By JOHN LESLIE
As Socialist Action goes to press, the health-care debate in Washington is on hold. The GOP plan, which was hatched in secret in a Senate back room, is wildly unpopular. Yet the Republicans seem intent on passing something that will give the appearance that Trump kept his campaign promise to “repeal and replace Obamacare”—no matter the consequences for working people.
Democrats posture as advocates for the people, but their rhetoric won’t pass the test. The “alternative” they put forward is the continuation of Obama’s neoliberal health-care reform, the Affordable Care Act. Regardless, the health and well-being of working people is in the crosshairs.
The new GOP health plan has stalled in the face of massive opposition, including skepticism among some Republican lawmakers. The stalemate on Trumpcare culminated in the Senate’s going on recess for the July 4 holiday without any forward motion. Frustrated with Senate inaction, Trump tweeted, “If Republican Senators are unable to pass what they are working on now, they should immediately REPEAL, and then REPLACE at a later date!” This contradicts his earlier promises that there would be “insurance for everybody.”
A couple of weeks before the inauguration, on Jan. 3, Trump spokesperson Kellyanne Conway promised that there would be a replacement plan, saying, “We don’t want anyone who currently has insurance to not have insurance.” This “repeal now, fix later” notion has gained some support among Republicans.
The differences among GOP lawmakers are split between those on the hard right, who argue that the bill is too much like the Affordable Care Act, and more moderate forces, who worry that the bill will place too great of a burden on states, as well as cutting coverage for at least 22 million people currently covered under the ACA.
The proposed law also includes a massive tax cut for the rich, meaning that the cost of Trumpcare will be balanced on the backs of workers and the most vulnerable. Federal subsidies for coverage would be reduced by $424 billion.
Under the new law, premiums would increase significantly, especially for older people. Insurers could charge older people five times as much as younger people for coverage. The bill also eliminates the individual mandate included in the ACA and also the mandate that companies with more than 50 employees provide insurance.
The measure under consideration includes deep cuts to Medicaid and will leave millions without coverage. Medicaid expansion would be ended and funding slashed. Funding for Planned Parenthood also faces elimination.
Some 80 million people depend on Medicaid for their health care. Of these, 31 million are children, 19 million are adults, (mostly low-income wage earners), 9 million are people with disabilities, and 5 million are senior citizens. Medicaid is the largest single health insurer in the United States.
The ACA is only marginally better than Trumpcare. The ACA keeps for-profit insurance companies at the center of the medical care system. The ACA system is based on a sliding scale of cost tiers referred to as the metal plans—bronze, silver, gold and platinum—in which the costs are managed through differing plans based on varying premiums and out-of-pocket expenses.
For example, the “bronze” plan has lower premiums and higher co-pays while the “gold” plan has higher premiums but offers more coverage options and lower out-of-pocket expenses. Lower-income workers are more likely to choose a plan with a lower premium, but their out-of-pocket expenses can be prohibitive if a health crisis occurs.
Premiums continue to rise, with a projected 24% increase in 2017 and health care costs continuing to rise across the board. The massive overhead due to administrative costs of private, for-profit, insurance companies continues to contribute to the high cost of health care.
Obamacare amounts to neoliberal health care designed to cut across any movement towards single-payer health care. Candidate Obama had been in favor of single payer, but changed his perspective after receiving millions of dollars in contributions from the insurance industry.
The aspects of the ACA that are progressive, such as extending coverage for children until the age of 26, coverage for pre-existing conditions, and those provisions protecting women’s reproductive health, should be defended. As we build a movement for universal health care, we should make it clear that the price for cutting Medicaid and Medicare will be high for politicians of both capitalist parties.
As the health-care debate rages, socialists should try to redefine the terms of that debate. First, we believe that quality, affordable, health care is a basic human right. We also believe that the profit motive must be removed from the health-care system. The political influence of health-care corporations, private insurance companies, and pharmaceutical giants is an obstacle to basic human needs.
Republicans excoriate Democrats for saying that the new bill, especially cuts to Medicaid, will result in people dying, but this is undoubtedly true. People will die, but the GOP doesn’t care as long as their rich paymasters get tax breaks. However, the Democrats have proven that they are not allies in the struggle for a just health-care system. Recently, in California, the Democrats scuttled an attempt to pass a statewide single-payer bill in the state. Democratic leaders, including Speaker Nancy Pelosi, have made it clear that single payer is not going to be part of the discussion.
Winning a real alternative to both the ACA and Trumpcare will require building an independent mass movement based in the unions and organizations of youth, oppressed nationalities, and women. Healthcare workers, including doctors, who are increasingly wage earners and not single practitioners, are natural allies in this struggle.
We must fight uncompromisingly against cuts to current programs as we struggle for a single-payer health plan. Single payer should be seen as transitional towards a national health system that places the health-care infrastructure under public ownership. A socialist contribution to the health-care debate must include the clear demand that health care in the U.S. include full prescription, vision, mental health, and dental coverage.
Cuba’s health system shows what is possible
Capitalist politicians, both liberal and conservative, argue that taking the profit out of health care stifles innovation. The staggering number of vaccines, cancer treatments, and other medical breakthroughs made by the Cuban health-care system stands as a sharp repudiation of the assertion that a profit-driven system is best for patients and providers.
Working under conditions of scarcity, and under siege by U.S. imperialism, the Cubans have managed to build a system of medical care unlike any other. The Cuban people don’t have to worry if they will be able to afford a doctor or vital medicines. Medical school is free, unlike the U.S., where doctors often graduate with a huge student debt.
In Cuba, the emphasis is on preventative care, with doctors and nurses working in neighborhoods and workplaces. Cuba’s infant mortality rate is lower than in the U.S. and ranks as one of the lowest worldwide. Life expectancy is 78, among the highest in the Americas.
The Cuban government has famously sent medical aid, including doctors, to war-torn regions and to the care for the victims of natural disasters. Thousands of Cuban doctors and other medical personnel are currently in Africa, Latin America, Asia, and the Caribbean.
Imagine what benefits there would be to the world if this model of internationalism and concern for human need over greed were applied in the U.S.
Photo : Protesters in Elizabethtown, Ky., on June 30 greet arrival of Republican Senator Mitch McConnell, a proponent of the new health-care bill. Timothy D. Easley / AP