By Andrew D. Coates, M.D.
Portside news service, March 22, 2013
Nelson Lichtenstein (“Obamacare’s other benefit,” L.A. Times, March 19) is correct to hint at the potential for human liberation that universal, free access to necessary health care would bring to the United States, especially in view of the declining standard of living for the great majority of our population.
But his effort to spin the Affordable Care Act (ACA) and the corporate-backed enrollment of millions of people in private insurance plans as a liberating blow for democracy is an impossible stretch.
In this new, post-ACA era, inadequate access to care, uninsurance, underinsurance, medical bankruptcy and state-by-state rationing of care for the poor will remain the order of the day.
Enrollment in Medicaid and/or a costly, insufficient private insurance policy will not prove liberating for the American people, let alone for those who gain such inadequate “coverage.”
The present acceleration of hideous inequalities, long a hallmark of our unjust health system, will further erode, not restore, democracy in the United States.
Health system planning in the U.S. is increasingly based upon maximizing corporate profits, consolidating financial control, and otherwise enhancing corporate interests. It is based less and less upon individual and community health needs.
Despite its modest benefits, the ACA does not resolve these problems. In many ways it exacerbates them.
Yet Lichtenstein waxes enthusiastic about the potential for the ACA’s state health insurance exchanges, the instruments through which the government aims to compel the uninsured to purchase private health insurance, to contribute to a new flowering of civic involvement and democracy.
He does this even as he acknowledges that the “stakeholders” in the drive to expand private insurance and Medicaid are the big insurers, private hospitals and Big Pharma.
On top of this Lichtenstein invokes the great progressive reform movements of the last 100 years – the battle for women’s suffrage, the fight for jobs and justice during the Great Depression, the struggle for Civil Rights, and the movement to save the environment – as the inspiration for … enlisting people in exchanges where they can buy what will certainly be shoddy private health insurance.
“Because signing up for Obamacare will be complicated,” he envisions a campaign modeled on an army of H&R Block tax preparers! This notion of “Obamacare civic activism” is not only wrongheaded as historical analogy — it is shockingly disrespectful of the creative self-action and self-sacrifice of so many, including those who gave their lives for the causes he cites.
When it comes to health care needs in the United States, we must keep our eye on the prize. The fact remains that nothing short of a public, national single-payer health program will be able to control costs, guarantee access to all, improve the quality of care and protect the vulnerable.
Yes, the movement that wins health care for all will need to draw lessons from the great social movements of the past. Yes, real health reform will give new impetus to our nation’s democracy. Peddling private health insurance policies to the working poor will not get us there.
Dr. Andrew D. Coates is president of Physicians for a National Health Program (pnhp.org).