The health care bill: What it means for workers

By Fred Goldstein
Mar 24, 2010

Tens of millions of people in this country were hoping to be delivered from the clutches of the ruthless profiteers who control the health care system and were hoping for universal health care. But the very opposite has happened.

The latest so-called health care reform bill, signed into law by President Barack Obama on March 23, has consolidated and legalized the position of the health care profiteers as the central force in the system of health care — under minimal supervision and regulation by the capitalist state.

Furthermore, this bill has been passed by bargaining away women’s reproductive rights and the rights of undocumented and documented immigrants. Its effect is to destroy solidarity while it turns its back on millions of mostly poor women and immigrants.

A statement by Terry O’Neill, president of the National Organization for Women, explained that one of the bill’s effects is to make public funding of abortion impossible and private funding almost impossible. She wrote that the bill “imposes a bizarre requirement on insurance plan enrollees who buy coverage through the health insurance exchanges to write two monthly checks (one for an abortion care rider and one for all other health care). Even employers will have to write two separate checks for each of their employees requesting the abortion rider.”

O’Neill also wrote that the “bill imposes harsh restrictions on the ability of immigrants to access health care, imposing a five-year waiting period on permanent, legal residents before they are eligible for assistance such as Medicaid, and prohibiting undocumented workers even to use their own money to purchase health insurance through an exchange. These provisions ... are there because of ugly anti-immigrant sentiment, and must be eliminated.”

Those who stubbornly and valiantly fought for some form of universal national health care were shunted aside by the Democratic Party leadership and the Obama administration. Single payer was pushed off the agenda and substituted with the miniscule provision for a “public option.” This was mainly a sop in order to change the subject. The Obama administration had early on negotiated with the health care industry and agreed that there would not be a public option.

Thus health care is still to be sold as a commodity on the capitalist market for profit, instead of being the right that it should be. It is in stark contrast to the socialized health care in Cuba, for example, where despite a U.S. blockade that has impoverished the country for decades, health care is free and accessible to everyone. This is because Cuba’s socialist system means people’s needs are a priority, not profits like under capitalism.

One of the features of this bill is that the masses have been kept in the dark about the process and the bill itself from the beginning to the end. Only the politicians and the lobbyists from the various health care industries and medical professions were able to follow the inner course of the negotiations. Now that it is over, various bourgeois experts have surfaced to “explain” the bill.

Workers to wait until 2014 while 45,000 a year die

The details that are buried in the bill will only come out over time, if ever. Here are some of the major features of the bill that have come out.

To begin with, even the most optimistic estimates project that 23 million people will still be uninsured in 2014.

The bill imposes onerous conditions on millions of uninsured who, starting in 2014, would be forced to buy health insurance from an insurance company or face a fine. This is the bill’s version of giving wider coverage. It was the result of a deal cut with the insurance companies to widen their diminishing customer base, which has suffered during the economic crisis as millions lost their jobs and their insurance, and to ensure future billions in profit.

In 2014 workers and the middle class are to be thrust into one of 50 state-run exchanges. This further atomizes the working class by leaving the burden on the individual to find “affordable” insurance on the Internet. Even when insurance premiums are affordable, the co-payments and deductibles can be in the thousands of dollars and make it unaffordable to actually use the insurance.

Medicare Advantage, home care and hospital payments are to be cut by $200 billion. This is a threat to seniors and the disabled, despite assurances that nothing will be cut. Cuts will be made in the reimbursement to the private insurance companies that work through Medicare Advantage; they will surely reduce services.

Adults with pre-existing conditions will have to wait until 2014, when they can no longer be denied coverage. Poor families of four earning less than $29,327 — 16 million people — will have to wait five years to be covered by Medicaid. Meanwhile 45,000 preventable deaths take place every year because of lack of insurance, according to Harvard Medical School. Half of all bankruptcies are due to medical costs.

The bill, of course, has some positive elements that cover the most outrageous and universally hated practices of the insurance companies. Any positive elements should be closely studied by the workers and taken full advantage of. Many of the practices to be eliminated were exposed in Michael Moore’s popular and widely viewed film, “Sicko.”

In the short run, the insurance companies will no longer be able to deny coverage if you are sick. They will not be able to put a lifetime cap on coverage. And they cannot deny children access because of a pre-existing condition. Youth up to 26 years old can stay on their parents’ insurance plan, although there may be an additional premium.

But millions of workers will still have to rely on their bosses to get their health care. If you lose your job, you still lose your health care. In this era of layoffs, mass unemployment and underemployment, there is an epidemic of people losing their employer-based coverage. And if you are allowed to keep your health care after you are laid off, few can afford to pay a group rate, let alone an individual rate.

Most important is that the insurance companies will be in charge of the immediate review process. The Department of Health and Human Services will eventually have a higher level of review. But the companies are expert at lying, manipulating and, in the long run, suffering fines in order to avoid giving coverage that is more expensive than the fines. It is a case of the fox retaining the right to guard the chicken coop.

Social Security and Medicare

The conventional wisdom being touted by the Democratic Party leadership is that this health care bill is in the tradition of the establishment of Social Security and Medicare.

In fact, the opposite is true. Marxists must try to understand the difference, not just in terms of personalities or parties, but in seeing the objective circumstances in which these different pieces of legislation were passed and what the class differences are. The most important factor is to view the relationship of class forces that existed then and that exist now.

The Social Security bill was passed in 1935 as part of the Franklin Roosevelt “New Deal.” But it was passed only after a period of mass struggle against unemployment, the famous veterans’ Bonus March in Washington, D.C., and the break up of the veterans’ encampment by federal troops in a pitched battle. It followed the general strikes in San Francisco, Minneapolis, Minn., and Toledo, Ohio, in 1934.

Even at that, it was a compromise in which the bosses wound up having to pay only half of Social Security, with workers paying the other half. But it became a working-class right. The money was held by the government for the workers and paid out every month by the government.

The Medicaid bill was passed in 1984 and the Medicare legislation was passed in 1965 as part of President Lyndon Johnson’s “Great Society” program. These bills were not passed because the capitalist government suddenly became socially conscious. They came after 10 years of the Civil Rights movement, massive rebellions in the streets of Harlem, N.Y., and Los Angeles, and a growing national liberation movement right here in the U.S.

Just like Social Security, Medicare and Medicaid became a legal and political right of the working class and the poor. They were not turned over to private companies and put on the capitalist market as commodities.

The present health care bill reflects the fact that the working class movement, including the movement of the oppressed, has been on the defensive for a long time and has not yet begun to fight back.

Consequently, the fate of the health care bill was really fought out by different factions within the ruling class and their two political parties without any significant intervention by the masses. Secret deals were made with the pharmaceutical and hospital lobbies as well as with elements in the health insurance industry. When these deals became known, there was no mass response. The bosses had their way, relatively unobstructed by any threat from below. The labor movement leadership restricted itself to minuscule protests and lobbying. And the communities and the political movement were unable to mobilize, despite militant attempts by various single-payer groups.

Fight racist, right-wing counterattacks

But this should lead into the next phase of the struggle. The great problem for the workers’ movement is that the health care bill, as minimal as it is, has been fought tooth-and-nail by the Republicans and the extreme right-wing Tea Party movement, which encompasses outright fascists. The Republicans and the corporations have in fact worked with the Tea Party movement to fan the flames of racism and anti-gay and anti-immigrant sentiment.

There was a fascist-like display at the Capitol building in Washington, D.C., the day the bill was passed, when a mob shouted racist epithets at African-American representative and former civil rights leader John Lewis of Georgia and spat on another Black legislator. The mob then accosted Rep. Barney Frank of Massachusetts, who is gay, and hurled anti-gay slurs at him. It is notable that this mob was allowed by the Capitol police to get right up in the faces of the lawmakers.

The right wing tried to bring down the Obama presidency over the health care bill. There is already talk among the Republicans of trying to overturn the bill and start up a new town-hall-style, ultra-rightist mobilization.

This fact does not make the bill any better. But it does mean that the workers’ movement, the progressive and revolutionary movement, must work together to assertively combat any reactionary and racist counterattack by the right while at the same time demanding real universal health care.

It is not known at this time if right-wing elements will succeed. But the progressive movement was taken aback during the town hall campaign last fall, when the first right-wing assaults were launched against the health care bill while whipping up a racist campaign against Obama.

Forewarned is forearmed. The fight for health care can be carried into the struggle against the right without having to abandon a working-class, progressive position. Fighting the racists and getting in their face while demanding universal quality health care and Medicare for all can and must be done. “Health care is a right!” should become the battle cry of the movement, along with pro-immigrant, pro-abortion rights, anti-racist slogans and so on. This is the way to resist any right-wing, racist mobilization based on opposition to the health care bill.

The Democratic Party leadership has given in all along the line. The workers, oppressed communities, students and youth all have a stake in this struggle. It can be united with the struggle for jobs, against the budget cuts and foreclosures, and to save public education. All these fronts in the class struggle form the basis to come together in People’s Assemblies or other organs of popular power to unite to launch a powerful, anti-capitalist movement.