.” “Affordable” is the polite code word used by establishmentarians for a capitalist service formula, as it implies private individual responsibility and varying degrees of access according to one’s income level. But the more problematic aspect of Obama’s plan, drawing on the Massachusetts initiative, and eerily reminiscent of Bush’s similar gift to the insurance lobby, his compulsory Medicare drug plan, is the obligation by all citizens to BUY private health insurance contracts of some kind (as in auto coverage), or else. If this is not a bald-faced giveaway to the insurance industry, I don’t know what is. Naturally, the fallback “liberal” position in Obama’s plan kicks in when it’s discovered, as it inevitably will be, that millions fail to buy insurance because they simply couldn’t afford it in the first place!  At that point, some taxpayer supported cash infusion will come to the rescue, but the real beneficiaries in that high-handed transfer of wealth will be the plutocrats, again, and not the public. Surprise anyone?  But here’s the real kicker: while there are plenty of legitimate reasons to see the Obama proposals as a cavein to business, the GOP and the right in general are apoplectic at what they perceive as a huge expansion of government expenditure and meddling in the private sphere. 

Background to the report on the Massachusetts mess

The report was written by Dr. Rachel Nardin, Assistant Professor of Neurology, Harvard Medical School, with Drs. David Himmelstein and Steffie Woolhandler (both Associate Professors of Medicine, Harvard Medical School). Dr. Nardin is a neurologist at Beth Israel Deaconess Medical Center in Boston. Drs. Woolhandler and Himmelstein are primary care physicians at Cambridge Health Alliance, Cambridge, Mass. The credentials are impeccable. 

The Massachusetts Health Reform Law of 2006 expanded Medicaid coverage for the poor and  made available subsidized, Medicaid-like coverage for additional poor and near-poor residents of  the state. It also mandated that middle-income uninsured people either purchase private health insurance or pay a substantial fine ($1,068 in 2009). Smaller fines (up to $295 per employee) were also levied on employers who fail to offer insurance benefits.

The reform law has not achieved universal health insurance coverage, although half or more of the previously uninsured now have some type of insurance policy. The reform has been more expensive than expected, costing $1.1 billion in fiscal 2008 and $1.3 billion in fiscal 2009. In the face of a state budget crisis in fall 2008, Gov. Deval Patrick announced that he will keep the reform afloat by draining money from safety-net providers such  as public hospitals and community clinics.

While the number of people lacking health insurance in Massachusetts has been reduced, several recent surveys demonstrate that substantial problems in access to care remain in the state. While the new health insurance improved access to care for some residents, many low-income patients who previously received completely free care under the state’s old free care program now face co-payments, premiums and deductibles that stop them from getting needed care.

In addition, cuts to safety-net providers have reduced health resources available to the state’s remaining uninsured, as well as to others who rely on safety-net providers for services in short supply in the private sector. These safety-net services include emergency room care, chronic mental health care, and primary care. The net effect of this expensive reform on access to care is at best modest, and for some patients, negative.

By mandating that uninsured residents purchase private health insurance, the law reinforced the economic and political power of health insurance firms. Thus, the reform augments the already high administrative costs of health care. Moreover, the agency that administers the new law (the “Connector”) adds an extra 4 to 5 percentage points to the already high overhead of private health insurance policies.

The reform failed to reduce overreliance on expensive, high-technology services. Indeed, some of its provisions such as changes in Medicaid rates and cuts to safety-net providers (who do more primary care) have further tilted health spending toward expensive, high-technology care. [READ ON]

RELATED ARTICLE: President ObamaHypocrite and Hater of Single Payer Health Care

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