The Next Phase in Health Care Apartheid

In Washington, “healthcare reform” has degenerated into a sick joke.

At this point, only spinners who’ve succumbed to their own vertigo could use the word “robust” to describe the public option in the healthcare bill that the House Democratic leadership has sent to the floor.

“A main argument was that a public plan would save people money,” the New York Times has noted. But the insurance industry — claiming to want a level playing field — has gotten the Obama administration to bulldoze the plan. “After House Democratic leaders unveiled their health care bill [on October 29], the Congressional Budget Office said the public plan would cost more than private plans and only 6 million people would sign up.”

At its best, “the public option” was a weak remedy for the disastrous ailments of the healthcare system in the United States. But whatever virtues the public option may have offered were stripped from the bill en route to the House floor.

What remains is a Rube Goldberg contraption that will launch this country into a new phase of healthcare apartheid.

People who scrape together enough money to buy health insurance will discover that they’re riding in the back of the nation’s healthcare bus. The most “affordable” policies will be the ones with the highest deductibles and the worst coverage.

We’re hearing that large numbers of lower-income Americans will be provided with Medicaid coverage in the next decade. Translation: If funding holds up, they’ll get to hang onto a bottom rung of the healthcare ladder. Many will not be able to get the medical help they need, from primary care providers or specialists.

Not long ago, we were told that the Obama administration was aiming for a public option that could provide coverage to one out of every four Americans. Now the figure is around one out of every fifty.

Not long ago, the idea was that taxpayer-funded subsidies were to be used only for the public option. But now the entire concept has been hijacked by and for the private insurance industry. As House Speaker Nancy Pelosi put it on October 8, private insurance companies “are going to get 50 million new consumers, many of them subsidized by the taxpayers.”

Pelosi was making the argument that the least the insurance industry could do, in return, would be to accept a higher level of taxation. But her comment was a telling acknowledgment that all the “public option” proposals now provide a massive funnel from the U.S. Treasury to the insurance conglomerates. The individual mandate is a monumental giveaway to private insurance firms.

The specter of “healthcare reform” that requires individuals to stretch their personal finances for often-abysmal insurance coverage is the worst of all worlds — government intrusion for corporate benefit without any guarantees of decent health coverage.

In effect, the individual-mandate requirement tells people that obtaining health coverage is ultimately their own responsibility — and the quality of the coverage is beside the point. In essence, when it comes to guaranteeing quality healthcare for all, the gist of the policy is: “Let’s not, and say we did.”

The predictable result is reinforcement of vast — and often deadly — inequities in access to healthcare.

With Washington making such a corporate mess of “healthcare reform,” the best way to get what we need — healthcare for all as a human right — will be to enact single-payer healthcare in one state after another.

But the House Democratic leadership has not been content to serve up a grimly pathetic “healthcare reform” bill. Speaker Pelosi has used her political leverage to quash Congressman Dennis Kucinich’s amendment — approved months ago by the Education and Labor Committee — that would grant waivers so that states could create their own single-payer system. Pelosi removed the Kucinich amendment from the House bill.

The California legislature has twice passed a strong single-payer bill, both times vetoed by the state’s current execrable governor. The official position of the California Democratic Party is unequivocally in favor of single-payer healthcare. And yet Nancy Pelosi, a California Democrat, did what she could to sabotage the single-payer position of her own party in her own state.


Vijay Prashad is the George and Martha Kellner Chair of South Asian History and Director of International Studies at Trinity College, Hartford, CT His new book is The Darker Nations: A People’s History of the Third World, New York: The New Press, 2007, which was chosen for the Muzaffar Ahmad Book Award, 2009. He can be reached at: vijay.prashad@trincoll.edu

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Vijay Prashad’s most recent book is No Free Left: The Futures of Indian Communism (New Delhi: LeftWord Books, 2015).

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