USA: The case for socialised medicine

THE FOLLOWING articles appear in Justice, the newspaper of Socialist Alternative -the Socialist Party's counterpart in the USA. They address the debate in that country over the lack of affordable healthcare and argue that the current failing system is the consequence of a health system geared to the profits of big business.

THE MOST refreshing aspect of Michael Moore's new movie Sicko is the direct, clear way it tackles the root cause of our healthcare crisis: big corporations, whose sole concern is profit, that run our healthcare system and it's making us sick!

Ty Moore, Socialist Alternative, USA

But perhaps more important, Sicko also makes a powerful case for an alternative, free, single-payer universal healthcare system, removing the profit motive.

The movie debunks the fear whipped up against "socialised medicine" by showing the vastly superior and cheaper national health services in Canada, Europe, and Cuba, where powerful workers' and socialist movements in the post-world war two decades established free or cheap, publicly-run universal healthcare systems.

(However, these systems are now being undermined by western governments applying a 'neo-liberal' agenda to public services, in some cases opening them up to private-profit companies to exploit. - editors)

The case for a free, high-quality national health service in the USA is absolutely clear. The United States spends twice as much on healthcare compared to any other advanced industrialised country yet 47 million Americans are without health insurance. For those fortunate enough to have coverage, they are slowly being crushed beneath exorbitant monthly premiums. For all this Americans have a lower life expectancy and higher infant mortality rates than any other advanced industrialised country.

The US healthcare system is a monumental testament to the lies of pro-capitalist ideologues who preach that private industry is more efficient than publicly-run programmes.

A major study by researchers at Harvard Medical School and Public Citizen in 2004 found that bureaucratic overheads account for 31% of US healthcare costs, compared to 16.7% in Canada.

The study estimated that under a US national health insurance system $286 billion annually could be saved in administrative costs alone. Just half these savings, $133 billion, would be enough to cover all the uninsured and all out-of-pocket prescription drug costs.

Similarly, the huge pharmaceutical companies play an extremely parasitical role. In 1997 Clinton's Food and Drug Administration allowed pharmaceutical companies to market drugs directly to consumers for the first time, bypassing physicians.

Such advertising increased five-fold in the following seven years to $4 billion in 2004, filling the airwaves with ads urging patients to pop away their problems with the latest brightly-colored pill.

Profit rates

In the last decade, the profit rates of 'big-pharma' dramatically expanded, making the industry among the most lucrative and powerful. The top three drug companies alone made over $30 billion profit in 2006.

Rather than squandering billions on advertising, or producing copy-cat versions of relatively trivial but profitable drugs like cold medicines, we could use these giant companies' resources to address pressing medical problems such as HIV/AIDS, cancer, and diabetes.

The HMOs, (health maintenance organisations) insurance, pharmaceutical, and other healthcare companies should be taken into public ownership to eliminate the profit motive from all aspects of healthcare and establish a publicly-owned, democratically-controlled, integrated healthcare system providing a free quality service to all.

Under such a system, patients and health professionals could make medical decisions based on patients' needs, not wealthy shareholders' profits. With payment for healthcare guaranteed by the government, workers would not be pushed to take certain jobs or intimidated from organising in their workplace for fear of losing their health benefits.

A national system also frees spouses and children from dependence on "primary breadwinners", whereas employer-based insurance reinforces sexism and discrimination against same-sex couples.

For a publicly owned health system to be run efficiently and justly, it needs to be democratically controlled and managed at the local and national levels by elected representatives of healthcare workers and the general public, not appointed government bureaucrats.

'Universal healthcare' plans of the Democrats fall short

WITH HEALTHCARE costs at an all-time high and one-in-five non-elderly Americans uninsured, 'universal healthcare' is a top promise of all the serious Democratic presidential hopefuls.

Dani Indovino, Socialist Alternative, USA

While calling for a universal healthcare system, the leading Democratic candidates are however actually advocating no more than a reorganisation of the current privatised system. Barack Obama's widely-discussed scheme, for example, calls for the currently uninsured to buy into a federally-offered private plan akin to what members of Congress already get.

This programme, while often low-cost to the poorest families, would discourage employer-based healthcare, only mandating they pay marginally higher taxes if they don't insure their employees. The Clinton plan is quite similar.

Obama also focuses on cutting current healthcare costs in hope that the savings will lower costs for working people. However, his fix of computerising medical records and streamlining claims procedures will mainly increase the profits of insurance companies. With no control on their profit margins, it is unlikely that health insurance costs would decrease at all.

The plans heralded by Democratic hopefuls will not take away the authority of insurance companies to decide what healthcare you receive. Many insured people are unable to get the procedures they need because of cost-cutting restrictions put on coverage by the insurance companies.

Before the release of Sicko, Michael Moore said of the Democrats: "They don't seem to want to grapple with the real issue. It's very sad. Even the well-intentioned people like John Edwards - his plan seems to be to take our tax dollars and put them into the pockets of the private insurance industry." (Sicko production notes).

Finally, there is no guarantee that Democrats can deliver even these paltry plans. History shows that campaign promises are nothing more than words. Bill and Hillary Clinton rode to office in 1992 on the promise of a new healthcare plan and, despite a Democratic-controlled Congress between 1992 and 1994, failed to deliver. The Democratic White House and Congress caved in to the crushing pressure of insurance companies.

For every member of Congress, there are four lobbyists from the healthcare industry in Washington DC. The leading politicians from both parties are effectively indentured to the industry through campaign contributions.

In this context, no policy that challenges the profits of the insurance companies or the HMOs is likely to be proposed by any serious contender in the Democratic primaries. Working people will need to look to our own strength and independent political mobilisations to win the kind of free national healthcare system we need.

End the rule of profit... we need a socialist economy!

THE BASIC goal of the capitalist owners of health insurance companies is no different from the goals of General Motors, Nike, or Texaco. Their aim is not to provide medical care, cars, shoes, or gas stations. Instead, to survive under capitalism, corporations must completely fixate on their profit margin at the expense of workers, consumers, and the environment.

If it makes sense to take the profit motive out of the healthcare industry and put it under public, democratic ownership and control, then why not the big oil and car companies who are blocking the transition to a renewable energy economy and fully developed mass transit systems?

Why not take big agribusiness into public democratic control to ensure safe food, sustainable farming methods, and an end to the malnutrition and hunger which affects one in four US children?

Is there any major company where workers could not elect management teams and cooperatively decide production priorities, investment, and wage scales? Socialists argue that we should take the top 500 US corporations and put them under democratic workers' control and management.

Public ownership of the 'commanding heights' of the US economy would allow, for the first time, real democratic control over the direction of our society. Instead of the profit-driven anarchy of the market, democratic economic planning and resource distribution would allow us to end class divisions, poverty, homelessness, unemployment, and much more.

The US is the richest nation in history. There is plenty of wealth to solve our pressing social problems. But until working people own and democratically control the goods and services we produce, the capitalist elite will continue to direct society toward their narrow interests.

Let's fight for a free, quality national health service, linking that campaign to the wider struggle for genuine democratic socialism.

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In The Socialist 19 July 2007:

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