Above: Kevin Zeese and Margaret Flowers at a single payer health care rally in Baltimore, MD.
Zeese and Flowers’ criticism of the Affordable Care Act centers on the fact that it “is based on continuing our complicated private health insurance or market-based system.
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In the months and years ahead, Americans will at long last have the chance to discover whether the health insurance law touted as President Obama’s greatest achievement to date is anything like the historical, humanitarian event his supporters claim it to be. The proposition, of course, is mistaken from the start. The callously named Affordable Care Act is not and never was Obama’s law. He didn’t write it. Insurance companies did, the very same that by a wide margin favored him financially over every other presidential candidate in 2008, and a close look at the measure’s products suggests that Obama was merely the health industry’s defender and salesman of choice against an increasingly agitated public.
Think back to the years leading up to 2008. Concern for America’s dismal health care was approaching a critical mass. Michael Moore’s documentary “Sicko,” which grossed $24.5 million at the box office, had laid the malignant and metastasizing tumors of private health insurance and the pharmaceutical industry on the examination table for all to see. It was known that 50 million Americans, nearly one in six of our neighbors, ran the risks of daily life without the safety net of insurance; 18,000 of them (a number that would be revised upward to 45,000 a few years later) were estimated to be dying in consequence; the quality of American health care had been ranked 37th in a study of 191 nations by the World Health Organization, despite the fact that the U.S. spent a greater portion of its GDP on services than any other country, or nearly $7,000 per person (compared with Cuba’s $251). Health-related expenses were found to be the primary cause of roughly half of all personal bankruptcies. Americans were getting righteously pissed, and their elected leaders knew they had to do something about it.
Now, enter marketing and media magazine Advertising Age’s 2008 “Marketer of the Year.” For two kinds of Americans—those suffering either poor health and finances or a bruised partisan ego—Barack Obama appeared as a blessed savior come to heal their wounds. His speeches showed that he understood what was wrong and was committed to a solution. “I happen to be a proponent of a single-payer universal health care plan,” he told attendants at a meeting of the AFL-CIO in 2003, as a senator. There is no reason why “the United States of America, the wealthiest country in the history of the world, is spending 14 percent of its gross national product on health care and not providing basic health insurance to everybody. … Everybody in. Nobody out. … That’s what I’d like to see.” (As Truthdig reader Bruce added in the comments section below, Obama then listed what needed to be done to make this a reality: a Democratic re-capture of the White House and both chambers of Congress. We delivered it to him, Bruce correctly said, but when he had his chance to use them, Obama reneged.)
During his quest for the presidency, he doubled down. Months before he was elected, Obama said to a crowd in Albuquerque, N.M., “If I were designing a system from scratch, I would probably go ahead with a single-payer system.” Combined with his minority appeal, constitutional law background and reputation as a community organizer, to many of his listeners, these public statements made him a believable leader of a crusade to fix health care in the name of social justice. As a frontman for Change, Obama was uniquely suited to placate the public.
A case for the view of our president-as-salesman was effectively made in an article published last week by pediatrician Margaret Flowers and lawyer and longtime activist Kevin Zeese. Flowers serves as a national board adviser for Physicians for a National Health Program, which advocates for universal, comprehensive single-payer health care. Along with Flowers, Zeese organized the Occupation of Freedom Plaza in Washington, D.C. and now operates PopularResistance.org. Both Flowers and Zeese have campaigned for years for a need-based rather than a profit-based health system.Zeese and Flowers’ criticism of the Affordable Care Act centers on the fact that it “is based on continuing our complicated private health insurance or market-based system. Despite their advertising slogans, private insurers primarily exist to create profit for their investors or, in the case of ‘nonprofit insurers,’ to pay exorbitant salaries to their executives. They care about health as much as Big Oil cares about the environment.”
They continue: “Health insurers make their profits from charging the highest premiums they can and by restricting and denying payment for care. They want to take in as much money as they can, while paying out as little on health care as possible. They have many tools with which to do this, and they’ve successfully skirted regulations for decades. When they can’t make a profit, they simply pull that product from the shelf and create new products.”
What are the alleged deceptions in the law? Contrary to the promises made in its advertisements, many people are discovering now, as the law goes into full effect, that they are being kicked off their existing plans and forced to buy comparable or lesser ones at higher premiums. Coverage is decreased in many cases as the program “significantly lowers what is considered to be adequate insurance coverage through its system of tiers.” In some cases, people are “likely to choose the least-expensive plans without fully understanding that a serious accident or illness could bankrupt them even though they have insurance.” The guarantee that insurance companies cannot turn away those with “pre-existing” illnesses may be undermined through such tactics as excluding hospitals where people with serious health problems go, providing poor service so customers are encouraged to change insurers, and manipulating prices at will. The much-vaunted assurance that youths will be covered on their parents’ plans until they are 26 is valid only if the parents can afford the increased premiums that come with covering additional members. Finally, the insurance companies succeeded at eliminating a cap on out-of-pocket spending, which means prices for the plans—which many uninsured Americans are required to buy—are officially free of regulation.
What emerges from this dim litany of contingencies is the sense that nothing that was pledged to an exhausted, ailing and impoverished public is certain to be delivered. Perhaps the greatest evidence that Obamacare will not be what the public thought it would is the projection by the Congressional Budget Office that due to changes made this spring to the criteria governing exemptions, 31 million people are estimated to remain uninsured by 2023. The law was advertised as “universal, affordable and guaranteed,” but a mess of loopholes and exceptions, achieved via the unnecessary complicatedness almost everywhere in its 10,535 pages, written in at whatever time its authors deemed convenient, reveals it as anything but.
Zeese and Flowers describe Obamacare as possibly “the biggest insurance scam in history” and a “con” enabled by the credulity of millions of desperate, ignorant or well-intentioned people. Their critique, which includes a must-read description of the process used to sell the law that follows steps laid down by a historical con man and regards the briefly floated public option as a deliberate bait-and-switch, leads me to suspect they are right. We don’t know exactly how Obamacare will proceed, but Zeese and Flowers have shown us some of the major flaws in its design, and the conclusion is inescapable. Its status as a continuation of the overwhelmingly successful neoliberal effort to pick the public’s pockets seems beyond question. And it’s not just an abstract service that is turned into a profit center for corporations; it’s our well-being and illness that are commodified, and those of our children, grandparents, neighbors and friends. For the benefit of a few already bloated corporations, the future health and goodness that could have become the American people’s through better means were cut down.
The president’s supporters may attempt to counter claims of outrage at broken promises by saying that during his campaign Obama never promised anything like single-payer, universal health care or a public option. In a strictly technical sense this is true. But rhetorical sleight-of-hand, some of them may be decent enough to admit, is fundamental to the art of politics. A seasoned politician can exploit hopeful individuals’ inborn desire to trust by speaking in a manner that convinces them and others present that the politician is on their side, even if the politician never said so, and even if his audience’s hopes diverge or stand opposed. Is there any doubt that for the sake of himself, Obama did this to millions of anguished people who thought Hope and Change meant a break from the profit-driven politics of the previous 30 years? This is a man who, in a campaign ad attacking the leader of the drug industry’s biggest lobby for rigging pharmaceutical prices, told supporters he wanted to end “game playing in Washington,” and who upon election met with that leader in secret and bargained away the very protections his ad claimed he wanted to protect. Among a dwindling portion of the left, which continues to view electoral politics as a practical means to change, Obama remains a master of shoving perception around, or at least of convincing his marks to complain little or not at all as they endure his betrayals.
The health care industry’s wishes are now the law of the land. Thanks in part to the work of Margaret Flowers and Kevin Zeese, our Truthdiggers of the Week, we have a humane means of measuring its grim success.