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Obama’s Corporatist Health Care Reform, Single Payer, and the Constitution

Supreme Insult

by PAUL STREET

As the United States Supreme Court prepares to release its ruling for or against the corporatist “health insurance reform” Barack Obama and the Democrats passed in early 2010 (the so-called Affordable Health care Act), let us pause briefly to consider what a hot plutocratic mess U.S. political culture has become. Think back two presidential election cycles to the conservative campaign of John Forbes “Reporting for Duty” Kerry – a man so thick that he declared himself a fan of (Ohio State) “Buckeye football” while campaigning in Michigan.

“So Little Support for Government Intervention in the Health Care Market”

Like all Democratic presidential nominees since at least Harry Truman, Kerry declared himself an advocate of “health care for all.”  What sort of plan did he propose? Not the single-payer (government as insurer) system (what we might call “Medicare for All”) that Truman advocated (imagine) – not the program that prevails in Canada and other industrialized states and that most Americans have long supported.  During the 2004 campaign, the press reported that Kerry “took pains…to say that his plan for expanding access to health insurance would not create a new government program.” Why did he do that?  Because, New York Times reporter Gardiner Harris explained, “there is so little political support for government intervention in the health care market in the United States.”[i]   In his aptly titled book Failed States (2006), Noam Chomsky found Gardiner’s comment “interesting.”  Chomsky elaborated:

“A large majority of the population supports extensive government intervention, 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% of Americans think it’s a good idea to guarantee health care for all U.S. citizens, as Canada and Britain do, with just 27% 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.’ One could only imagine what the figures would be if the topics were not virtually off the public agenda.”  [ii]

Then, as now, the nation’s “unelected dictatorship of money” (Edward S. Herman and David Peterson) had a standard response to such facts: “so what. Who cares?” It’s nothing new.  The great American philosopher John Dewey noted nearly a century ago that U.S. politics was little more “the shadow cast on society by big business.” He prophesized correctly that it would remain so as long as power rested in “business for profit through private control of banking, land, industry, reinforced by command of the press, press agents, and other means of publicity and propaganda.”[iii]  One could argue that the New Deal era (1932-1975) brought some real “countervailing power” and policy victories for popular forces through at least the early 1970s.  Since the onset of the long neoliberal age (wherein deepening inequality and regressive policy feed each other in a disastrous downward negative feedback loop that cannot be broken through the usual political means), Dewey’s shadow has morphed into a thick poisonous vapor that seeps into the corridors of policy and corrupts politics and media to a degree that almost defies belief.

“The Health Insurers Have Already Won” (August 2009)

Four years after the bumbling and boring aristocrat Kerry’s failed bid, the silver-tongued and “charismatic” (so they say) Barack Obama swept into history and the White House on the promises (among other things) to deliver universal health care and free ordinary people from he tyranny of the giant private health and drug companies.  Having campaigned on a pledge to let all voices be heard in a spirit of openness and conciliation, the Dollar Dalai Obama then proceeded to exclude single payer activists from even a tiny seat at the edge of the table of the health care reform process he advanced as the signature domestic policy priority of his presidency. It was brutal, consistent with his right wing corporatist chief of staff Rahm Emmanuel’s advice: “ignore the progressives.” While Obama golfed and confabbed with leading private insurance and pharmaceutical executives and lobbyists, the venerable black Congressman and single payer advocate John Conyers (D-MI) and Obama’s own “good  friend” Dr. Quentin Young (a longstanding single-payer proponent) had to fight even to get invited to the White House’s Health Care Summit.   There they were treated like forgotten stepchildren despite the curious fact that they represented the policy perspective of the nation’s purportedly sovereign citizenry.

The health “reform” that actually passed in early 2010 could have been called the “All Power to the Six Leading Insurance Companies and Big Pharma Act.”  The final bill left the private insurance and drug mafias in parasitic, profit-extracting control of the nation’s absurdly expensive health care system, whose costs are pushed up mainly by the insurance syndicates’ giant investment in marketing, tracking, and denial of service. These giant socio-pathological firms were happy to concede on matters like giving up their right to deny coverage to people with pre-existing conditions as long as the federal government would offer no competing public plans and all Americans would be compelled to purchase private health insurance.

The corporatist nature of the “Affordable Health Care Act” (AHCA) was a foregone conclusion, thanks to the aforementioned dictatorship, which strangles all potentially progressive policy in the corporate-state cradle. Knowing the authoritarian score, Business Week was able to candidly tell its readers that “The Health Insurers Have Already Won” in early August of 2009.  As the magazine’s health care correspondents Chad Tehrune and Keith Epstein explained:

“As the health reform fight shifts this month from a vacationing Washington to congressional districts and local airwaves around the country, much more of the battle than most people realize is already over. The likely victors are insurance giants such as UnitedHealth Group, Aetna, and WellPoint. The carriers have succeeded in redefining the terms of the reform debate to such a degree that no matter what specifics emerge in the voluminous bill Congress may send to President Obama this fall, the insurance industry will emerge more profitable. Health reform could come with a $1 trillion price tag over the next decade, and it may complicate matters for some large employers. But insurance CEOs ought to be smiling.”

“…The [insurance] industry has already accomplished its goal of at least curbing, and maybe blocking any new publicly administered insurance program that could grab market share from the corporations that dominate the business (emphasis added).[iv]

The key point for the corporate insurance bosses was to block any public insurance competition or alternative. They were ready to give on “pre-existing conditions,” lifetime benefit caps and the like in order to do that. They knew that “reform” was in the air and had support from many large business, political, and professional interests, not just the nation’s quaintly excited citizenry. A popular new president had staked his reputation and perhaps his re-election chances on some (almost any) version of “health care reform” being passed in his name. Something was going to happen, the big private insurance and drug protection outfits knew.  Their goal was to “redefine” and set the terms in a way that left core corporate prerogatives unchallenged by popular public alternatives.

That goal was achieved early on and in standard defiance of irrelevant public opinion. Contrary to politicians’ and dominant (corporate) media pundits’ insistent claim that public insurance lacked popular support, a CBS-New York Times polls in January of 2009 found that 59 percent of Americans supported a single-payer health insurance program. (The exact same percentage of doctors supported the same system in an April 2009 poll). In a poll conducted in late September of 2009, 65 percent of more than 1,000 Americans randomly surveyed by CBS and the Times responded affirmatively to the following question: “Would you favor or oppose the government offering everyone a government-administered health insurance plan – something like the Medicare coverage that people 65 and over get – that would compete with private health insurance plans?”[v]

Of course, none of this ugly plutocratic record stops the Orwellian right wing propaganda machine from insistently and absurdly calling “Obamacare” dangerously “socialistic” and even “Marxist.” The right propagandists will never inform those they egg into neo-McCarthyite dread that Obama’s “radical leftist” insurance bill is based on the legislative proposals of the Republican Heritage Foundation in the 1990s. Modeled largely on a state-level plan that  Republican presidential nominee Mitt Romney passed and oversaw as governor of Massachusetts, it is dedicated to a vision of “change” that leaves the corporate and financial oligarchy free to extort massive profits that drive health care costs to the breaking point for individuals, families, communities, non-profits, small businesses, and government. Touting his record as a “centrist” at the Associated Press luncheon last April, Obama himself boasted that the AHCA was taken from the Republicans in an effort to privilege what he called “market solutions” over “government solutions” in addressing the nation’s problems. [vi]

Supreme Irony, Supreme Insult

Which brings us to a final dark irony.  If the Supreme Court decides to strike down the AHCA, it will do so for constitutional reasons single payer would have skirted.

Imagine the fantastic, if you will.  Imagine that the Democratic Congress and President had in 2009 and 2010 decided to adopt the genuinely progressive health care plan – the plan favored by most Americans and in place across much of the industrialized world.  Envision them having decided on single-payer, whereby the government would raise revenue with taxes to pay the doctor, the hospital, the X-ray technician, the nurse, and the lab bills and drugs for just about everyone.

Would such a law be constitutional?  “The answer, unquestionably,” writes the veteran national political correspondent Jeff Greenfield, “is ‘yes.’ In fact, it would be the simplest law in the world to enact.” As Greenfield explains: “All Congress would need to do is take the Medicare law and strike out the words ‘over 65.’ Why is it constitutional? For the same reason Medicare and Social Security are: the taxing power.  Its reach is immense…The same Congress that could abolish the estate tax could…impose a 100 percent tax on estates over, say, $5 million.  If it decided that a national sales tax was an answer to huge budget deficits, it could impose one at whatever level it chose.” [vii]

It could do all that, constitutionally speaking. Obama’s health reform is in constitutional trouble because the key element in the plan – the mandate that uninsured Americans buy insurance or pay a penalty (required by the insurance companies to “compensate” them for the cost of no longer being permitted to do terrible things like deny coverage to people with pre-existing conditions and set lifetime coverage caps) – is based not on the federal government’s taxing power but on its power to regulate interstate commerce. Many, perhaps most of the Supremes do not think the Constitution’s commerce clause should be cited to compel a citizen to buy a specific product in the marketplace – in this case health coverage.

“For its effort to design a health care plan that moved in the direct of less government intrusion [and away from the popular single payer systems or public option],” Greenfield notes, “the Obama administration faces the distinct prospect of having its signature domestic program shot down for exceeding the limits of the constitutional power it did choose to use.”

Greenfield calls it a “Supreme Irony” that “a single payer plan – which he calls “genuinely radical” and “far more intrusive” than the AHCA – would be less vulnerable to constitutional invalidation by the court than Obama’s plan.

I prefer to call it a Supreme Insult from Wall Street Barry Obama and the corpotocracy to the citizenry. Think about it. The former constitutional law professor Obama was so determined to serve corporate and financial masters in his drive to pass anything that could be (deceptively) called universal health care that he was willing to advance a bill loaded with constitutional ambiguity in order to steer clear of constitutionally safe single payer and public option alternatives.  For what its worth, I look forward to the slight possibility of Obama’s insulting health care bill being invalidated by the high court.  If nothing else that might spark the movement for genuine and progressive health care reform to find its bearings in and around the simple, obvious, and compelling demand for single payer once again.

Paul Street, an Iowa City resident,  is the author or numerous books, including Racial Oppression in the Global Metropolis (2007), Barack Obama and the Future of American Politics (2008), The Empire’s New Clothes: Barack Obama in the Real World of Power (2010) and (co-authored with Anthony DiMaggio)  Crashing the Tea Party (Paradigm, 2011).  Street can be reached at paulstreet99@yahoo.com.

Notes.

[i] Gardiner Harris, “In American Health Care, Drug Shortages are Chronic.” New York Times, October 31, 2004.

[ii] Noam Chomsky, Failed States (New York: Metropolitan, 2006), 225.

[iii] Dewey is quoted in Chomsky, Failed States, 206.

[iv] Chad Terhune and Keith Epstein, “The Health Insurers Have Already Won,” Business Week, August 6, 2009, at www.businessweek.com/print/magazine/content/09_33/ b4143034820260.htm

[v] New York Times-CBS Poll, “Confusion Over Health Care,” survey of  1,042 adults, September 19-23, question number 57, p. 15 of 26, poll results at http://documents.nytimes.com/new-york-times-cbs-news-poll-confusion-over-health-care-tepid-support-for-war#p=15

[vi] Barack Obama, “Remarks by the President at Associated Press Luncheon,” Washington D.C. (April 3, 2012), read online at http://www.whitehouse.gov/the-press-office/2012/04/03/remarks-president-associated-press-luncheon. “I think it’s important to put the current debate in some historical context,” Obama told reporters in the Q&A. “Cap and trade was originally proposed by conservatives and Republicans as a market-based solution to solving environmental problems…Health care, which is in the news right now — there’s a reason why there’s a little bit of confusion in the Republican primary about health care and the individual mandate since it originated as a conservative idea to preserve the private marketplace in health care while still assuring that everybody got covered, in contrast to a single-payer plan.  Now, suddenly, this is some socialist overreach….So as all of you are doing your reporting, I think it’s important to remember that the positions I’m taking now on the budget and a host of other issues, if we had been having this discussion 20 years ago, or even 15 years ago, would have been considered squarely centrist positions.:

[vii] Jeff Greenfield, “Supreme Irony: Would a ‘Single Payer’ Health Plan Be Less Vulnerable to the Court than the Affordable Health Care Act?” Yahoo News (June 12, 2012), read online at http://news.yahoo.com/supreme-irony–would-a–single-payer–health-care-plan-be-less-vulnerable-to-the-court-than-the-affordable-health-care-act-.html