Health Care Hokum and U.S. Political Culture

Could United States political culture be any more degraded? According to leading presidential candidates of the Republican Party, the Democrats are advocating dangerous “socialized medicine” and “government-run health care” when they call for universal health insurance in the U.S. George W. Bush and other leading Republican politicians have used the same (supposedly terrible) terms to justify their Dickensian opposition to Congressional legislation that would expand a state-federal children’s health insurance program (the so-called SCHIP system). 


Never mind that the John Edwards/ Barack Obama/Hillary Clinton health care plan would seek to strengthen employer-provided health benefits and could generate new markets for private policies purchased on an individual basis. The Edwards (et al.) plan would create a Medicare-like government option to compete with—not replace—private insurance companies. This might lead to a socialized health insurance some day if everybody were to choose government insurance—unlikely, given (among other things) the Democrats’ failure to advocate exploiting public sector economies of scale by opening the existing 43 million-strong Medicare program to anyone who prefers government over private insurance. 


But even a fully government-funded Medicare-style/ single-payer health insurance plan would not be “socialized medicine.” Fully “socialized medicine” happens when doctors, nurses, and other medical staff are employed by the government and when drugs, medical technology, and other basic medical means and materials are provided by the public sector. Nobody in the Democratic Party is advocating such full-blown socialization. Under the United States’ relatively successful and popular Medicare program, the government pays for senior patient care and sets reimbursement rates, but the system’s beneficiaries receive medical services from predominantly private doctors, clinics, and hospitals. In a similar vein, the State Children’s Health Insurance Program (SCHIP) that Bush denounces as a Trojan Horse of medical Bolshevism typically provides care through private health plans and private doctors, clinics, and hospitals. 

Meanwhile, for what it’s worth, George W. Bush and an army of other Washington politicians who denounce “socialized medicine” receive regular care from the federal government’s National Naval Medical Center in Bethesda, Maryland. As Philip Boffey notes, “politicians who deplore government-run health care for average Americans are only too happy to use it themselves…” They do not dare call for the privatization of the nation’s large number of government-owned and -managed Veterans’ hospitals and clinics, which generally provide comparatively high-quality and low-cost care. They are understandably cautious about advocating for the privatization of the nation’s really existing single-payer health insurance plan for Americans over 65 (Medicare). At the heights of Orwellian absurdity, Mitt Romney calls the Edwards/Obama/Clinton plan “European-style socialized medicine” despite numerous strong similarities between the Democrats’ plan and the health care program he touted and passed as the governor of Massachusetts.  street3.JPG

Romney’s xenophobic reference to “Europe’s” evil health care “socialism” is interesting given some facts of life and death within and beyond what Hendrick Hertzberg calls “the only advanced capitalist democracy on earth that does not guarantee health care to its citizens.” Hertzberg continues, “We spend twice as much [on health care] as the [single-payer] French and Germans and two and a half times as much as the [single-payer] British, yet we die sooner [despite greater per capita national wealth] and our babies die in greater numbers. Thirty-eight million Americans were uninsured in 2000; now it’s forty-seven million. Employer-based health insurance is increasingly expensive, stingy, and iffy” (the New Yorker, October  2007). 


“Tell Me Something Interesting” 


But bad political faith on health care is hardly restricted to the Republican side of the narrow U.S. political aisle. In rolling out her plan, which heavily plagiarizes John Edwards’s proposal (issued many months ago), Hillary Clinton has made repeated references to her supposedly heroic effort to face down the big bad insurance companies and deliver health care for the masses in the early 1990s. She’s “been there before,” she claims, fighting the good populist fight against big health care capital on behalf of the people. Never mind that the four largest health insurance companies—Aetna, Prudential, Met Life, and Cigna—helped draft and fund the indecipherable and corporate-neoliberal “managed competition” scheme the Clintons briefly advanced and then completely dropped to pursue such lovely social programs as the North American Free Trade Agreement (NAFTA), the elimination of poor families’ entitlement to federal cash assistance, and the beefing up of the nation’s burgeoning prison-industrial complex. 


Her early 1990s health-care plan, should have been called “All Power to the Big Five Insurance Corporations.” As Robert Dreyfuss of Physicians for a National Health Care Program (PNHP) observed at the time, “the Clintons are getting away with murder by portraying themselves as opponents of the insurance industry. It’s only the small-fry [insurance companies] that oppose their plan. Under any managed-competition scheme, the small ones will be pushed out of the market very quickly.” 


One of many low points in the Clinton administration’s pathetic health care campaign came when Dr. David Himmelstein of PNHP told Hillary Clinton that more than two-thirds of the U.S. population had evinced support for an American version of single-payer health insurance. “David,” a dismissive Clinton said to Himmelstein, “tell me something interesting.” 


Having come up with a plan that embodies the worst of bureaucracy and the worst of “free enterprise,” and having seen it fail abjectly because of its abysmal and labyrinthine complexity, the Clintons dropped the subject of health care for good. The president threw away the pen that he told Congress would only sign a bill for universal and portable coverage, and instead proposed no bill or remedy at all. Thus was squandered a political consensus on health care which had taken a decade to build up, and which had been used by the Clintons as a short-term electoral vehicle against a foundering Bush I. 


Obama’s Preference for “Voluntary” Solutions 


In 2006 Edwards’s other health policy plagiarist Barack Obama told David Sirota that he rejected Canadian-style single-payer health insurance partly on the curious grounds that such a welcome social-democratic change would cause employment difficulties for workers in the private insurance industry. Similarly, could this mean that he supports the American scourge of racially disparate mass incarceration on the grounds that it provides work for tens of thousands of prison guards? Or that the U.S. should maintain the illegal operation of Iraq and pour half of its federal budget into imperial “defense” expenditures because of all the soldiers, mercenaries, and other workers who find employment in endless war and the military-industrial complex? How about people working for the gun industry and the gun lobby, which the famously cautious Obama and the other leading Democrats refused to challenge after the shocking atrocity at Virginia Tech? How about the people who manufacture cigarettes or the violent video games that do so much to fuel school shootings and military enlistments? 



Did the “progressive” Senator really need to be reminded of the large number of socially useful and healthy alternatives that exist for the investment of human labor power at home and abroad—wetlands preservation, urban ecological retrofitting, drug counseling, teaching, infrastructure building and repair, safe and affordable housing construction, the building of windmills and solar power facilities, and the list goes on? 


In a 2006 interview with Time’s Joe Klein, Obama expressed interesting misgivings even about the Massachusetts non-single payer plan for universal health insurance. He told Klein that “voluntary” solutions are “more consonant” with “the American character” than “government mandates.” 


Never mind that, as Noam Chomsky noted in 2006: “A large majority of the [U.S.] population supports extensive government intervention [in the health care market], it appears. An NBC-Wall Street Journal poll found that ‘over 2/3 of all Americans thought the government should guarantee everyone the best and most advanced health care that technology can supply’; a Washington Post-ABC News poll found that 80 percent regard universal health care as ‘more important than holding down taxes’; polls reported in Business Week found that ‘67 percent of Americans think it is a good idea to guarantee health care for all U.S. citizens, as Canada and Britain do, with just 27 percent dissenting’; the Pew Research Center found that 64 percent of Americans favor the ‘U.S. government guaranteeing health insurance for all citizens, even if it means raising taxes’ (30 percent opposed). By the late 1980s, more than 70 percent of Americans ‘thought health care should be a constitutional guarantee,’ while 40 percent ‘thought it already was’.” 


Obama, it is worth noting, received $708,000 from medical and insurance interests between 2001 and 2006 (Center for Responsive Politics, 2007). His wife Michelle, a fellow Harvard Law graduate, was a vice president for Community and External Affairs at the University of Chicago Hospitals, a position that paid her $273,618 in 2006. 


Single Payer as Beyond the “Mainstream” Pale 


It is symptomatic of the United States’ debased and corporate-crafted political culture that no candidate with a serious chance of running a viable campaign is willing to endorse the most obvious, fair, progressive, and simple health insurance solution—an extension of the single-payer Medicare (the Canadian and “European”) model to the entire U.S. population. That policy would certainly be welcomed by a significant majority of U.S. citizens and would not involve the implementation of that neo-McCarthyite bubagoo, “socialized medicine.” But since single-payer is considered too radical for the big money masters of the U.S.’s so-called “advanced capitalist democracy,” it is off the table of serious political and policy discussion—kind of like the number of Iraqi civilians murdered by Washington’s criminal war for oil and power. Dennis Kucinich and others are free to discuss single-payer all they wish, just as long as the discussion can’t be meaningfully or respectfully heard—except beyond the officially designated lunatic fringe of our self-contradictory “market democracy.” 



Paul Street is vice president for Research and Planning at the Chicago Urban League. A writer and ZNet commentator, his articles and essays have appeared in Z Magazine, Monthly Review, the Journal of American Ethnic History and Dissent. He is the author of The Vicious Circle: Race, Prison, Jobs, and Community in Chicago, Illinois, and the Nation (Chicago Urban League, 2002).