No one really denies anymore that there is a health care crisis in the US. Every Republican and Democratic presidential hopeful is touting some kind of plan to fix it. In reality, there are two versions of the health care crisis in the US - one for the working class and a separate one for the ruling class.
The Health Care Crisis for the Workers
Any worker in America can give you the details on the health care crisis. Those who are lucky enough to have medical benefits at their jobs find that these benefits are under a generalized, all-out attack. Medical benefits have been a central feature in virtually every strike in the past three years, as workers seek to resist the erosion of their benefits. Costs for workers are spiraling out of control. It used to be that companies paid 100% for health insurance as part of the wage/benefit package. But today workers are forced to pay for a percentage of the medical premiums. Once management wins the end of 100% employer-paid insurance, the percentage workers must contribute is constantly being increased. Within the plans themselves, worker's costs are skyrocketing, co-pays, fees, and deductibles are constantly going up. Workers' insurance coverage is being eroded. Younger workers often lack coverage or have substandard coverage that doesn't cover much, and they have to pay exorbitant contributions to extend coverage to the entire family.
Quality of care is also declining, and the government keeps granting doctors, hospitals, and pharmaceutical companies exemptions from liability for malpractice, incompetence, and defective drugs with disastrous side effects. Then of course there are the estimated 46+ million Americans who have no medical insurance at all. While the poorest Americans are covered by Medicaid, sponsored by the federal government's social welfare system, and Medicare covers retired workers, increasing numbers of workers who earn too much to be covered by Medicaid are left to their own devices. Recent court rulings have empowered unions and companies to drop retirees from medical insurance programs, forcing them to rely solely on Medicare and purchase their own supplemental coverage while retired from private insurance companies.
The Health Care Crisis for the Bourgeoisie
For the ruling class the health care crisis is that they are saddled with an incredibly inefficient and expensive system that damages American capitalism's economic competitiveness on the world market. Insurance costs, doctor fees, hospital costs, overhead and administrative costs are out of control. The US has the costliest health care system in the world, with per capita expenditures more than double that of most major industrialized nations. Health care costs as a percentage of GDP are 9.9% for Canada, 10.1% for France, and 8% for the United Kingdom, but an astronomical 15.2% for the US. And all of this extra cost provides an inferior quality medical care that makes the US look ridiculous on the international scene. Patient outcomes are among the worst in the industrialized world. In Australia, Canada, France, Germany, Japan, Sweden, and the United Kingdom, life expectancy ranges from 79.5 years (France, UK) to 82.5 in Japan. In the US it lags behind at 77. A study by the World Health Organization evaluating the overall quality of health systems ranked the US as 37th in the world, trailing behind Dominica, and Costa Rica. Infants born in the US are three times more likely to die in their first month as children born in Japan, and newborn mortality is 2.5 times higher in the United States than in Finland, Iceland or Norway.
The cost of having so-many uninsured people actually hurts the US economy, as the costs for emergency care for such patients is passed on to everyone else. The dominant fractions of bourgeoisie see the value in rationalizing the system, getting more people covered to save overall costs and help competitiveness. So there should be no mistake. The motivation for health care reform is NOT to improve the health of workers in America, but rather to cut costs and improve competitiveness in the world economy. The crisis is so serious actions are already being taken on a piece meal basis. Massachusetts, for example, has passed a plan to implement a near-universal mandatory coverage law, requiring residents to purchase health insurance - the so-called individual mandate. Maine, Pennsylvania, and Vermont are also considering universal systems at the state level. In California, Republican governor Arnold Schwarzenegger is pushing a plan that also includes an individual mandate-requiring residents to purchase insurance coverage or pay extra taxes. Unions, especially the breakaway Social Employees international Union (SEIU) supports ending employer based health care and has actually teamed up with Wal-Mart to push this agenda on the "corporate elite." SEIU Pres. Andy Stern is a strong advocate of this approach.
Health Care "Reform" and the Presidential Campaign
Presidential candidates in both parties are floating proposals to overhaul the health care system and to provide coverage for the uninsured. Republican candidates tend to propose some version of so-called "market-based" reforms that will use tax credits and deductions to encourage people to purchase medical insurance. The Democratic candidates tend to propose some form of direct government intervention to control costs and provide universal coverage. For example, Republican Rudolph Giuliani has proposed granting tax credits of up to $7,500 for individuals and $15,000 for families, provided the money is spent on health care insurance -that gives you an idea of how expensive health insurance can be. Senator John McCain proposes a similar plan, with tax deductions of $2,500 for individuals and $5,000 for families. Former Arkansas Governor Mike Huckabee is more vague, proposing a plan to "encourage the private sector to seek innovative ways to bring down costs and improve the free market for health care services." Mitt Romney proposes allowing the cost of insurance premiums, deductibles and co-pays to be taken as a tax deduction.
Among the Democrats, Hillary Clinton and John Edwards advocate requiring health insurance for everyone, requiring employers to contribute to covering the costs and funding the rest by rescinding Pres. Bush's tax cuts on Americans earning over $250,000 per year. Barack Obama favors requiring only that all children will have to be covered by insurance, which he claims will lead to near universal coverage as families will wind up purchasing insurance for the parents as well.
Meaning of the proposed "reforms"
The campaign propaganda about "universal" health care has tremendous mystifying power for the ruling class. For individuals who currently have no health insurance, any of the plans proposed by the politicians surely sound like they'll be better than nothing. The leftists push for universal care as a central "reform" demand. In his recent Sicko documentary, filmmaker Michael Moore portrayed the health care systems in France, England, and Canada in the most idyllic light, as if those countries were heaven on earth. However, wherever these so-called universal plans exist, they are in crisis. Everywhere the bourgeoisie faces the same task, to cut costs, to attack health care. This is especially true as the post World War II baby boom generation begins to retire and suffers deteriorating health.
Whatever form they may take, the coming change in the health care system will NOT be a reform, not an expansion of health care, not an attempt to improve the health of the working class. It will be an austerity attack. The goal is the same as in Europe -- to cut society's expenditure on health care. None of the plans will do anything to combat the erosion of health benefits for workers already insured at work - co-pays and premiums will go up, coverage will continue to deteriorate. Those covered by the new plan will pay a lot of money. Most of what has been proposed will only provide very basic coverage to the poorest people. Everyone who can "afford it"-i.e. the working class will have to take their employers' plan, or pay out of their own pocket for basic coverage. These plans give employers an incentive to drop coverage and pay less into the state fund instead. Coverage will decline for most who already have "good coverage".
The US ruling class is trying to manage a crisis that threatens its economic competitiveness, not to solve a medical crisis. Yes, more people will be covered-but they will have to pay for it and coverage will be minimal with no reimbursement until you have paid considerable out of pocket expenses. The health care crisis is yet another manifestation of the general economic crisis of world capitalism. The attack on medical benefits and on pensions is essentially an attack on workers wages, the total compensation package paid to the workers for their labor. More and more the economic crisis forces the ruling class to attack the working class standard of living, amply demonstrating that capitalism has no future to offer humanity. The attacks on pensions and medical benefits pose life and death issues for the working class. Only the replacement of a society driven by the quest for profits, with one where the operating principle is the fulfillment of human needs offers the possibility to seriously address the health problems that we confront today. --J. Grevin, 1/8/08.