Louis Proyect: The Unrepentant Marxist

June 30, 2012

Reflections on Obamacare

Filed under: health and fitness,Obama — louisproyect @ 8:15 pm

On September 9th 2009 Barack Obama gave a speech to Congress that defined his approach to health care:

There are those on the left who believe that the only way to fix the system is through a single-payer system like Canada’s, where we would severely restrict the private insurance market and have the government provide coverage for everyone. On the right, there are those who argue that we should end the employer-based system and leave individuals to buy health insurance on their own.

I have to say that there are arguments to be made for both approaches. But either one would represent a radical shift that would disrupt the health care most people currently have. Since health care represents one-sixth of our economy, I believe it makes more sense to build on what works and fix what doesn’t, rather than try to build an entirely new system from scratch. And that is precisely what those of you in Congress have tried to do over the past several months.

This amounted to the opening salvo in a policy debate that seems to have been concluded with the Supreme Court decision this week. There are a number of points that can be made about these two dubious paragraphs.

When Obama was starting out as an ambitious young politician, he had no problem speaking as one of “those on the left” who backed a single-payer system:

As should be obvious to anybody who has been following his sorry career, he is a master trickster who knows how to adopt popular positions when they are to his advantage and to drop them once they are a liability.

Also, in the first paragraph there is this business about those on the right “who argue that we should end the employer-based system and leave individuals to buy health insurance on their own.” Does anybody have an idea what the fuck he is talking about? I for one make a point of listening to Rush Limbaugh and Sean Hannity from time to time just to see what the anti-Christ is up to but have never heard such an argument from those quarters. In fact the rightwing in the U.S. is very happy about employer-based systems and attack Obamacare mostly on the basis that it is a threat to the status quo.

For me the most interesting point was the one made in the second paragraph, namely that health care represents 1/6th of the economy. While most of the discussion about the Supreme Court decision has revolved around rather secondary questions such as what makes John Roberts tick or how the decision impacts the 2012 presidential race, I remembered something I wrote about health care before Obama became president:

Another adviser with a particular interest in health care is David Cutler, a Harvard economist who was also an adviser to Bill Clinton–surprise, surprise. Cutler wrote an article for the New England Journal of Medicine in 2006 asserting that “The rising cost … of health care has been the source of a lot of saber rattling in the media and the public square, without anyone seriously analyzing the benefits gained.”

Anxious to show the good side of rising costs, Cutler and a group of other economists defend the idea that a powerful and profitable medical industry can serve as an engine of economic growth in the USA as the wretched Gina Kolata reported in the August 22, 2006 NY Times.

By 2030, predicts Robert W. Fogel, a Nobel laureate at the University of Chicago Graduate School of Business, about 25 percent of the G.D.P. will be spent on health care, making it ”the driving force in the economy,” just as railroads drove the economy at the start of the 20th century…

Other economists agree.

David Cutler, an economist at Harvard, calculated the value of extra spending on medicine. ”Take a typical person aged 45,” he said. ”They will spend $30,000 more over their lifetime caring for cardiovascular disease than they would have spent in 1950. And they will live maybe three more years because of it.”

It makes sense to think of insurance companies, drug companies and health care providers as part of the same sector of the capitalist economy. Any threat posed to the insurance companies would also be perceived as a threat to the institutions that provide medical care based on profit. If you are for cutting costs by eliminating the insurance companies, naturally you will want to bring health care costs under control.

On June 8th the New York Times reported on Obama’s contacts with lobbyists from this sector. While the newspaper of record does get pilloried from the left for all the correct reasons, it does do some very good investigative reporting from time to time that led one rightwing idiot I used to work with at Met Life back in 1968 to call it the Jew York Times.

The article begins:

After weeks of talks, drug industry lobbyists were growing nervous. To cut a deal with the White House on overhauling health care, they needed to be sure that President Obama would stop a proposal intended to bring down medicine prices.

On June 3, 2009, one of the lobbyists e-mailed Nancy-Ann DeParle, the president’s health care adviser. Ms. DeParle reassured the lobbyist. Although Mr. Obama was overseas, she wrote, she and other top officials had “made decision, based on how constructive you guys have been, to oppose importation” on a different proposal.

Just like that, Mr. Obama’s staff signaled a willingness to put aside support for the reimportation of prescription medicines at lower prices and by doing so solidified a compact with an industry the president had vilified on the campaign trail. Central to Mr. Obama’s drive to remake the nation’s health care system was an unlikely collaboration with the pharmaceutical industry that forced unappealing trade-offs.

Since there has been so much liberal jubilation over the Great Victory, including in the pages of the Communist Party’s newspaper, there’s a tendency to forget about the resistance to that very piece of legislation when it first surfaced. Even though it fell far short of the single-payer approach that the young Obama backed, the House Bill in early 2010 included a public option that would have signaled the entrance of the government after the fashion of Medicare. Those who could not afford private insurance would be able to go to a provider that did not operate on the profit principle. Since Obama cared much more about the interests of the insurance companies than the poor, the public option was sacrificed at the altar of the Free Market deities.

Of course, when Obama found it convenient to back a public option, he said so. Words are cheap, after all.

As most people know, the Senate is even more undemocratic than the House. States with small, largely white, rural and reactionary populations get the same number of Senators to represent them as much larger, multiracial, urban and liberal-leaning populations. Montana, for example, has less than a million residents, many of whom are typical Rush Limbaugh fans. Meanwhile, New York, a state that has 20 times as many residents, gets the same number.

Keeping this in mind, how does a Montana Senator, a Democrat named Max Baucus who received thousands of dollars in contributions from Jack Abramoff, the arch-reactionary lobbyist infamous for the crooked deals that landed him in prison, end up supervising the drafting of the Senate legislation that became Obamacare?

The always useful Wikipedia describes Baucus’s economic record:

Baucus has a 74 percent pro-business voting record as rated by the United States Chamber of Commerce. He twice voted to make filing bankruptcy more difficult for debtors, once in July 2001 to restrict rules on personal bankruptcy, and a second time in March 2005 to include means-testing and restrictions for bankruptcy filers.

In March 2005, Baucus voted against repealing tax subsidies that benefit companies that outsource U.S. jobs offshore. On January 4, 2007, he wrote an editorial in the Wall Street Journal calling on Democrats to renew President George W. Bush’s fast-track authority for international trade deals.

A perfect background for someone drafting healthcare legislation. And just to make sure that it came out right, he lined up someone named Liz Fowler to write the 85-page piece of legislation that MSNBC and the Communist Party are throwing confetti over.

As it turns out, Fowler was a former executive at WellPoint, a big insurance company. Imagine that! The Guardian described a perfect match between Baucus and Fowler, something that could have been used in an online dating TV commercial:

Baucus took $1.5m from the health sector for his political fund in the past year. Other members of the committee have received hundreds of thousands of dollars. They include Senator Pat Roberts, who last week tried to stall the bill by arguing that lobbyists needed three days to read it.

Baucus holds dinners for health industry executives at which they pay thousands of dollars each to be at the table, and an annual fly-fishing and golfing weekend in his home state of Montana that lobbyists pay handsomely to attend. They have included John Jonas, who represents healthcare firms for Patton Boggs, widely regarded as the top lobbying firm in Washington. Jonas, who formerly worked on the congressional staff, acknowledges that political contributions are intended to buy influence and says it works.

“It would be very naive to say they’re not influenced. The contributors certainly hope they’re influencing and the recipients probably ultimately are influenced,” he said. “I think it’s a morally suspect practice, and then you have to look at its application to see if it’s morally bankrupt … I think what’s bad about the system is it’s got more and more lax over time.

“When I started in this practice you did not talk issues at a fundraiser. It was impolite. And then with this need for money, the system has got coarser over time so that they go around the room asking what issues you’re interested in, much more of a linkage of dollars to a discussion of the issues now.”

The health industry permeates the process in other ways. At Baucus’s side, drafting much of the wording of the reform, was Liz Fowler, a senate committee counsel whose last position was vice-president of the country’s largest health insurer, Wellpoint, which stands to be a principal beneficiary of the new law.

Health companies and their lobby firms also recruit heavily among congressional staffers as a means of maintaining influence.

So that’s what the Communists and Ed Schultz are giddy with delight over, and what the Nation Magazine’s editor Katrina vanden Heuvel called “a beginning to the end of America’s healthcare crisis”–a crappy piece of legislation that was written by an insurance industry lobbyist under the supervision of a yahoo from Montana who took bribes from Jack Abramoff.

Off with their heads.


  1. Excellent skewer, Louis. I myself was hoping the Supremes would throw out the whole Obamacare. Since I was a young man, and way before I joined any socialist group, I have argued for socialized medicine. It works. It’s the only solution. It already exists, in the form of the Veterans Administration. No veteran I know has argued in favor of getting rid of the socialized medicine of the VA (despite the problems with the system, mostly owing to underfunding). Yet this was the elephant in the room during the deliberations on Obama’s pathetic giveaway to the insurance industries. It should be pointed out that, despite the CP’s disgusting whoopdedo over the Supremes’ upholding of Obamacare, among all American left groups, the CP, to its credit (hollow though that seems now!) has long made an issue out of the need for socialized medicine. How many other left groups did that? Not one, so far as I can tell. The left, such as it is, does little more than react to an agenda set by the ruling class, and nobody pays any attention to it because it cannot be taken seriously on the health issue, mainly because it never made an issue of it. It seemed more worked up over issues like gay marriage and allowing open homosexuals to join the imperialist military. Those issues are of no consequence to most Americans, including homosexuals. But medical care is. Where was the left on this issue over the past several decades? Nowhere.
    There are a few useful and supportable aspects to Obamacare (e.g., obliging the criminal ripoff insurance industry to accept people regardless of existing medical “conditions”–though that doesn’t take effect for two more years!). But the entire program is designed to uphold the secular religion of “private enterprise.” Far more intelligent would be to make health care a right. Every citizen should be entitled to health care, regardless of income, and removing the insurance industry from the equation would solve the problem. Meanwhile, it is outrageous that the Supremes require citizens to buy insurance from private companies. That ought to be unconstitutional. And Obama is not merely a changeling (as your piece proves), but a fraud. If the Republicans win both houses of Congress in the next election (and maybe the White House), they will seek to repeal Obamacare, but if they do, will the masses rise up and demand a genuine solution to pervasive problem? I’m not holding my breath. Obamacare doesn’t even address the question of dental care, which, as Frontine recently documented, is a huge problem for most Americans, whose teeth are falling out and who are being taken advantage of by private companies setting up clinics subsidized by big corporations like General Electric. When I first visited Norway in 1964 (before oil was discovered, and the country was still poor), every citizen had a right not only to medical care but to dental care. Why haven’t the unions or even the left made an issue out of the travesty that in 2012 the USA is at the bottom of of the list in providing basic health care? It makes me ashamed to be an American.

    Comment by David Thorstad — June 30, 2012 @ 8:55 pm

  2. My suspicion is that if Romney gets in, he will tinker around the edges of ObamaCare, rather than abolish it. It’s too good a deal for the insurance industry to overturn. And if they do, I think Romney must realize that could open the door for single-payer.

    Comment by Jim Farmelant — July 1, 2012 @ 12:18 am

  3. Of course, Michael Moore has just posted an article talking about how this is a great victory, even though the Affordable Care Act is “deeply flawed”.

    The failure to implement a single payer system, or, at least incrementally expend Medicare to those over 55, will have serious consequences. Over the next 10 years, there will be a concerted effort to accomplish the opposite, the incorporation of the millions covered by Medicare (and also Medicaid) into the mandatory for profit system created by the ACA. Absent a dramatic change in the political environment, the proponents of such an effort will succeed.

    Comment by Richard Estes — July 1, 2012 @ 4:04 pm

  4. While I have little problem with most of what Louis and others write here, there is one problem that David Thorstad unknowingly points out in his comment. He writes:

    Every citizen should be entitled to health care

    But what about the over 30 million persons living in the U.S. who are not “citizens”, including over 10 million who are considered “illegal” by the powers-that-be and by most of the settler-descended “citizen” population? How can the left come up with demands and slogans that don’t reinforce special privileges for “citizens” over non-“citizens”, or “legal” residents over “illegal” ones?

    Some slogans and demands that come to mind are “Health Care for All!” and “Health Care is a Human Right!“. Unfortunately, more specific suggestions like “Medicare for All!“, although not necessarily bad, do raise the problem of how undocumented persons, and even “legal” non-permanent residents, are going to be covered.

    Any ideas?

    Comment by Red Snapper — July 1, 2012 @ 5:50 pm

  5. A friend of mine was saying the other day that the act makes allowances for healthcare for homeless people. What provisions of the law outline such developments?

    Comment by Michael Hureaux Perez — July 1, 2012 @ 6:53 pm

  6. To expand on my previous comment:

    I won’t argue that demands that don’t immediately help undocumented residents are necessarily bad. However, we should never phrase any slogan or demand in a way that legitimizes discrimination against undocumented persons, or against non-“citizens” of the U.S.. Even if David meant the word ‘citizen’ (in “Every citizen should be entitled to health care”) in the informal, non-exclusionary sense that it had, e.g., in revolutionary France, it would not be taken that way in national-chauvinist “America”.

    Comment by Red Snapper — July 1, 2012 @ 9:42 pm

  7. PPACA should be called “The Pharmaceutical Profits and Astronomical Costs Act.”

    Comment by Tom the Printer — July 2, 2012 @ 2:15 am

  8. As a retiree one can get world class health care for a fraction of the price with so called medical tourism. Expect much more of this going into the future.

    Comment by purple — July 3, 2012 @ 7:09 am

  9. A technicality: Small population states (like Montana) that are “overrepresented” are not necessarily “rural”. A larger proportion of NY’s population is rural than Montana’s (even though Montana has no metro areas over 125,000 people).

    Also, Max Baucus is not a yahoo. He’s a bland corporate (?) lawyer, who started his stint in Congress 35 years ago as a vague liberal, and through continuous re-election, rose through the Senatorial ranks such that he became a key senior figure (such as on the Finance Committee), thus attracting all kinds of FIRE donations and lobbyist attention. Not a yahoo, just a corruptible mediocrity.

    Comment by ld (Montana raised) — July 3, 2012 @ 7:35 pm

  10. “overrepresented” in Congress, that is

    Comment by ld (Montana raised) — July 3, 2012 @ 7:36 pm

  11. er, in the SENATE (sorry).

    Comment by ld (Montana raised) — July 3, 2012 @ 7:37 pm

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