US Health Care Bill – A step forward?

The passage of President Obama’s flagship policy to reform the US healthcare system with a narrow majority of 219-212 in the House of Representatives has been presented by the media as a historic success for his presidency. He “doubled up” and risked all to secure passage of health reform. The reality is, however, somewhat less overwhelming.

Most US citizens currently either pay for private health care insurance or have it paid by their employers. The elderly and disabled have access to a “single-payer” option called Medicare provided they have paid taxes. The poor and immigrants have to rely on the Medicaid programme which pays for their insurance but poverty is no guarantee of eligibility (it is estimated that 60% are ineligible).
Before the passage of this bill, it was estimated that 46 million citizens (about 16%) could not afford medical insurance (that doesn’t include the additional 28 million “illegals”).

Health insurance companies will no longer be able to refuse to cover children or anyone with pre-existing medical conditions; however, there is nothing to stop them from imposing hefty costs for such insurance. Even worse, the bill compels citizens or their employers to pay for insurance, under threat of fine.

The likelihood is that bills will continue to rise and that employers will pay $2,000 fines in order to avoid family insurance costs averaging $13,000. Furthermore, the legislation specifies that public monies cannot support any medical cover associated with abortion (which must be paid for privately).
The progressive changes enacted by the bill could have been achieved by less dramatic legislation; these include allowing parents to retain children on their cover until the age of 26 and the partial extension of availability of Medicaid.

The Democrats were swept into power on a platform including the promise of health reform including a public (low-cost) insurance option. The nature of their victory reflected the widespread demand from the US working-class for change – a change that has not been delivered by the Obama presidency despite his having overall majorities in both Houses.

The widespread liberal euphoria surrounding the passage of this severely restricted bill largely reflects the strength of the campaign organised against it. This campaign has seen the coming together of the powerful health insurance lobby, “tea-party” campaigners (many of whom are out-and-out racists) and the Republican party.

In response, Obama’s town hall meetings have been largely ineffectual. The failure to present a simple case for comprehensive, “single-payer” health cover resulted in the disengagement of ordinary working people. Further, his case has not been helped by the parochial demands worked into the original legislation by right-leaning Democrats in return for their support. These failures were reflected in the loss of the “safe” Massachusetts senate seat to the Republicans.

The need to counter this potentially existential threat resulted in the Democrats uniting behind this limited bill. From the perspective of the private insurance companies, their campaign opposing reform has been highly effective and has easily neutered the threat posed by the Democratic “left”.
However, many US workers already understand that the law passed has been undermined by the health insurance lobby and the political right. The passage of this legislation does not represent the end of matter. Increasingly, through experience, the demand to take profit out of healthcare will grow. This offers workers and socialists in the US an opportunity to continue building independent coalitions of trade unions and communities to fight for, among other issues, universal public healthcare, an end to corporate subsidies and an end to the US wars.

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