United States: `Clunker' healthcare bill protects private insurers, damages democracy

By Billy Wharton

March 24, 2010 -- Americans desperately need healthcare. The need is so desperate that many are buying into a “something is better than nothing” philosophy to support a healthcare bill that actively works against their own interests. The bill that US President Barack Obama plans to sign into law is being dubbed a “reform”, but actually amounts to a corporate restructuring that will solidify the reliance on the same private insurance companies that have caused the crisis in the nation’s healthcare system.

As single-payer heathcare activist Dr. Margaret Flowers stated, “The Democratic Party has now moved so far to the right that they have just passed a Republican health bill.” This is no surprise, private insurers and pharmaceutical companies have flooded the electoral system with money in order to guarantee their continued ability to accumulate profits.

[In the United States, "single-payer healthcare" refers to universal public health insurance schemes similar to Canada's scheme and Australia's Medicare.]

Junk healthcare plans and the race to the bottom

At nearly 2500 pages, the bill contains a myriad of loop holes that will allow insurance companies to continue nearly all of the immoral practices that have, according to a Harvard University study, resulted in more than 40,000 deaths per year due to treatable conditions. In fact, private insurers will now receive taxpayer funds to subsidise the sale of junk healthcare plans that the group Physicians for a National Health Program estimates will only cover 70% of people’s medical needs. This will likely spark a race-to-the-bottom as employers look to provide the minimum amount of coverage possible, insurers grab ever-increasing chunks of public money and people continue to face the prospect of soaring out-of-pocket costs, deep medical debts and death from treatable illnesses.

However, Americans have adjusted to profit-driven healthcare by avoiding it. A study by the Kaiser Family Foundation found that 6 out of 10 Americans had deferred or delayed what they understood as necessary medical treatment. To close this option, the healthcare bill lends the coercive power of government to private health insurers. For the first time in US history, citizens will be forced to purchase health insurance or face stiff annual fines. Such a mandate guarantees that millions of people will be herded into the new “health insurance exchanges”, an idea created by the right-wing Heritage Foundation, in order to fork over their money to private insurers. Estimates are that this will produce more than 20 million new customers for abusive insurance corporations such as Humana, Oxford and Aetna.

When corporations own democracy

The bill is a remarkably clear demonstration of the power of corporate money and influence in US politics. Health insurance corporations spent an average of US$600,000 a day in lobbying during the first six months of 2009. Lobbyists had a seat at the table during all parts of the writing, debate and approval of the bill. When single-payer advocates from the Physicians for a National Health Program and Healthcare-NOW attempted to participate in proceedings at the Senate Finance Committee, they were first denied a seat at the table and then arrested. All along, the insurance lobby followed the basic strategy they have employed since the 1990s – either prevent any reform or stick people with a bad reform. Welcome to the bad reform.

The fix was in from the beginning. This was clear as Democrats stumbled through “town hall meetings” during the summer of 2009. Most could not explain the details of the plan and relied on vague appeals to the obvious fact that people needed access to healthcare. Most Democrat legislators had already taken hefty campaign contributions from the insurance and pharmaceutical industries.

Meanwhile, the bill grew in size and in pro-corporate credentials. Republicans added more than 100 amendments, Democrats negotiated away any even vaguely progressive language and the insurance industry opened profit-rich loopholes. Along the way, Obama made anti-abortion pledges and immigrants were thrown out of the legislation. Gone was Obama’s campaign pledge to create “universal healthcare” it was replaced by the neoliberal slogan of “choice and competition”.

Democrats: For sale or lease

A few Democrats put up symbolic resistance. House Representative Anthony Weiner cashed-in politically by running a slick public relations campaign nominally in support of single-payer healthcare before fading back into line with Obama. Senator Bernie Sanders, an independent, tried the insider route, attempting to carve out provisions that would allow state-by-state single-payer systems and that would create a public option. This failed and Sanders withdrew, choosing to go-along-to-get-along.

Dennis Kucinich was held up as a “last honest man” figure. Kucinich has serious single-payer credentials and seemed fearless in his criticism of both the content and process of the bill. He correctly surmised that the bill "would put the government in the role of accelerating the privatization of health care” and voted No during the first round in the House of Representatives. Yet, as the clunky pro-corporate bill lumbered toward a final vote, Democratic Party leadership broke Kucinich, squeezing a "Yes" vote out of him, presumably by threatening to run a well-financed candidate against him in future elections. In a scene more reminiscent of an Orwellian dystopia, a defeated Kucinich held a press conference to describe why he was going to vote for a bill that he opposes.

Along the way, the Democrats received a wonderful political gift – the Tea Partiers. Both the conservative and liberal media focused in on tea-party demonstrations in order to craft them as the face of the opposition to the bill. A reactionary motley crew of racists, gun lovers and right-wing libertarian yahoos provided pro-corporate Democrats with the chance to appear as the rational defenders of the people. Single-payer advocates were unable to break this embargo despite a variety of tactics ranging from civil disobedience to letter writing. Ultimately, the Obama administration was able to present the struggle as one between healthcare “reformers” and far-right whackos looking to wreck his presidency. All this was done in the service of protecting the insurance companies from the serious critique offered by single-payer healthcare.

A medical `cash-for-clunkers'

The healthcare bill fits smoothly into the Obama administration’s now clearly established economic strategy. Unlike the Bush administration, which attempted to use jumbled down-home rhetoric to cover class war from above, Obama has created a grotesque form of lemon socialism disguised by the language of reform. Under lemon socialism, financial losses are laid on the public while private corporations retain the profits. Consider this bill as the healthcare version of "cash-for-clunkers". Public money that could be used for the social good will be sent to bankroll abusive, inefficient and anti-human private corporations. Just as with the bank bailout, the war economy and education policy. The administration speaks the language of reform, but enacts the policies of neoliberal privatisation, no matter what the cost to the public in terms of funds or lives.

There are simple lessons to be learned from all of this – the market and corporations have no role to play in either healthcare or politics. Insurance companies merely disrupt the relationship between doctors and patients. They add nothing to the healthcare system and suck off profits by limiting or denying access to care. These profits are then re-deployed in the political system to buy both Democratic and Republican politicians through a corrupting system of lobbying and campaign contributions. Now that the US Supreme Court has provided corporations with an unlimited ability to donate money to candidates, these trends are sure to increase.

Democracy or the rich?

Now is the time to put an end to this process. On healthcare, we need to re-build the single-payer movement, rooting it in poor and working-class communities, winning over our trade unions and growing into a mass movement whose demands can neither be denied nor ignored as utopian. Single-payer healthcare can open the door for a fully socialised medical system in which healthcare is finally recognised as a guaranteed human right.

Such a movement will be one part of a broader upsurge for democracy from below that seeks to address the fact that 5% of the population in the United States controls 85% of the wealth. As the reformer Justice Louis Brandeis once wrote, “We can have democracy in this country or we can have great wealth in the hands of a few, but we can’t have both.” We can accomplish this by voting for green and red candidates who support single-payer healthcare and in the streets by creating an uncompromising social movement that puts human needs first and aims to relegate the insurance companies, the banks and the multinationals to the position they so rightly deserve – the dustbin of history.

[Billy Wharton is a writer and activist whose articles have appeared in the Washington Post, Counterpunch, Common Dreams, Dissident Voice, the NYC Indypendent, Links International Journal of Socialist Renewal, Spectrezine and the Monthly Review Zine. He is co-chair of the Socialist Party (USA).]


By Physicians for a National Health Program

As much as we would like to join the celebration of the House's passage of the health bill last night, in good conscience we cannot.  We take no comfort in seeing aspirin dispensed for the treatment of cancer.

Instead of eliminating the root of the problem -- the profit-driven, private health insurance industry -- this costly new legislation will enrich and further entrench these firms.  The bill would require millions of Americans to buy private insurers' defective products, and turn over to them vast amounts of public money.

The hype surrounding the new health bill is belied by the facts:

  • About 23 million people will remain uninsured nine years out.  That figure translates into an estimated 23,000 unnecessary deaths annually and an incalculable toll of suffering.

  • Millions of middle-income people will be pressured to buy commercial health insurance policies costing up to 9.5 percent of their income but covering an average of only 70 percent of their medical expenses, potentially leaving them vulnerable to financial ruin if they become seriously ill.  Many will find such policies too expensive to afford or, if they do buy them, too expensive to use because of the high co-pays and deductibles.

  • Insurance firms will be handed at least $447 billion in taxpayer money to subsidize the purchase of their shoddy products.  This money will enhance their financial and political power, and with it their ability to block future reform.

  • The bill will drain about $40 billion from Medicare payments to safety-net hospitals, threatening the care of the tens of millions who will remain uninsured.

  • People with employer-based coverage will be locked into their plan's limited network of providers, face ever-rising costs and erosion of their health benefits.  Many, even most, will eventually face steep taxes on their benefits as the cost of insurance grows.

  • Health care costs will continue to skyrocket, as the experience with the Massachusetts plan (after which this bill is patterned) amply demonstrates.

  • The much-vaunted insurance regulations -- e.g. ending denials on the basis of pre-existing conditions -- are riddled with loopholes, thanks to the central role that insurers played in crafting the legislation.  Older people can be charged up to three times more than their younger counterparts, and large companies with a predominantly female workforce can be charged higher gender-based rates at least until 2017.

  • Women's reproductive rights will be further eroded, thanks to the burdensome segregation of insurance funds for abortion and for all other medical services.

It didn't have to be like this.  Whatever salutary measures are contained in this bill, e.g. additional funding for community health centers, could have been enacted on a stand-alone basis.

Similarly, the expansion of Medicaid -- a woefully underfunded program that provides substandard care for the poor -- could have been done separately, along with an increase in federal appropriations to upgrade its quality.

But instead the Congress and the Obama administration have saddled Americans with an expensive package of onerous individual mandates, new taxes on workers' health plans, countless sweetheart deals with the insurers and Big Pharma, and a perpetuation of the fragmented, dysfunctional, and unsustainable system that is taking such a heavy toll on our health and economy today.

This bill's passage reflects political considerations, not sound health policy. As physicians, we cannot accept this inversion of priorities.  We seek evidence-based remedies that will truly help our patients, not placebos.

A genuine remedy is in plain sight.  Sooner rather than later, our nation will have to adopt a single-payer national health insurance program, an improved Medicare for all.  Only a single-payer plan can assure truly universal, comprehensive and affordable care to all.

By replacing the private insurers with a streamlined system of public financing, our nation could save $400 billion annually in unnecessary, wasteful administrative costs.  That's enough to cover all the uninsured and to upgrade everyone else's coverage without having to increase overall U.S. health spending by one penny.

Moreover, only a single-payer system offers effective tools for cost control like bulk purchasing, negotiated fees, global hospital budgeting and capital planning.

Polls show nearly two-thirds of the public supports such an approach, and a recent survey shows 59 percent of U.S. physicians support government action to establish national health insurance.  All that is required to achieve it is the political will.

The major provisions of the present bill do not go into effect until 2014.  Although we will be counseled to "wait and see" how this reform plays out, we cannot wait, nor can our patients.  The stakes are too high.

We pledge to continue our work for the only equitable, financially responsible and humane remedy for our health care mess: single-payer national health insurance, an expanded and improved Medicare for All.

Oliver Fein, M.D.

Garrett Adams, M.D.

Claudia Fegan, M.D.
Past President

Margaret Flowers, M.D.
Congressional Fellow   

David Himmelstein, M.D.

Steffie Woolhandler, M.D.

Quentin Young, M.D.
National Coordinator

Don McCanne, M.D.
Senior Health Policy Fellow

Physicians for a National Health Program is an organization of 17,000 doctors who support single-payer national health insurance. To speak with a physician/spokesperson in your area, visit www.pnhp.org/stateactions.


In the US, "single-payer" is generally used to refer to a nationalized health *insurance* system (the most popular example is Canada), rather than a more comprehensive system of nationalized health*care* (a la NHS). The former is a popular proposal (and not just among the Left) while the latter is exceedingly marginal (even among the Left).


Havana. March 25, 2010

Reflections of Fidel
Health reform in the United States
(Taken from CubaDebate)

BARACK Obama is a fanatical believer in the imperialist capitalist system
imposed by the United States on the world. "God bless the United States," he
ends his speeches.

Some of his acts wounded the sensibility of world opinion, which viewed with
sympathy the African-American candidate’s victory over that country’s
extreme right-wing candidate. Basing himself on one of the worst economic
crises that the world has ever seen, and the pain caused by young Americans
who lost their lives or were injured or mutilated in his predecessor’s
genocidal wars of conquest, he won the votes of the majority of 50% of
Americans who deign to go to the polls in that democratic country.

Out of an elemental sense of ethics, Obama should have abstained from
accepting the Nobel Peace Prize when he had already decided to send 40,000
soldiers to an absurd war in the heart of Asia.

The current administration’s militarist policies, its plunder of natural
resources and unequal exchange with the poor countries of the Third World
are in no way different from those of its predecessors, almost all of them
extremely right-wing, with some exceptions, throughout the past century.

The anti-democratic document imposed at the Copenhagen Summit on the
international community – which had given credit to his promise to cooperate
in the fight against climate change – was another act that disappointed many
people in the world. The United States, the largest issuer of greenhouse
gases, was not willing to make the necessary sacrifices, despite the sweet
words of its president beforehand.

It would be interminable to list the contradictions between the ideas which
the Cuban nation has defended at great sacrifice for half a century and the
egotistic policies of that colossal empire.

In spite of that, we harbor no antagonism toward Obama, much less toward the
U.S. people. We believe that the health reform has been an important battle,
and a success of his government. It would seem, however, to be something
truly unusual, 234 years after the Declaration of Independence in
Philadelphia in 1776, inspired by the ideas of the French encyclopedists,
that the U.S. government has passed [a law for] medical attention for the
vast majority of its citizens, something that Cuba achieved for its entire
population half a century ago, despite the cruel and inhumane blockade
imposed and still in effect by the most powerful country that ever existed.
Before that, after almost half a century of independence and after a bloody
war, Abraham Lincoln was able to attain legal freedom for slaves.

On the other hand, I cannot stop thinking about a world in which more than
one-third of the population lacks the medical attention and medicines
essential to ensuring its health, a situation that will be aggravated as
climate change and water and food scarcity become increasingly greater in a
globalized world where the population is growing, forests are disappearing,
agricultural land is diminishing, the air is becoming unbreathable, and in
which the human species that inhabits it – which emerged less than 200,000
years ago; in other words, 3.5 million years after the first forms of life
emerged on the planet – is running a real risk of disappearing as a species.

Accepting that health reform signifies a success for the Obama government,
the current U.S. president cannot ignore that climate change is a threat to
health, and even worse, to the very existence of all the world’s nations,
when the increase in temperatures – beyond the critical limits that are in
sight – is melting the frozen waters of the glaciers, and the tens of
millions of cubic kilometers stored in the enormous ice caps accumulated in
the Antarctic, Greenland and Siberia will have melted within a few dozen
years, leaving underwater all of the world’s port facilities and the lands
where a large part of the global population now lives, feeds itself and

Obama, the leaders of the free countries and their allies, their scientists
and their sophisticated research centers know this; it is impossible for
them not to know it.

I understand the satisfaction in the presidential speech expressing and
recognizing the contributions of the congress members and administration who
made possible the miracle of health reform, which strengthens the
government’s position vis-à-vis the lobbyists and political mercenaries who
are limiting the administration’s faculties. It would be worse if those who
engaged in torture, assassinations for hire, and genocide should reoccupy
the U.S. government. As a person who is unquestionably intelligent and
sufficiently well-informed, Obama knows that there is no exaggeration in my
words. I hope that the silly remarks he sometimes makes about Cuba are not
clouding his intelligence.

In the wake of the success in this battle for the right to health of all
Americans, 12 million immigrants, in their immense majority Latin American,
Haitian and from other Caribbean countries, are demanding the legalization
of their presence in the United States, where they do the jobs that are the
hardest and with which U.S. society could not do without, in a country in
which they are arrested, separated from their families and sent back to
their countries.

The vast majority of them immigrated to Northern America as a consequence of
the dictatorships imposed on the countries of the region by the United
States, and the brutal policy to which they have been subjected as a result
of the plunder of their resources and unequal trade. Their family
remittances constitute a large percentage of the GDP of their economies.
They are now hoping for an act of elemental justice. When an Adjustment Act
was imposed on the Cuban people, promoting brain drain and the dispossession
of its educated young people, why are such brutal methods used against
illegal immigrants of Latin American and Caribbean countries?

The devastating earthquake that lashed Haiti – the poorest country in Latin
America, which has just suffered an unprecedented natural disaster that
involved the death of more than 200,000 people – and the terrible economic
damage that a similar phenomenon has caused in Chile, are eloquent evidence
of the dangers that threaten so-called civilization, and the need for
drastic measures that can give the human species hope for survival.

The Cold War did not bring any benefits to the world population. The immense
economic, technological and scientific power of the United States would not
be able to survive the tragedy that is hovering over the planet. President
Obama should look for the pertinent data on his computer and converse with
his most eminent scientists; he will see how far his country is from being
the model for humanity he extols.

Because he is an African American, there he suffered the affronts of
discrimination, as he relates in his book, The Dreams of My Father; there he
knew about the poverty in which tens of millions of Americans live; there he
was educated, but there he also enjoyed, as a successful professional, the
privileges of the rich middle class, and he ended up idealizing the social
system where the economic crisis, the uselessly sacrificed lives of
Americans and his unquestionable political talent gave him the electoral

Despite that, the most recalcitrant right-wing forces see Obama as an
extremist, and are threatening him by continuing to do battle in the Senate
to neutralize the effects of the health reform, and openly sabotaging him in
various states of the Union, declaring the new law unconstitutional.

The problems of our era are far more serious still.

The International Monetary Fund, the World Bank and other international
credit agencies, under the strict control of the United States, are allowing
the large U.S. banks – the creators of fiscal paradises and responsible for
the financial chaos on the planet – to be kept afloat by the government of
that country in each one of the system’s frequent and growing crises.

The U.S. Federal Reserve issues at its whim the convertible currency that
pays for the wars of conquest, the profits of the military industrial
complex, the military bases distributed throughout the world and the large
investments with which transnationals control the economy in many countries
in the world. Nixon unilaterally suspended the conversion of the dollar into
gold, while the vaults of the banks in New York hold seven thousand tons of
gold, something more than 25% of the world’s reserves of this metal, a
figure which at the end of World War II stood at more than 80%. It is argued
that the [U.S.] public debt exceeds $10 trillion, more than 70% of its GDP,
like a burden that will be passed on to the new generations. That is
affirmed when, in reality, it is the world economy which is paying for that
debt with the huge spending on goods and services that it provides to
acquire U.S. dollars, with which the large transnationals of that country
have taken over a considerable part of the world’s wealth, and which sustain
that nation’s consumer society.

Anyone can understand that such a system is unsustainable and why the
wealthiest sectors in the United States and its allies in the world defend a
system sustained only on ignorance, lies and conditioned reflexes sown in
world public opinion via a monopoly of the mass media, including the
principal Internet networks.

Today, the structure is collapsing in the face of the accelerated advance of
climate change and its disastrous consequences, which are placing humanity
in an exceptional dilemma.

Wars among the powers no longer seem to be the possible solution to major
contradictions, as they were until the second half of the 20th century; but,
in their turn, they have impinged on the factors that make human survival
possible to the extent that they could bring the existence of the current
intelligent species inhabiting our planet to a premature end.

A few days ago, I expressed my conviction, in the light of dominant
scientific knowledge today, that human beings have to solve their problems
on planet Earth, given that they will never be able to cover the distance
that separates the Sun from the closest star, located four light years
distant, a speed that is equivalent to 300,000 kilometers per second – if
there should be a planet similar to our beautiful Earth in the vicinity of
that sun.

The United States is investing fabulous sums to discover if there is water
on the planet Mars, and whether some elemental form of life existed or
exists there. Nobody knows why, unless it is out of pure scientific
curiosity. Millions of species are disappearing at an increasing rate on our
planet and its fabulous volumes of water are constantly being poisoned.

The new laws of science – based on Einstein’s theories on energy and matter
and the Big Boom theory as the origin of the millions of constellations and
infinite stars or other hypotheses – have given way to profound changes in
fundamental concepts such as space and time, which are occupying
theologians’ attention and analyses. One of them, our Brazilian friend Frei
Betto, approaches the issue in his book La obra del artista: una vision
holística del Universe (The Artist’s Work: a Holistic View of the Universe),
launched at the last International Book Fair in Havana.

Scientific advances in the last 100 years have impacted on traditional
approaches that prevailed for thousands of years in the social sciences and
even in philosophy and theology.

The interest that the most honest thinkers are taking in that new knowledge
is notable, but we know absolutely nothing of President Obama’s thinking on
the compatibility of consumer societies with science.

Meanwhile, it is worthwhile, now and then, to devote time to meditating on
those issues. Certainly human beings will not cease to dream and take things
with the due serenity and nerves of steel on that account. It is a duty – at
least for those who chose the political profession and the noble and
essential resolve of a human society of solidarity and justice.

Fidel Castro Ruz
March 24, 2010
6:40 p.m.

I submitted this March 24 to the Marxism List, where most of the errors I see were very prevalent. It received mixed reviews, which represented progress in my opinion.

I want to express my satisfaction that as far as I can tell the socialist organization I belong to, Solidarity, did not fall into the trap of CAMPAIGNING for the DEFEAT of the bill. We make a lot of mistakes, but we apparently didn't fall for this one.
Fred Feldman

I think the very small and basically powerless far left in the United States went way off the deep end in calling for the defeat of the health care bill.

The basic argument is that it still leaves the insurance industry and pharmaceutical industry in the catbird seat, which is true. In fact, it is quite clear that today, in the existing relationship of class forces, no bill could have passed that did not do that.

In calling for DEFEAT of the bill, they demanded that Congress vote down:
(a) barring immediately denying children insurance because of pre-existing or other illness ((b) barring all other such denials within two years (3) adding 16 million people to Medicaid eligibility; (d) extending fanily health care for sons and daughters to the age of 26 (previously ended at 19); (e) taking millions of people out of the category of uninsured, with the availability of government aid. And a number of other like things

How can we call for DEFEATING THIS when we today have absolutely no viable alternative that is politically possible at this time. And in calling for defeating it, we effectively relied on the ultrarightist (these days) Republican Party and the right-wing Democrats to win our "victory" for us. Our political influence is of course nil. It's a version of Alexander Cockburn's left-right alliance politics, in my opinion.

The ISO's Socialist Worker says you can't solve the medical crisis without taking the profits from the insurance companies and big pharma. True enough, but does anyone imagine that abolishing or defeating the insurance companies and pharmaceutical companies was on the agenda in 2010? Not even single payer was possible in this period, and that would not make medical care anywhere near totally nonprofit.

Medicare, by the way, demands both big premiums and leaves people with sizable doctor bills.

Why should we stand for denying millions of people things they actually need right now, under today's class struggle circumstances, because we know a better way.

We insist on single payer or even socialism now and demand that anything less be REJECTED in a practical alliance with rightists who want to abolish all public health services, and who think that medical care is a privilege that must be earned making enough money to pay your own way. And we demand all or nothing at a time when the labor movement is prostrate, the women's and Black movements passive, and the immigrants trying to fight their way out of a legally tightening pariah position. This seems nuts to me.

And it gets into the implausible position of effectively arguing that the Tea Partiers and right-wing Democrats, what ever they may have been wrong about, voted RIGHT, while all the liberal Democrats simply and purely voted WRONG.

We seem to imagine that the defeat of this bill would have stimulated a huge increase in support for single payer, mobilizations, etc.-- kind of After the Tea Partiers, Us. On the contrary, the only political beneficiary would have been the right, and their arguments would have become even more the official mainstream than they are today. The confusion and depression among working people would have been deepened, not relieved.

I am not saying we should have supported it. We have no members of congress.
We have no mass political influence. We could have objectively reported what was positive and negative and argued for what we support -- single-payer or better -- without starting to sound like Left Wing tea-partiers. (This JUST makes things worse! It's the end of the health care for working people♦!)

Of course, there are gravely bad and negative things (above all, in my opinion, the exclusion from its provisions of all immigrants and elective abortions for women, in the legislation and we should explain them, but I think unhysterically is best. Trying to DEFEAT it was a mistake and a potentially discrediting one (although at this point our relative obscurity may serve as our best defense).

A lot of scapegoating of liberal Democratic Rep.Dennis Kucinich, who had opposed the measure for a time because of its inadequacies and general corporate orientation♦. Actually, once his efforts to improve the bill had failed, he had no choice but to cross over and Obama's appeal just built him a bridge for a dignified exit. He could not have survived helping to defeat this bill in alliance with the far right. I've never been a huge fan of Kucinich but frankly the description of his vote as a great betrayal sounds like more left-wing hype to me.

The new law is not an insuperable obstacle to the fight for single payer.- The main obstacle to winning single payer all is not legislation or even institutions but the relationship of class forces -- the demobilization and depression among the social forces who have an interest in single payer. I'm relieved there was enough sentiment and mobilization to soften some of the worst aspects of the bill and keep in some of the better stuff.

But positive changes in the class struggle will create new openings despite the institutional obstacles including this legislation.

Part of this is the far left view that the ruling class is kind of plotting to make life unlivable in the United States, or as Louis Proyect put it on the Marxism list, to reduce the masses in the US to the condition of "China or some other third world country." I would first point out that some third world countries are moving in the opposite direction of the United States in cultural, economic, and social areas -- upward and not downward. There are many indications that, warts and all, China belongs in this category.

But more importantly, the rulers have every intention for the United States to stay imperialist and for wide layers of Americans to stay privileged relative to other peoples and to remain a base of support for US imperialism. This plan may go awry if another financial-industrial-trade crisis hits but they do not "plan" the opposite.

One underlying motivation of this reform legislation, with all its anti-working-class aspects, is to retain a substantial degree of popular support or acceptance for the increasingly complex network of wars and interventions and conflicts with other countries that US imperialism is carrying out.

A total collapse of US health and living standards will not further that project, so I think Obama and the imperialist ruling class he represents would like to prevent it. That is one of the functions of this legislation.
Fred Feldman


Thank you for your comments. I respect and consider them carefully since they come from a member of Solidarity, an American socialist group that is conducting important work among our class.

I would make three points in defense of my position:

1 - As I mentioned in the article the healthcare bill fits into the larger pattern of the Obama administration's economic strategy. I see this strategy as pretty solidly neoliberal. The bank bailout and cash-for-clunkers being other concrete examples of corporations converting public funds into a resource to ride out the economic crisis. In this edition, the administration skillfully built a center-left coalition that was beholden to the right. Much closer to the left-right alliance Cockburn describes. Presenting a left pole in opposition to this formation while also attempting to build concrete power in poor and working class communities is necessary. I think the socialist left in the US should be working on this task together. If we support this bill how do we then dissent from the proposed changes in education? Or, the attack on Social Security? Or, the further trimming of Medicare? Obama is certain to build center-left coalitions around right-wing demands to accomplish such damaging work.

2 - Most serious left-wing groups have worked in alliance with single-payer advocates. While many left parties have wavered on this issue as Bill was certain to pass, preferring either silence or go-along-to-get-along, our single-payer partners have not. They have staunchly contested the bill as it went through Congress and have attempted to either modify or derail it on several occasions. To abandon groups such as Healthcare NOW and PNHP now seems quite opportunistic.

3 - I, among others, believe that this bill will do little, perhaps even nothing, to stem the tide of the collapse of healthcare in the US. I will spare you the details - no caps on skyrocketing costs, weak fine on pre-existing conditions, junk plans, mandates that millions will pay instead of paying for premiums, shifting the financial burden onto state Medicaid systems. Why support a bill that empowers the institutions - private insurers and big pharma - we are attempting to combat? To score public relations points? To seem like we are on the "progressive" side of the debate? Further, why let the tea-baggers monopolize opposition?

4 - Finally, Comrade Castro's comments offer an interesting dilemma for the left - the distance between internal actors in a nation and external observers. This speaks to the need for great international communication and, if not a formal "International" then some space for consultation between left parties. Immanuel Wallerstein has a wonderful article that looks at Brazil from this inside/outside perspective. Here is the link. Recommended reading:

Thank you again Fred for your insightful comments. This is a discussion that the American left needs to be having in order to prepare for the coming struggles.

Billy Wharton



Dear Healthcare-NOW! Supporter:

While many celebrate the passage of the health bill, Healthcare-NOW! remains committed to building the movement for the healthcare we need in an expanded and improved Medicare-for-all system.

The new health bill closely resembles the legislation written by Liz Fowler, former Vice President of Public Policy for Well Point, one of the nation's largest health insurance companies, as she served as Senator Max Baucus' chief Health Aid in 2009. Unfortunately, this bill tweaks the same failing non-system of healthcare in the United States and further entrenches the for-profit private health insurance, drug, and hospital industries diverting to them the resources needed to achieve high quality, universal, comprehensive healthcare.

While some of the holes in the barrel have been plugged, the same problems that we currently face in the nation's healthcare crisis will persist: huge numbers of uninsured people, denials of needed care, deaths due to lack of care, bankruptcies by those who have insurance due to inadequate coverage, and the waste of a third of our healthcare dollars on things other than healthcare to prop up the private health insurance, pharmaceutical and hospital industry.

Let's look to the social movements of our nation's history to remember what we must do to keep fighting. We are building a movement for the healthcare we need based on equality and fairness. Fire doesn't burn from the top down, but from the bottom up. We do not have to negotiate or compromise, but rather create a movement that is confident, educated, and action-oriented that is ready to do the hard work of advocating for the needs of our people to be met and getting others to join us.

Many folks who share the same principles of the national single-payer movement have identified the public option as a worthy goal to fight for in a path to universal healthcare, and we admire the courage and tenacity with which that campaign was led. We hope that those who supported the public option will join with us to build a renewed movement for truly universal, publicly funded healthcare. A movement that learns from the past and doesn't start out by negotiating against itself or allowing our less than visionary politicians to define our agenda. The enemies of our ideas are the same, and they will fight us just the same. Let's go to battle for what we truly want and need.

To join the movement and hear about next steps, consider becoming a Healthcare-NOW! member today!

For a our full statement, please click here.

For Medicare for All,
Healthcare-NOW! National Staff and Steering Committee

Despite having access to the technology to help alleviate global problems like starvation and famine, world governments haven’t found a cost efficient way to work together to solve them. Although wealthier nations do send aid throughout the world it’s still difficult to ensure that the people who are suffering actually receive the help they need. Corruption is prevalent throughout the world and to some degree even in developed western nations.

So the fact we can’t get a health bill reform right is no surprise.