The vote Sunday night by the US House of Representatives to approve Obama’s health care overhaul was accompanied by declarations that the measure represents the greatest social reform in generations.
With predictable demagogy, Obama, in a statement following passage of the bill, hailed the measure as a historic reform a century in the making, a vindication of the “American dream” and proof that “government of the people and by the people still works for the people.”
After months of closed-door negotiations with insurance CEOs and pharmaceutical executives, Obama made the absurd claim that the measure came “from the bottom up.” In fact, the legislation was entirely dictated from the top. It represents the opening shot in a sweeping attack on health care for working people.
A staggering level of cynicism has been exhibited throughout the so-called health care “debate.” Evasions and outright lies have been utilized to conceal the real content of the bill. With its final passage, a media-led orgy of self-congratulation will no doubt follow.
In the end, what decided the bill’s passage was pressure brought to bear by the White House, acting on behalf of the most powerful sections of the financial elite.
There has always been a stark difference between the public appeal made by the Obama administration, accompanied by phony populist attacks on the insurance companies, and the fundamental strategic aims guiding the health care overhaul, which were worked out by Washington think tanks behind the backs of the American people.
Details on what is actually included in the legislation have deliberately been left vague. The public presentation by the administration and congressional Democrats is designed to conceal far more than what it reveals. Through no fault of their own, most people are largely in the dark as to what the implementation of the bill’s provisions will mean for them and their families. For all of Obama’s talk of the great debate over health care, there has been no serious or honest public discussion.
The main features of the bill include hundreds of billions of dollars in cuts to Medicare, and the requirement that individuals and families obtain insurance or pay a fine, thus providing a new influx of cash-paying customers for private insurance companies. Businesses are under no obligation to provide their workers with insurance, paying only minimal fines if they do not.
The government and the corporations are to a large extent absolved of any responsibility for funding health care, and the working population made to foot the bill.
Those elements of the overhaul which, within the framework of American liberal politics, were proclaimed to be absolutely essential—such as the public option—were abandoned long ago. They were initially included as a fig leaf, to make it easier for Obama’s liberal supporters to sell the scheme to the American people.
Concession after concession to the Republican Party was said to be necessary in order to obtain bipartisan support. But after it became clear that no Republican support would be forthcoming, rather than restoring the discarded provisions, new regressive measures were added.
A shameful agreement was reached with the most right-wing sections of the Democratic Party itself to further restrict abortion coverage. Final passage was secured through a deal with Democratic Representative Bart Stupak, an anti-abortion advocate from Michigan. Obama agreed to sign a last-minute executive order confirming that no federal funds would be used for abortions under the terms of the bill.
The executive order, as well as language in the bill itself, means that individuals receiving government subsidies—that is, the working class and the poorest layers of society—will be prevented from purchasing insurance that covers abortion.
This testifies to the political bankruptcy of the liberal and so-called “left” supporters of Obama. What they claimed for decades was the central issue necessitating support for the Democratic Party—the right to an abortion—was abandoned without a protest.
Comparisons to the passage of Social Security (in 1935) and Medicare (in 1965) proliferate in the media and in statements from the White House and congressional Democrats. When these landmark reforms became law, however, people were clear on their implications.
Enactment of Social Security meant that retirees would receive a monthly check in the mail. With Medicare, people knew that when they reached the age of 65 they would receive medical coverage under the government-run program. With this so-called “reform,” by contrast, nobody knows what to expect.
The earlier measures, like every social reform wrested from the American ruling class, were connected to broad social struggles. Enactment of Social Security came as a response to the mass movement of the working class for industrial unions. Medicare coincided with the civil rights movement, a wave of militant strikes, urban uprisings, and the initial stirrings of popular opposition to the war in Vietnam.
This measure has been drafted and imposed from above. It is entirely in line with the overall policy of the Obama administration.
The White House and Congress have responded with indifference and contempt as millions have been made jobless, lost their homes, and struggled to pay their rent and utility bills. While trillions of dollars have been allocated to bail out Wall Street, no meaningful measures have been taken to alleviate the catastrophe facing working class families.
All of Obama’s policies have been geared toward increasing social inequality. School closures and privatizations and mass teacher firings have been endorsed by his administration. General Motors and Chrysler were driven into bankruptcy in order to create conditions where the wages, working conditions and health benefits of auto workers could be savagely attacked.
The claim that the health care overhaul is an oasis of progress in this desert of social reaction is simply a lie. The experiences of millions of people—who have seen no sign that the government is in any way responding to their needs—have fueled well-deserved skepticism and outright opposition to the health care legislation within wide layers of the population.
The bill aims to deal with what is seen as a pressing problem for the ruling elite. While corporations, with the collaboration of the unions, have been able to drive down wages and increase productivity, they have not been able to put a brake on spiraling medical costs. These come in the form of increased costs for employee insurance coverage, as well as care for the poor and uninsured who seek medical treatment at emergency rooms and public clinics, thus driving up costs overall.
A solution to this problem for big business—one which is addressed by Obama’s health care restructuring—is to dump these more vulnerable sections of the population into bare-bones plans, where limitations are placed on more expensive and “unnecessary” tests, treatments and drugs. These will include stripped-down Medicaid plans, a gutted Medicare program where care is rationed according to “cost effectiveness,” and substandard plans available for purchase on insurance “exchanges.”
The health care legislation sets a dangerous precedent for a far broader assault on social programs, elements of which have already been put in motion by the administration. Last month, Obama established by executive order a bipartisan commission on deficits, which will propose measures to slash government spending on Medicare, Medicaid and Social Security.
In the coming period, when millions become clearer on the real implications of the health care bill, the brutal reality will inevitably provoke an enormous sense of betrayal and anger. This will set the stage for the emergence of new forms of struggle as people begin to consider the alternative to a corporate-controlled health care system—that is, one based on a socialist program that begins with basic human needs rather than corporate profit.
