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Root of Our Health Care Problems: Privatization

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Patients gather outside the Virginia-Kentucky Fairgrounds for their turn to enter the Remote Area Medical (RAM) Health Expedition in Wise, Va., July 24, 2009. Photo by Paul Morse for AARP Bulletin Today

“The root of the problem is the privatization of the funding and organization of medical care.”

Consequences of the Privatized Funding of Medical Care and the Privatized Electoral Process

By Vicente Navarro, M.D.
American Journal of Public Health, Jan. 14, 2010

The current state of health care reform in the United States reveals the enormous limitations of democracy in this country, unparalleled in the western world. Why is there such a large gap between what people want from their representatives in Congress – including universal access to health care as a matter of right – and what they get?

To answer this question, we first need to look at what is happening in the U.S. medical care sector. I think it’s fair to say that what we see there is also unparalleled in the western world. Forty-seven million people are without any form of health insurance coverage (and a million more are added each year) and 102 million have insufficient coverage (and many aren’t aware of how limited their coverage is until they find out that an illness or needed test is not covered). The clearest indicator of the inhumane system of funding and organizing medical care in the United States is that 40 percent of people in the terminal stages of illness say they are worrying about how to pay their medical bills. No other major country comes even close to this level of inhumanity.

The root of the problem is the privatization of the funding and organization of medical care. Most of the funds are collected and services administered by private insurance companies. This system is rooted in the Taft-Hartley Act (the same act that forbade the working class to act as a class, by forbidding sympathy strikes that would allow workers from different employment sectors to strike to defend their class interests). Taft-Hartley shifted the responsibility for working people’s health benefits coverage to highly decentralized collective bargaining agreements, which explains the great variability in coverage. One consequence is that when American workers lose their jobs, they lose not just income but health benefits for themselves and their families. It is not surprising that the United States has the fewest working days lost to strikes. Workers are afraid to make trouble in the workplace, because getting fired could mean losing medical care for
their families.

It has been a traditional demand of the labor movement to get rid of the consequences of the Taft-Hartley Act. The demand for universality of health care, with every American having the right to access care, has been a constant in the labor and progressive movements. The majority of Americans agree with this demand, but they are unlikely to get it.

The reason for this gap between what people want and what people get is, again, privatization – a privatized electoral process, in which most campaign funding of candidates for political office comes from private sources. That private money does not mainly come (as myth would have it) from multitudes of average Americans sending in $50. The great majority comes from huge economic interests (components of the “Corporate Class”), including the insurance, pharmaceutical, and medical equipment companies; the professional associations; and other components of the medical-industrial complex. The six key members of the Senate Finance Committee, chaired by Sen. Max Baucus (D-Mont.), have received support from these interests. They received a million dollars each.

To further compound the problem created by a privatized electoral process, U.S. democracy is a nonproportional type of democracy— that is, the population is not represented in Congress in proportion to the size of the electorate. Each state is represented by two senators, regardless of its size, which gives enormous power (as the country’s founders intended) to rural, conservative states. The six key senators on the Finance Committee represent rural states that, in sum, include only about 3 percent of the U.S. population, and these senators have the future of health care reform in their hands.

Democracy in the United States is indeed extremely limited. The opening of the nation’s founding document, the U.S. Constitution, suggests that it is “We the People . . .” who make decisions, but it should include a footnote saying “or Corporate America.” Furthermore, those who do decide are not fully representative of the population. Still, the United States is not a dictatorship, but a democracy so tilted in favor of corporate and conservative interests that an enormous effort is required to create change. The election of President Obama seemed to be such a change and a sign of hope, because this was the trademark of his campaign. But since coming into office, he seems to have been poorly advised on his strategy for implementing the promised change. He has made several big mistakes.

OBAMA’S MISTAKES

1. An emphasis on the issue of economic viability of the system, stressing that medical expenditures (private and public) are increasing too rapidly and enlarging the federal deficit. This message has been repeated in many different ways, emphasizing that a primary goal of health care reform is to reduce the federal deficit. Most of the reforms the administration is calling for (which will, undoubtedly, cost money) will be funded by increasing the efficiency of the current public and private programs. People’s well-founded skepticism about Congress explains why so many (including Medicare beneficiaries) have expressed their concern about the meaning of “increasing the efficiency,” which they interpret to mean reducing their benefits. It is not surprising that the major opposition to the Obama reform proposal comes from the beneficiaries of these public programs, especially Medicare.

2. The concern about costs and the need to improve efficiency expressed together with an emphasis on covering the uncovered as a moral problem that needs to be resolved. This is indeed a moral issue. But, when Obama adds that he plans to pay for this expansion of coverage by increasing the efficiency of current programs, he is calling on people’s compassion, with the possibility of most people (who do have coverage) seeing their benefits reduced to take care of the uncovered. We have plenty of experience (with antipoverty and other means-tested programs) to show that compassion is not a good motivator. Solidarity (I take care of you on the condition that you take care of me) is a much better motivator.

What Obama should have done is expand and improve the Medicare Program to all Americans. This would resolve the problems of the uncovered and of everyone else. The call for a universalism mandated by government (not a mandate that individuals must buy their own health insurance, just as they have to buy car insurance) is far more ambitious (and more realistic) than a gradual path to universalism, which is likely to fail.

3. Antagonizing the left. Achieving a universal right to health care requires a huge mobilization, comparable to that which got Obama elected. For this the president needs the left. Obama could not win only by mobilizing the left, but he could not win without it. He has antagonized the left by excluding single-payer health care from the negotiating table. I can understand why he changed his mind and decided not to support the single-payer option, but I cannot understand (because it was a tactical error) why, after saying that all options would be included, he excluded the single-payer option – the alternative preferred by the trade unions, the major social movements (such as the civil rights, feminist, and green movements), and others who were the core of his support and are the grassroots of the Democratic Party. To make things worse, he is ready to eliminate even the public option, which is seen as a way of introducing the single-payer option through
the backdoor. So, it is not surprising that the left is feeling frustrated, angry, and demoralized (and did not show up at the town hall meetings).

All of this reminds me of what I saw during and after my time on the Clinton White House health care reform task force (as the “token single-payer expert”). Clinton had won the election of 1992 with a commitment to provide universal coverage. But once in office, he gave priority to reducing the federal deficit (not even in his campaign program), under pressure from Wall Street through Treasury Secretary Robert Rubin, and to approving the North American Free Trade Agreement, which was opposed by the trade unions and the majority of the Democratic Party. This antagonized the left of the party, and large numbers of Democratic voters stayed home in the 1994 congressional elections. The “Gingrich Revolution” was a consequence of this abstention of the Democratic grassroots. The Republicans received about the same number of votes in 1994 as in 1990 (the preceding nonpresidential election year). There was no increase in the Republican vote, but rather a decline in the Democratic vote. I am afraid that the same could happen in 2010.

Vicente Navarro is with Johns Hopkins University, Baltimore, Md. Correspondence should be sent to Vicente Navarro, M.D., Ph.D., Professor of Health Policy, The Johns Hopkins University, 624 N. Broadway, Rm 448, Baltimore, MD 21205 .

This article was accepted November 11, 2009. doi: 10.2105/AJPH.2009.187633

References

1. Hellander I. The deepening crisis in U.S. health care: a review of data, Spring 2008. Int J Health Serv. 2008;38(4): 607–623.

2. Ann Intern Med. 2000; :132– 145.

3. Navarro V. Dangerous to Your Health. Capitalism in Health Care. New York, NY: Monthly Review Press; 1993.

4. Washington Post/ABC News. 2008.

5. Kaiser RG. So Damn Much Money: The Triumph of Lobbying and the Corrosion of American Government. New York, NY: A Knopf; 2009.

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11 Responses

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  1. A LINE IN THE SAND – From jacksmith – WorkingClass

    http://fdlaction.firedoglake.com/2010/01/21/fixing-health-reform-through-the-reconciliation-sidecar-13-improvements-6-ways-to-save-money-4-important-benefits/

    http://firedoglake.com/2010/01/21/ma-voters-seek-more-and-faster-change-economy-jobs-top-concern-taxing-health-insurance-very-unpopular-poll-says/

    My Fellow Americans and People Of The World

    A strong Government-run MEDICARE like Public Option is STILL! CRITICAL!

    We have had a long hard struggle to find out what would be the BEST! that this congress and the Whitehouse could do to fix our highly dangerous, poor quality, most costly, and MOST! disgraceful healthcare delivery system in the world. It is clear that congress can do much more for the American people than what is proposed so far.

    It is clear that congress can pass a strong GOVERNMENT-run public option CHOICE. Available to everyone on day one. Expand Medicare and not levy any new taxes on workers healthcare benefits and plans. LET THIS BE YOUR LINE IN THE SAND!

    Lastly, there can be NO! INDIVIDUAL MANDATES without a strong Government-run MEDICARE like Public Option CHOICE. Or the American people WILL! and SHOULD! revolt with an all out CIVIL WAR against congress and this Government.

    House and Senate progressives and the tri-caucuses should aggressively push for the inclusion of a strong Public Option, Medicare expansion, and no new taxes on workers healthcare benefits and plans. If the obstructionist kill meaningful healthcare reform, then you should kill this bill. Because it will be far worse than the healthcare disaster we have now. It’s failure will be on the obstructionist heads. And they will be punished and replaced.

    WITHOUT A PUBLIC OPTION CHOICE, THIS BILL WILL KILL FAR MORE AMERICANS THAN IT WILL SAVE.

    What is proposed in the Senate bill is the worst case scenario for health-care reform. It would shift trillions of taxpayer, public and private dollars into the hands of the private insurance industry (The single most costly, deadly and dangerous product sold in America). And it would compel by law millions of Americans to financially support this oxymoronic criminal enterprise. You cant have a individual MANDATE WITHOUT A STRONG PUBLIC OPTION CHOICE!

    You will have NO! realistic way of controlling cost and quality. Cost will continue soaring through the roof bleeding the American people dry, and KILLing our economy. And our quality of healthcare will continue to decline below our current ranking of “WORST! quality of healthcare delivery in the developed World”.

    From the very start, the American people have been crystal clear about what they wanted. They wanted a humane single payer system like the rest of the developed world has (HR676). Or at least a humane strong GOVERNMENT-run public option CHOICE!! This is what the American people gave the democrats control of the house, control of the senate, and control of the Whitehouse to do.

    Those of you that can, should prepare now to remove every member of congress that fails to support YOUR healthcare reform with a strong Public Option, Medicare expansion, and no new taxes on workers healthcare benefits and plans. Run against them in teams if you have to. But take them out. And replace them with a strong single payer or PRO PUBLIC OPTION CHOICE candidate.

    Now! is the time to bring maximum pressure on your members of congress. Contact your representatives and spread the word.

    The Public Option http://tinyurl.com/yfftf76

    H1N1 IS A WEAPON OF MASS DESTRUCTION!

    I have to tell you now that the H1N1 virus is a man-made WEAPON OF MASS DESTRUCTION! and TERROR! It is a WEAPONIZED version of a flu virus. It has swept the planet infecting millions. And causing a global pandemic that has killed tens of thousands, and injured millions.

    The H1N1 virus is the product of the DISGRACEFUL, GREED DRIVEN PRIVATE FOR PROFIT MEDICAL INDUSTRIAL COMPLEX! It was released in the U.S. in Texas in early January of last year, but not recognized until around April 2009 in California. The reason I know this is because when it came to America, it came to see me FIRST! How sweet…

    This was around the time the MEDICAL INDUSTRIAL COMPLEX! assaulted the Whitehouse with all their devils deals to cripple and weaken YOUR! healthcare reform. Especially your right to have a single payer system like HR676 (Medicare For All) which most of you wanted.

    They don’t even want you to have your HUGE!!! compromise position of a strong government-run MEDICARE like Public Option CHOICE. To compete with their DISGRACEFUL, GREED DRIVEN, MURDEROUS, PRIVATE FOR PROFIT PRODUCT (The single most costly, deadly and dangerous product sold in America).

    They also wanted to take away your rights to have your government meet it’s responsibility to use it’s full power to regulate, negotiate, and control drug cost, healthcare cost and quality. Something every other civilized country in the developed World has done for it’s people. Their Greed! moral degeneracy and lack of patriotism knows no bounds.

    Many of you will remember that before we knew about H1N1. I posted a open message to the President and Congress warning them to be vigilant about their health, and cautious about any medical advice they received. As I said then “they will not hesitate to try and hurt you”.

    The U.S. and the World have been under a BIOLOGICAL TERROR ATTACK! for over a year now. It is CRITICAL that We The People Of The United States take away control of our healthcare system from the GREED DRIVEN MEDICAL INDUSTRIAL COMPLEX!

    For our own National security, and the security of the world.

    A Strong, government-run, MEDICARE like Public Option CHOICE. Available to everyone on day one, with the full unfettered power of the federal government to regulate, negotiate, and control cost and quality. Would be the most workable way to deal with this global crisis at this time. Including patent suspensions as needed for national security or the greater good.

    As an American I invite the peoples of the World to help us fix our healthcare crisis. And bring pressure on our government to meet it’s responsibility to protect global security by controlling, and removing the corrupting influence of GREED and the PRIVATE FOR PROFIT motivations from healthcare in the U.S. and around the World.

    I call on the governments of the World and the global intelligence community to track down these MASS MURDERERS, and bring them to justice. CONNECT THE DOTS! And be vigilant that they don’t slip in another viral strain on you under the cloak of H1N1 sequestration.

    Further, the proposed patent protection on biologic’s must be stripped from the US bill. And greatly shorten/restricted, or abolished completely. This is a grave danger to humanity and global security.

    I think President Obama is doing the best he can at playing the disastrous deck of cards he inherited from the previous administration. And I think he is doing an excellent job. But the wolves and devils of the medical industrial complex! are trying to exploit, and take advantage of his good heart, and desperate desire to help suffering Americans. But we must be strong and insist that healthcare reform be done right for the American people. Or everyone loose’s.

    This is all I can say in a message post. I’ll try to find a way to tell you more later.

    God Bless You My Fellow Human Beings

    jacksmith – Working Class

    p.s. The so-called nominal H1N1 virus is designed in such a way as to make it more lethal to children and young adults. The medical community must be more vigilant of secondary bacterial infections in the young caused by H1N1. And remember, a viral infection is also a transfer of genetic code to you. Think about it, and be vigilant. 😦

    jacksmith

    January 26, 2010 at 9:11 pm

  2. I have to admit this countrys health care issues are beyond sad. On top of that billions of dollars a year from fraud medicare is stolen!

    Cody Tessmer

    January 26, 2010 at 9:48 pm

  3. […] original here:  Root of Our Health Care Problems: Privatization « Wake-up Call tags: are-collected, environmentally, funds, limited-government, problem, proven, […]

  4. […] is the original: Root of Our Health Care Problems: Privatization « Wake-up Call tags: baltimore, charles, health, hopkins, JOHNS HOPKINS University, johns-hopkins, katie, […]

  5. Your link to American Journal of Public Health at the top is bad. You ought to fix it, so it doesn’t hurt the credibility of this excellent post.

    Professor Smartass

    January 27, 2010 at 5:29 am

  6. […] Root of Our Health Care Problems: Privatization « Wake-up Call Share and […]

  7. Thanks for the info. The link to the full text that worked yesterday is gone, so I have had to use one that links to the journal but requires a log in. I’ll keep looking for a better one.

    laudyms

    January 27, 2010 at 10:22 am

  8. I can’t stress how many people I’ve tried to push similar views upon. Everyone kind of pushes it to the side. I’m glad to see that someone agrees with me about privatization.

    Donny Ve

    February 1, 2010 at 3:56 pm

  9. Thanks Donny. It is a little bizarre that so many seem to believe the Insurance Industry deserves to get rich for making our lives miserable.

    laudyms

    February 1, 2010 at 8:05 pm

  10. Nice post!

    Cynthia Harper

    February 1, 2010 at 10:58 pm

  11. Very energetic article, I enjoyed that bit. Will there be
    a part 2?

    air jordan 2014 940 form

    September 24, 2014 at 4:24 am


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