U.S. Health Care Reform – The Democratic Debate Ruthless Criticism

US Health Care Reform –
The Democratic Debate

A fierce debate has raged since the submission of the Democrats' proposal to introduce universal mandatory health insurance in the USA. Protesters warn of impending socialism and accuse Obama of un-American activities with pictures of Hitler and Stalin. In its way, the media tells us something about the pending health care reform. One can see pictures of massive numbers of patients waiting in gyms to be given free medical treatment; the audience is shown a warning that these are not images of U.S. doctors abroad, but of a local charity event which offers Americans free examination and treatment – and obviously meets a great demand. On the other hand, images are also happily exhibited of British patients waiting for an operation, or Canadian patients who want to be allowed treatment in the USA, and gloomy hospital wards in countries where there is compulsory state insurance, thus socialized medicine. (Interviews with the affected persons guarantee that the pictures are not mistaken for shots of a US community hospital.)

Attuned in this way, US citizens take such television images as a model to argue at home or in public townhall meetings as to which of these two systems they would be worse served by with their limited means. They weigh whether the risk is greater of catching a serious illness and thereby losing everything – particularly now that unemployment and losing one's coverage are the order of the day – or the risk of going broke because of the planned compulsory insurance and maybe at the same time one has the bad luck of not even getting sick. In all their calculations and debates, the one thing that the citizens all assume as given is their poverty. It is completely self-evident to them that such life necessities as seeking the opinion of a medical professional or even undergoing treatment can't be privately paid for out of their wages.


Up to now, the United States has taken care of this circumstance just like other countries. The effects of poverty on the will and the ability of the people's health is not to be simply left to the evaluation of the affected persons. So since the middle of the 1960s the USA has ensured medical basic care for the elderly (from age 65 on) and introduced Medicare, a universal health insurance. [1] In addition, Johnson's War on Poverty in 1965 initiated Medicaid, a medical insurance for objects of special state protection such as children under 21, pregnant women and parents of authorized children. [2]

The state never introduced universal health care – that has always been considered too expensive. Rather it has made this need a subject of negotiation between capital and labor and promoted workplace agreements, likewise starting in the 1960s, with tax incentives. For 2/3 of the population, for the majority of employees, some type of insurance emerged (according to contract, depending on company size, union membership, etc).

Now the success – as well as the failure – of U.S. capital has in recent years made this care shaky. [3] Over the past 10 years, the number of insured has dropped by more than 10%, which has also not made the insurance business more lucrative; to compensate, family members are less often co-insured and the scope of coverage has been greatly reduced. Since the Big 3 car manufacturers have partly successfully tried to fundamentally get rid of their bargained health insurance obligations by referring to incidental wage costs as a barrier to competition, the contractually agreed upon types of insurance in all large companies are by now subject to negotiation as bargaining chips for preserving the always threatened jobs. Accelerated by the crisis, health insurance coverage as a fixed salary component is in dissolution across the board.

With nearly 50 million uninsured, of which more than 10 million are children, and more than 2 million losing private insurance a year (already before the crisis), plus a substantial part of the population not having much more than basic insurance, the state now considers the condition of its people's health to be more alarming. [4] After four decades and various attempts, a consensus now prevails that reform is necessary and universal health insurance is inevitable. [5] The goal: to make health insurance accessible to all Americans. The biggest hurdle of the reform, everyone agrees, is the costs.


So the stuff for a controversy customary for state power, with considerations of its own about health services, is opened in Washington. In arbitrary order: how medical care for the people would be secured and offered; how payments for medical services can be made from the weakening means of a family income and how this can also endow the health care industry (insurance, pharmaceuticals and research, hospitals, etc.) with a reliable purchasing power, therefore growth, without the risk of unwanted side effects on the cost-price of labor. The latter consideration is extended against the background of the problems of wanting to free capital as much as possible from the incidental wage costs for health care. Every party has their own designs on these issues and, of course, there is also a bipartisan proposal which wants all this, what the Obama-Pelosi plan, Stability and Security For all Americans, announces in customary beautiful words: “It will provide more security and stability to those who have health insurance. It will provide insurance to those who do not. And it will lower the cost of health care for our families, our businesses, and our government.”

The citizens can download the different program summaries and study for themselves how the respective plans make everything right: offer the greatest possible business with the slightest monetary deposit; guarantee the most favorable insurance offer with the best medical care; and all this without jobs being lost, Medicare being cut and taxes being raised. America's middle-class and the hardworking Americans would get all this without having to spend even one cent more. [6] With all their back and forth, neither the proponents of Obama's reform proposal nor its opponents with their own plans promise the masses anything more than basic care, given the money which those to be insured will still not have in the future and which the state sees itself not in a position to raise.

But even for this minimal goal, the involved parties – the citizens and the insurance companies – must be “brought” together. So the government makes an insurance offer which (almost) nobody can refuse. The citizens may choose between an insurance with tax incentives or an annual penalty charge which should be between $750 for individuals and $1,900 for families. And the insurance industry, always at your service and ready for business, has to be open to any business: it can not refuse service to anyone, regardless of gender, skin color or any previous illness. Only in this way is it guaranteed that those who can not really afford this nice offer will take out an insurance policy, and on the other hand will be able to find an offer. Finally, companies should, if possible, continue to offer company health care: so that this does not hinder them from their real task – the creation of competitive jobs – the state in this case is so kind as to take over at least a majority of this burden.

This is the “raging” controversy – of course, with varying emphases on the recognized goals. Republicans see themselves naturally as the sole representatives who ensure business (insurance and others) with supply, thus caring for competition and choice. The caring Democrats declare themselves for their part as having the sick especially in mind and therefore regulate the legal framework so that big business must do more than just fill their pockets; they also try to sharpen their social profile, so they in addition want to impose a special tax contribution on those who earn more than $500,000 per year, and so on.

On the other hand, however, all have a fundamental concern as to how, in the middle of the Great Recession, a medical care should be paid for which capital and private individuals together are hardly and/or not at all able to manage. Certainly, everyone still appears impressed by the dimensions of medical non-care, which is exactly why America (business and citizens) is afraid to over-strain itself with this reform. This concern, the reason for the rejection of earlier reform proposals, is put aside for the first time in view of the collapsing coverage, of the growing burden on the state budget and weakening insurance business. So the struggle about its scope, thus the costs, is all the more heated.

All America, from top to bottom, is involved in this question and in all their dissent agrees: a health care which is dispensed by the state of science and medical treatment is not affordable, harmful to business and therefore not planned.


There are also some, on the other hand, who have campaigned for a long time and on principal for universal health care: the American left. They demand that the citizens should have a right to health care and in their nation money must be available for this purpose, especially if this is already practiced in other countries, such as in Europe. Poverty and medical emergency are for the US left self-evident failures of their state in its tasks – they do not take it as information about the purpose and interests of the state that has produced it. For them, the state must be compelled by public opinion to do its good deeds. (Why, actually, if it is part of its tasks, nobody wonders.) Under the leadership of their new heavyweight, Michael Moore, the left has brought its case to the public. In his widely acclaimed agitational prelude to this debate, the movie “Sicko,” Moore equates all the troubles and worries of Americans with attacks on the community of the American people. When he deplores health conditions in which every year 18,000 people die as a result of non-treatment, he can not describe and quantify the damage in any other way than a) in an image of a breach of patriotic duty, as he counts up the dead that would correspond 6 times annually to the victims of 9/11 and that this b) is a tremendous loss and a tragedy for America and the American people, who generally c) are deprived of their rights and their dreams by a Mafia of representatives from the insurance and pharmaceutical industries who only crave profit. In his film, he shows that the terrorists at Guantanamo, according to the State Department, receive good medical care (God forbid!) and demonstrates how, on the other hand, America's 9/11 firemen heroes – who have gotten asbestosis, lung cancer, etc. in the line of duty – have gone untreated. And so it wounds national pride when five of those exemplary New York firefighters are allowed treatment by the arch-enemy Cuba. America has not seen a sharper indictment of the lack of medical care for a long time. At least none that hits America more. All the misery of individuals is a consternation to America – that Moore in his film fills in more drastically than the ordinary television program.


Finally, there is a different kind of contribution to the controversy: the American right and its always prepared supporters of life, liberty, and the pursuit of happiness (and they are often not the wealthiest). They do not complain about the condition that a majority of the population cannot afford medical status, but conversely castigate state intervention as an improper and malicious obstruction of the citizens in their striving for private advantage. They can not be led astray by false sympathy: caring about the inevitable social misery in the competition society counts for them as system endangering relativism and falsification; in the long run, as bowing to all those who do not prove themselves in competition, or even don't have to try because of government welfare programs. These holy warriors of competition defend against the threat of mandatory health insurance as if they were the last bastion in Armageddon. They see a threatening USSA, if it comes to that, that the poor will now get their hard-earned money just to finance Washington's damn plans, to make insurance companies and the state rich and the lazy fat; because then socialism has finally triumphed over the God-given right to be able to lead honest, decent lives in self-responsibility. No less than morality and the principles of the competition society are endangered by the state and therefore threaten the right to success; those who exert themselves are punished and must bear the costs for the self-inflicted poverty of others. This sort of “criticism of the system” has nothing against the effects of competition, but only against the costs associated with the support and maintenance of competition. It demands the ideal of bourgeois society – untroubled by the consequences of its own conditions. This has its tradition and its adherents in the food stamps impoverished country of the hardworking Americans. However: these freedom fighters are of no great relevance. Even if the Republicans use them as a chance to score points and even if they play the poverty card of the people in their propaganda against the reform – too expensive, America and the Americans cannot afford this and it really isn't such a big change anyway – the opinion remains shared: the health care system is broken.


So in essence unity prevails in America about the fact that the disintegration of the privately organized health insurance system cannot continue to be watched from the sidelines without fear of damage to the nation. Nevertheless, the introduction of health insurance after over 40 years of debate would be no reason for Americans to rejoice.

The view is too prevalent that, even if health is considered as damaged, more than this lines up for repair: the American way of success. The pride of a whole nation feels duped if, on the one hand, the nation's warriors are not taken care of and if, on the other hand, the care generally raises serious questions of capability. Then America, supporters as well as opponents of socialized medicine, feels this reform debate is part of and a reaction to lost national greatness, and this lets them see in the television and film images ultimately only a congestive crisis of the success of the nation.

Controversy arises in what America should do, but above everything in what it can afford in matters of health. Here one may think again of the television pictures of the advocates as well as the opponents of socialized medicine and with the striking options which one is left with in the administration of poverty in capitalism: either how bad socialized medicine is or how bad it is with the continuation of non-insurance. For the people, these alternatives present no reasons for them to get involved because nothing is in it for them.


[1] As a consequence of Social Security, introduced in the Great Depression 1935, not being sufficient for the health insurance of the majority of the elderly. For more information about this: The proletarian version of the “American way of life”

[2] In this program, participatory states get one U.S. dollar grant from Washington for every dollar spent.

[3] Economic success (ie, the lowering of unit labor costs) leads to fewer contributors, smaller insurance business, thus higher risk for the insurer. Also, on the other hand, the lowering of wages per unit, as well as decreasing salaries, do not lower the cost of health care to the same level. So the cost of individual labor goes up for the employer.

[4] As a consequence of the non-insurance, a study in 2003 found that nearly half of Americans diagnosed cannot be treated. According to the study, this means: “The deficits we have identified in adherence to recommended processes for basic care pose serious threats to the health of the American public. The New England Journal of Medicine, June 26 2003; 348(26): 2635-45.

[5] Now in addition to Massachusetts, California also introduces a compulsory health insurance; both states are governed by Republicans. It is not that there are two totally different views in this question.

[6] Three of the most prominent proposals http://www.whitehouse.gov/issues/health-care/plan:; http://www.gop.gov/solutions/healthcare; http://www.bipartisanpolicy.org