Newsletter: Is Health Care A Commodity Or Right?

| Newsletter

With just a week left before Congress’ budget reconciliation process ends, the Senate is once again peddling a poorly-thought out plan to repeal and replace the Affordable Care Act (ACA). If Senators vote before the September 30 deadline, they only need 50 votes instead of the filibuster-proof 60 votes to pass amendments. And once again, people are rising up in opposition to the plan, making it unpopular and unlikely to pass.

At the same time, support for a National Improved Medicare for All single payer healthcare system is increasing and there are bills in both the House and Senate with record numbers of co-sponsors. Will the United States finally join the long list of countries that provide healthcare to everyone?

Overall, it is a time to be optimistic. The movement for National Improved Medicare for All has made great strides this year. Whether we succeed still hangs in the balance. We discuss what it will take to win and how to proceed.

Join Health Over Profit for Everyone (HOPE) , a campaign for National Improved Medicare for All.


First, Some History

Efforts to create a national health insurance have existed in the United States for the past 100 years. Health historian, David Barton Smith, writes (in a draft chapter) that the fundamental struggle in the US has been over the question of whether health care is a commodity that belongs in a market or whether it is a basic necessity that requires the protection of government so that it is universal. Smith breaks up the past one hundred years into five phases and argues that in each phase, compromises were made that failed because they did not meet the fundamental criteria of covering everyone and achieving effective governmental oversight. He refers to these compromises as “more palatable approaches” that were considered to be politically feasible, but each “self-destructed.”

These failures, including the most recent ACA, have driven health care deeper into the pockets of private industry from the provision of medical services to the the production and distribution of pharmaceuticals and medical devices. Doctors are turning their practices over to large institutions, “going corporate,” in order to have the negotiating power to simply exist in this environment. Mergers by health insurers, hospitals and pharmaceutical companies have been acts of desperation, as each sector fights for control. But the bottom line in this fight is profit for a few, not health for the many, and so it is the public who suffers. Dr. Adam Gaffney traces and explains this trend from the 1940s to the present in “The Neo-liberal Turn in American Health Care.”

Make no mistake, currently, in the United States, health care is a commodity, and the profiteers are going wild. Since passage of the ACA, major health insurance company stock values have quadrupled. And they are never satisfied. Democrats and Republicans in Congress are discussing a “bipartisan approach,” as outlined by the Center for American Progress, which is funded by health industry lobbyists, to fix the healthcare system. Their plan is to give billions of more dollars to the industry to encourage it to cover our healthcare needs. They refer to this as “stabilizing the market.”

Any person who says that health care is a right or basic necessity but supports keeping the existing market-based structure is either confused or lying. The market model of health care is a failure. Even Fareed Zakaria, conservative host of CNN, understands this.

This history is important because the elites in power are working to maintain their grip on the system. Incrementalists were out in full force after the failure of repeal attempts this summer. Writers who claim to be progressives argued that those who want National Improved Medicare for All are asking for too much, that it is just not politically feasible and that we must compromise. But what they might consider to be doable won’t solve the healthcare crisis.

Incremental steps that were taken in the past did not succeed because they failed to meet the basic requirements of being both universal and properly overseen by the government. This is why we say that the smallest incremental step that we can take in the US is to create a National Improved Medicare for All, a universal publicly-funded healthcare system that relegates private insurers to a supplemental role to provide extras that the system does not cover. Beyond that, there will still be a lot to do to make sure everyone has their healthcare needs met.


National Improved Medicare for All is on the table

A victory this year is that there are bills in the House and Senate that outline a National Improved Medicare for All healthcare system, and they have record numbers of co-sponsors. HR 676 is considered the ‘gold standard’. It has been introduced every session since 2003 and it has broad support from the single payer healthcare movement. It would truly treat health care as a public necessity and not a commodity.

Under HR 676, all people living in the US would be included in the system, there would be free choice of health professional, the coverage would be comprehensive and care would be provided as needed without financial barriers. HR 676 would create a publicly-financed not-for-profit healthcare system. It currently has 119 co-sponsors, all Democrats, plus Rep. John Conyers, who introduced it.

S 1804 is the Medicare for All Act in the Senate that was introduced on September 13 of this year by Senator Sanders with 16 co-sponsors, all Democrats. It has strengths and similarities to HR 676 as well as weaknesses. Its strengths are that it endeavors to achieve a universal Medicare for All system with more comprehensive coverage than what most people have now. It has strong language protecting women’s reproductive rights and it removes most co-pays and deductibles.

The weaknesses of S 1804 prevent it from fully transforming our healthcare system to a public service. Investor-owned facilities are permitted to continue to operate within the system and budgetary controls that might restrain them were excluded from the bill. Another weakness is the exclusion of long term care and keeping it in Medicaid, which forces people and their families to live in poverty to receive benefits.

Perhaps one of the greatest concerns about S 1804 is the long transition period. Most universal systems are started at once – on a certain date everyone is in the system. This is how we did Medicare as a totally new system in 1965 before we had computers. The delayed implementation period over four years is such a complex transition that there are concerns it will proceed poorly and support for a universal healthcare system will disappear before it is complete. With complexity, comes greater costs. HR 676 would start all at once, which would not only allow the savings needed to cover everyone but would also put us all in the same boat so that we all have an interest to fix any problems that arise.

We created a chart comparing HR 676 and S 1804 and a chart outlining the transition for S 1804.

Jim Kavanaugh of The Polemicist argues that S 1804 may actually be a “Trojan Horse” for the Democrat’s favored proposal, a public insurance they refer to as a ‘public option’ being added to the current mix. We call the ‘public option’ a “Profiteer’s Option” because it will serve as a relief valve for private insurers to jettison people who need care.

Health Over Profit for Everyone (HOPE), a campaign of Popular Resistance, sent a letter to Sanders before he introduced his bill urging him not to compromise from the start. Thank you to all of you who wrote to his office.


Next Steps

Winning the fight for a National Improved Medicare for All healthcare system is possible. It will take preparation and hard work. Our opponents are those who profit from the current healthcare system, such as the pharmaceutical companies behind the opioid epidemic, those who are ideologically opposed to public safety nets, the commercial media, as Yves Smith describes, and legislators from both major parties, even those who claim to be progressive, because our political system is dominated by Wall Street. We can’t be fooled by progressive veneers. President Obama’s ACA was written by and for the medical industrial complex to enrich the few, and he is already receiving hundreds of thousands of dollars for Wall Street speeches.

We counter our opponents through the principals of I.C.U.:

I =Independence – we must be independent of political parties and willing to pressure all members of Congress, the White House and federal institutions to achieve the healthcare system we need. We cannot attach this movement to any political party or politician’s agenda. To have lasting success, this needs to be a multi-partisan effort on the movement’s terms. If one party or person takes ownership, then the issue can become a political football, as the ACA has become.

C = Clarity – we must educate ourselves and others about basic health policy so that we understand what elements are required for the system to meet our goals and our needs. We will be the watchdogs for the system to make it the highest quality system it can be. This includes understanding which proposals are insufficient too, such as the much-promoted public option and lowering the age of Medicare.

U = Uncompromising – we must stay strong and united around the basics that we need to achieve for the National Improved Medicare for All healthcare system to function. We are often told that politics involves compromise, but some compromises undermine our goal. Movements for social transformation have always been told they are asking for too much. We are asking for what many other countries have and what we are already spending enough money to have – a healthcare system that is universal high quality and comprehensive. We spend more than twice per person per year what other countries spend that have achieved this. For those who say we should have anything less than a universal system, we ask: who should be left out?


The People will Win Improved Medicare for All

Our goal for the HOPE campaign is to achieve National Improved Medicare for All. We provide the tools and information you need to accomplish this. Sign up for HOPE here.

People across the country are organizing teach-ins and movie nights, doing outreach in their communities, attending town halls and meeting with their members of Congress. We urge you to join the effort and join the monthly education and organizing national calls.

When we win the fight for a universal healthcare system, it will represent a political sea change in the US that will bring solidarity and empowerment to fight for the many other changes that we require. Health is connected to having an education, a job, a home, clean air and water and much more.

As medical student Mike Pappas describes, we need to look beyond access to care and recognize that:

“We must address the social determinants of health. Taking the social determinants of health into account can no longer be something nice to do if there is ‘extra time.’ It must become the focus of medical practice. This will require changing medical education and medical practice.”

It’s time for a real healthcare revolution of, by and for the people!






  • The reality of US history/policy since WWII is that there are always a variety of govt. social contracts, taxes, social programs etc. Taken together we can call them a social contract. Finding a generally agreeable social contract that supports universal healthcare is not difficult so long as we notice where compromise is sensible. The right sort of plan would have the following features: a) healthcare insurance for everyone, for all universally covered treatments, b) government negotiating low prices for all covered treatments, c) the set of covered treatments expanding over time, but NOT including every treatment developed or offered by the frontiers of medical research – cost effectiveness is still key for covered treatments, d) private access to non-covered treatments is not prohibited – rich people still have the right to buy additional healthcare in type and quantity, e) there are built in incentives to patients and providers to conserve the amount of care demand – this is necessary to keep costs manageable/efficient, f) private HMOs & insurance plans can still play a role, but they cannot charge at rates above the maximum negotiated rate for a given treatment, nor can they extract hidden fees – they can only profit by providing standards compliant service at costs below the negotiated rates.

  • Linda Jansen

    “a) healthcare insurance for everyone, for all universally covered treatments,”

    Healthcare insurance for everyone? How about healthcare for everyone, which would eliminate the need for “conserv[ing] the amount of demand.” How? The decisions about care needed would be made by your physician. I’m sure the rich will find ways to pamper themselves somehow, but the basic care for everyone should be the same. Why include private plans? Their administrative costs will eat away resources needed by the system as a whole.

  • There are approved standards of care made by national medical bodies. These are somewhat political. They change over time. Physicians can order or offer extra things and they are typically given a lot of financial incentive to do that. The cost conserving system has to block that in some ways – mainly, I suggest, by compensating universally for basic standard of care at a fixed maximum price. Individuals and doctors and corporations would be free to purchase outside of that standard, as they are now, but on their own dime. Administrative costs for that would also be part of their own dime. The healthcare client would have financial incentives not to seek extra/unnecessary care, but not financial incentives to avoid care that is truly important for long term health.

  • chetdude

    The one “compromise” that not sensible, is obviously failing and is duplicated NO WHERE ELSE among affluent nations is allowing the corporations that comprise the current USAmerican for-profit sick care system to “charge whatever the ‘market’ will bear” in order to constantly increase quarterly profits…

    This not only guarantees constantly increasing “costs” for those unfortunate enough to have to use the system but perverts “health care” into remedial care designed to maximize profits rather than effect cures or promote Health…

    The attributes you list are all included in HR676 – Expanded and Improved Medicare for All…

  • In prose: One can conceptualize a two different moving frontiers in healthcare tech & cost delivery – the first includes the care that is off patent and common in medical training – this set grows all the time, should be available to all, and should be cost regulated, insured, and covered by universal healthcare. The second set involves the products of new, costly research. Corporations should be able to charge what the market will bear for those products in order to fund new research/safety & effectiveness trials, etc. That is necessary to keep that frontier moving, and have it feed into the common frontier when the most successful treatments come off patent and become common practice.

    In key: One needs to oppose violence, crime, control of the press & free speech for secret criminal purposes, slavery, non-consensual sex, and especially icy murder/replacement. Heine gangs are all about those things. One can’t really hope to reform it, as they are pure predators. Sex is just an excuse. The naive public supports full LGBT rights, as I do.

  • Aquifer

    OK, Josh – re those “new, costly research” products – a) are you aware that such companies spend more on advertising than on research – so to cut their “need” for higher prices – stop advertising ,,, b) many of those “new’ products are simply variations on a theme of old ones, often no better and sometimes worse than the old, but all at higher prices c) much of the basic research is already done by the government – then farmed out to private companies who patent it and sell it at a profit d)other countrues have developed new therapies as well and provide them at much lower cost –

  • Aquifer

    Independence from political parties – “We cannot attach this movement to any political party”
    Well considering that just about any discussion oh healthcare policy currently involves “discussion” of the duopoly parties, it seems to me that a truly non-partisan discussion wouod involve the positions of other parties as well – because, in the end, if you want HR 676 enacted – you have to have folks in office who will enact it – neither the Ds nor Rs, as a whole appear to be up to the task – but as long as we are under the impression that TINA – we will continue our LOTE voting pattern whicg has serve us soooo well over the years
    So though you do not want to “attach” your movement to any political party – in the name of “fair and balanced” reporting, perhaps you could at least mention whether perchance some political party has “attached” itself to your movement ….

  • Precise data is hard to formalize and even harder to come by, but your construal of the overall costs for new drug development is distorted by selection bias. Think of it this way, at time T1, the company begins many, many different research efforts. The vast majority of those produce nothing of value. Why? Either they don’t find anything new, or what they find isn’t an improvement, or what they find has bad side effects, or a competitor comes up with something better first, or what they find is too costly to justify it’s marginal efficacy, etc. After finding something, there is an expensive process to run drug trials to test safety and efficacy and get it approved. After all that happens, if the company is awarded an exclusive patent, then at that point the profit margin is high and they advertise the heck out of it, etc. They also corrupt physicians in various ways to authorize overly expensive or unneeded treatments – that is a different issue/problem. But the overall cost is amortized over those other failed efforts that produced nothing of value, only cost. So it must be must higher than the production costs of the new drug for the system to make any sense and produce anything new that is ready for consumption.

    At the same time, you are correct that the public has made a huge investment in training the researchers and publicly funding basic research and sometimes publicly funding some of the applied research. So the public has a kind of indirect investment stake in what is produced too.

    The biggest risk to the public in all areas of government nowadays is corruption and regulatory capture. Legislators as a whole are corrupted, not representing the interests of the general public, and the public is so out of power and helpless in the face of the ongoing criminal onslaught that it has little effect on current Congressional outcomes. But for reasons stated above, the intrinsic ability to charge high prices for truely innovative medications isn’t a great example of this global problem.

  • Margaret Flowers

    The majority of breakthrough research is conducted in public institutions, particularly the National Institutes of Health. Pharmaceutical companies engage in tweaking the chemical structure of current drugs, patenting them and then marketing them, even though they don’t have to prove that they are better than what is currently available.

    Drug companies want the public to believe that their high prices are justified while in reality, they are not. See this for example:

  • Your link doesn’t claim that most drug companies don’t do research or that the research is not costly. The link says that is difficult to measure research costs, and so their study will, instead, focus on the cost of development of a drug that has already been discovered and put forward as a candidate.

    You and I both note the potential problem of medical doctors prescribing expensive drugs that are not needed or meaningfully superior to generic alternatives. Sometimes insurance companies balk at those treatments and sometimes they don’t. When they do, people sometimes get mad and say the insurance company is being just a greedy profiteer.

    These things are clear: the public wants research to continue, research at all stages is expensive, and the cost is a lot higher than the final production cost of a new drug. None of us in this discussion think the current system is optimal. In my original comment though, I suggest that it does make sense to have a market for truly new treatments, and also that debate should focus more on making existing treatments more available and affordable for the public at large. I propose ways to cut the connection between the cost/price of new treatment and the cost price of existing treatment. The cost/price of the former shouldn’t be driving the price of the latter. That’s an important insight and important change to make. Putting the government as sole provider of both would tend to link them even more and can backfire when the government is more corrupt or more inefficient that a competition between private companies.

  • kevinzeese

    Look at the profits of drug companies. They are in the range of 15% to 40%. Why? They are ripping us off and people like you are justifying it with false arguments.

    Look at how much people in the US pay for the same drugs as people in other countries and the rip-off gets more obvious.

    Look at the salaries of executive in the tens of millions of dollars. Why because pharmaceutical companies are ripping us off.

    Stop putting forward pharmaceutical company propaganda and look at the facts.

  • Margaret Flowers

    As I stated, the link was to an article about drug companies trying to justify their high prices.

    A market makes no sense to me for drug research and development. A drug company’s incentive is to make a profit. It doesn’t have the interests or needs of the population in mind.

    Often the easiest way to make a profit is to tweak current drugs and push those. That’s what drug companies spend their R&D dollars on. From 2002 to 2011, there were 2 breakthrough drugs and 918 new drugs that offered little or no clinical advantage.

    What we need as a nation is to prioritize our health needs and invest in research that addresses those needs, as we do at the NIH. Then we need to produce those drugs ourselves to keep the cost down and so that our public investment reaps some public financial as well as health benefit.

  • The statements above include two pretty radical claims without supporting sketchs of an argument:

    1) “From 2002 to 2011, there were 2 breakthrough drugs and 918 new drugs that offered little or no clinical advantage. – clearly there is a big apparatus of medical clinicians, bureacrats, insurance companies, etc. that disagree with the no advantage, and the definition/factual basis of “breakthrough” is not apparent.

    2) “invest in research that addresses those needs, as we do at the NIH. Then
    we need to produce those drugs ourselves to keep the cost down and so
    that our public investment reaps some public financial as well as health
    benefit.” – a new proposal is here to transform the NIH from a research and grant funding agency to a non-profit drug development and production apparatus. Could be good or bad. Not a lot of precedents to compare it to. A different, simpler “solution” would be to alter the patent system in terms of duration/criteria or non-exclusivity clauses – the granting of patents is the main basis in govt. behavior/law that actually provides the support for high markups over production costs. Federal development would lower the market for what the NIH produces, but not affect the ability of private companies to charge higher prices for what they patent.

    3) the idea that there is a big problem with “drug companies trying to justify their high prices”. It’s not a question of trusting or believing the drug companies. It’s a question of relevance. They are free to charge what they will & the insurers are free to decline to pay those charges. In a lower cost system, patients would have more incentive to help figure out if the treatment/cost was a good idea or something different should be used.

  • I explain “why” above. Venting about it misses all the relevant points. I point out what is relevant. That’s not about defending or attacking any drug companies.

  • kevinzeese

    Your comments are clearly about defending the drug companies despite the facts. Enough said, people reading this exchange can go to the varous links themselves and make their own decision. The facts are pretty obvious and your ignoring of them is also obvious.

  • No, ass I have zero connection or financial interest or political connection to any drug company. The reality is that YOU are one of a legion of criminal traitor Heine gang people working for FBI/CIA/NSA/DOD or security firms they employ or slaves they keep in warehouses. Trolls like you are employed to make dump noise on independent websites that sometimes criticize the criminal US government and attack indy people reading those websites.

    You will say anything honest. You will not say who you are working for, or what your real identity is. You will lie and call me crazy and be offensive. And there are 10000 others like you destroying the Internet for honet people.