U.S. healthcare & Obama's concessions

The current U.S. system is expensive and inefficient.

[T]he incredible cost of US health care is breath-taking, whether you're a reformer or anti-reformist. The US spent some $2.2 trillion (£1.34 trillion) on healthcare in 2007. It is a mind-boggling number which amounts to over 16% of US GDP. That is nearly twice the average spent by other rich nations with advanced health systems - yet you have to wonder if this is value for money when, by most measures, the US is a less healthy nation than other rich countries, on everything from infant mortality to longevity.

The U.S. healthcare system needs reforming. Cue Barrack Obama, one time advocate of single payer healthcare system.

As Paul Krugman writes, the single payer healthcare system would be the best option for reform.

True “socialized medicine” would undoubtedly cost less, and a straightforward extension of Medicare-type coverage to all Americans would probably be cheaper than a Swiss-style system.

The evidence makes interesting reading.*

Despite his previous endorsement of single payer healthcare, Obama repositioned himself in opposition to single-payer healthcare during the presidential candidacy campaign. His new proposition was for a public option to compete with private insurers.

Since the presidential election, Obama has constantly made concessions. In March 2009, Obama talked about the importance of being pragmatic

Each of us must accept that none of us will get everything that we want, and that no proposal for reform will be perfect. If that's the measure, we will never get anything done.

This was an exceptional piece of positioning; he presented himself as being open-minded and pragmatic whilst simultaneously ruling out a single payer solution. Since then, Obama has gone even further to placate those in opposition to significant healthcare reform, Obama recently said:

[T]he public option, whether we have it or we don't have it, is not the entirety of health care reform. This is just one sliver of it, one aspect of it. And by the way, it's both the right and the left that have become so fixated on this that they forget everything else.

Obama's change of discourse suggests that the competing public option proposal is now off the table. In a generous light, the initial change of stance could be viewed as born of the ugly reality of electoral politics rather than unprincipled toadying. If Obama makes this latest concession, which he seems willing to make, there can be no such generosity. In three moves Obama's stance on healthcare has changed from seemingly principled, to apparent pragmatism, to sell-out.

In the light of Obama making concession after concession, will the considerably watered down healthcare reform package pass?

At this point, all that stands in the way of universal health care in America are the greed of the medical-industrial complex, the lies of the right-wing propaganda machine, and the gullibility of voters who believe those lies.

Oh dear ... The lessons of Clinton healthcare plan of 1993 teaches us that this is a formidable opposition.

During the Clinton administration, support for completely rebuilding the health care system peaked in the spring of 1993 [55%] and declined subsequently. By June 1994, just 37% said the health care system needed to be completely rebuilt.

This does not mean that the opposition to healthcare reform is insurmountable. Healthcare reform has popular support. As Chomsky notes in Failed States, the majority of Americans recognise that their healthcare system needs reforming.

"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 percent of Americans think it is a good idea to guarantee health care for all U.S. citizens, as Canada and Britain do, with just 27 percent dissenting'."

Regardless of the fact the U.S. polity is contradicting the will of the majority, the question is whether a reform so far removed from perfect is worth 'getting done' at all?

On the one hand, the reform itself is to be welcomed for improving America's healthcare system by potentially providing universal healthcare. The proposed healthcare reforms will make U.S healthcare more like the Swiss healthcare system, which primarily provides universal coverage through regulation and subsidy.

On the other hand, whilst the Swiss system provides good care, it is expensive. The only reason that the Swiss-style system is an improvement is that the status-quo is so inefficient and iniquitous. Obama has thrown away the opportunity to implement a progressive government-run healthcare system that would benefit more Americans significantly more so than this fudge. (Even his seemingly discarded proposal of 'competitive public option' system would be preferable).

With his endless concessions, Obama may have bought the votes of the odd 'blue dog', but by and large, the latest proposal continues to face the same opposition that a proposal for a single payer healthcare system would have faced. America needs Obama to be the strong and principled leader he portrays himself to be. America needs a president that ignores manufactured opposition, listens to the right-minded, and defends the interests of the people he serves. What America has is flaccid corporatist**.

*UK citizens might be interested to note that the NHS is comparatively cheap and efficient. In contrast to the current U.S system, it provides better care on almost every measure and costs around 40% as much per person. Although, when considering healthcare provision, it is important to bear in mind more than the degree of privatisation and amount of expenditure. Policy priorities significantly influence results. For instance, Cuba's universal healthcare includes preventive health care provision. Japan's citizens have healthy lifestyles. In both of these considerations the U.S. lags behind, which makes U.S. healthcare very inefficient in terms of expenditure versus life expectancy. A point well made by Chris Dillow at Stumbling and Mumbling. The American system is also hugely wasteful in term of 'over-treating' the elderly. (Of course, the argument could always be made that such factors are economically determined, but I digress).

** The link is to an excellent (but very long) article by Paul Street about Obama. As it is on Znet, you may have to register to view it.

Update

I might try to re-write this and offer it as a new post in the future, because, in attempting to pre-emptively defend my argument, it has become diffuse. The latest article by Paul Krugman reiterates some of the arguments contained above in a clearer manner.

[T]here’s a point at which realism shades over into weakness, and progressives increasingly feel that the administration is on the wrong side of that line. It seems as if there is nothing Republicans can do that will draw an administration rebuke: Senator Charles E. Grassley feeds the death panel smear, warning that reform will “pull the plug on grandma,” and two days later the White House declares that it’s still committed to working with him.

It’s hard to avoid the sense that Mr. Obama has wasted months trying to appease people who can’t be appeased, and who take every concession as a sign that he can be rolled. [...]

[T]he supposed alternative, nonprofit co-ops, is a sham. That’s not just my opinion; it’s what the market says: stocks of health insurance companies soared on news that the Gang of Six senators trying to negotiate a bipartisan approach to health reform were dropping the public plan. Clearly, investors believe that co-ops would offer little real competition to private insurers.

Also, and importantly, the public option offered a way to reconcile differing views among Democrats. Until the idea of the public option came along, a significant faction within the party rejected anything short of true single-payer, Medicare-for-all reform, viewing anything less as perpetuating the flaws of our current system. The public option, which would force insurance companies to prove their usefulness or fade away, settled some of those qualms. [...]

So progressives are now in revolt. Mr. Obama took their trust for granted, and in the process lost it. And now he needs to win it back.

Basically, Obama should take a leaf out of Barney Frank’s book.

Noam Chomsky Political Discourse Dictionary

Preface

Almost every term in political discourse has a literal meaning and a propaganda version. […] The propaganda version - which is typically the one that prevails - that's the version presented by those who have the power to control discourse, propaganda, framework of discussion, and so on. And, in that case, that means primarily the United States.

Presented below select definitions of the ‘propaganda version’ of terms offered by Chomsky. It is a work in progress. Further suggestions (preferably sourced) and comments are encouraged.

Anti-Globalization - a propaganda term devised by the advocates of a particular investor-rights version of international integration. No sane person is opposed to globalization, surely not the left or the workers movements, which were founded on the commitment to international solidarity - that is, a form of globalization that is concerned with the rights and needs of people, not private capital.

Debt Repayment, International - commercial banks made bad loans to their favorite dictators, and those loans are now being paid by the poor, who of course had absolutely nothing to do with the process.

Democracy, Developing Nations – requires that the media and political system be in the hands of local oligarchies or similar elements committed to the form of “development” favoured by U.S. investors, that the public be marginalized (by violence, if necessary), and that the military, with its long-established links to the U.S. system of violence, be granted free rein.

Democracy Promotion - The neoliberal rollback of democracy.

[Note]. Where neoliberal rules have been observed since the '70s, economic performance has generally deteriorated and social democratic programs have substantially weakened.

Demographic Problem – a term devised to disguise the obviously racist presuppositions

Deterrence - means the opposite of what it says. Our offensive stance should primarily be based on nuclear weapons because they are so destructive and terrifying. Furthermore, just the possession of massive nuclear forces casts a shadow over any international conflict, as people are frightened of us because we have this overwhelming force.

Economic Interest, National - a misleading term because countries don't have economic interests, groups inside of them do and those interests may differ.

Failed State - a state that has the formal political institutions, but they are not functioning. Functioning in a democratic society is supposed to mean that public policy somehow reflects public interests and concerns.

Financial Crisis - "the crisis" has a clear enough meaning: the financial crisis that hit the rich countries with great impact, and is therefore of supreme importance.

Globalization - specific form of international economic integration that has been instituted within the "neoliberal" framework of past several decades.

Humanitarian Crisis - a problem somewhere that threatens the interests of rich and powerful people [as opposed to] the massacres in Colombia, for example, or the slaughters and expulsions of people in south-eastern Turkey, which are being carried out with crucial support from Clinton. Those aren't humanitarian crises.

International Community, The - a technical term referring to Washington and whoever happens to agree with it.


Labour Flexibility - a fancy way of saying that when you go to sleep at night, you don't know if you have a job tomorrow morning - and that's supposed to be a very good thing. […] Labour-market flexibility has gotten a bad name as a euphemism for keeping wages down and workers out, which in fact is exactly what it is, which is why it's gotten that bad name.

Legal - in US-Israeli parlance means "illegal, but authorized by the government of Israel.”

Libertarian - means the opposite of what it always meant in history. Here [the U.S.] it means ultra-conservative - Ayn Rand or Cato Institute or something like that.

Literal meaning

Socialist and anti-state, an anti-state branch of socialism, which meant a highly organized society, completely organized and nothing to do with chaos, but based on democracy all the way through. That means democratic control of communities, of workplaces, of federal structures, built on systems of voluntary association, spreading internationally.

Etymology of literal meaning
Throughout modern European history meant socialist anarchist. It meant the anti-state element of the Workers Movement and the Socialist Movement. It sort of broke into two branches, roughly, one statist, one anti-statist. The statist branch led to Bolshevism and Lenin and Trotsky, and so on. The anti-statist branch, which included Marxists, Left Marxists - Rosa Luxemburg and others - kind of merged, more or less, into an amalgam with a big strain of anarchism into what was called "libertarian socialism."



Manufacturing Consent –

Etymology
“The term "manufacturing consent" is not mine, I took it from Walter Lippmann, the leading public intellectual and leading media figure of the twentieth century, who thought it was a great idea. He said we should manufacture consent, that's the way democracies should work. There should be a small group of powerful people, and the rest of the population should be spectators, and you should force them to consent by controlling, regimenting their minds. That's the leading idea of democratic theorists, and the public relations industry and so on”

Moderate - 'they do what we say' - willing to conform to US demands, irrespective of the nature of the regime.

NAFTA Miracle - a "miracle" for U.S. investors and the Mexican rich, while the population sank into misery.

National Security Interests - only an incidental relation to the security of the nation, though they have a very close relation to the interests of dominant sectors within the imperial state, and to the general state interest of ensuring obedience.

Nicaragua, The U.S. War Against - if we want to be kind to the United States - we could say it was international terrorism. A stronger, probably more accurate, term would be outright aggression.

Peace Process - conventionally used to refer to whatever the U.S. government happens to be doing, often undermining diplomatic efforts.

Radical - not under U.S. control.

Rogue State - is used to refer to any state that is disobedient, that the US has in the sights of its rifles. […] An instrument of propaganda, to beat selective enemies over the head.

Stability

1. a code word referring to a “favourable orientation of the political elite” – favourable not to their populations, but to foreign investors and global managers.
2. subordination to Washington’s will 

Terrorism - literal meaning - the calculated use of violence against civilians to intimidate, induce fear, often to kill, for some political, religious, or other end. It turns out to be almost the same as the definition of official U.S. policy. Except, when it is U.S. policy, it is called ‘counter-insurgency’ or ‘low-intensity conflict’ or some other name. Furthermore, if you apply the literal definition, you conclude that the U.S. is a leading terrorist state because it engages in these practices all the time.

propaganda version - directed against the United States or its allies and carried out by enemies


Terrorism, International - introduced during the 1980s when it was pretty clear that the Soviet pretext was collapsing and another one had to be found and "international terrorism" was invented as a pretext to replace it.


Tough love - love for the rich and privileged, tough for everyone else.


Trade - propaganda version [used in addition to literal meaning]. An operation inside of a command economy which has to cross borders. E.g. US trade with Mexico after NAFTA - about half of it is not trade in any serious sense. It's just interaction as internal to a command economy. If General Motors makes the parts in Indiana and sends them to Mexico to be assembled because they have cheaper labor and fewer environmental constraints, and then sends them back to Los Angeles to sell the cars, that is called trade in both directions, but it is not trade in any reasonable sense. 


U.S., The -

1. a leading terrorist state.
2. "United States" is conventionally used to refer to structures of power within the United States; the "national interest" is the interest of these groups, which correlates only weakly with interests of the general population.

Chomsky on Israeli settlement expansion

Chomsky wrote the following about the planned expansion of Israeli settlements in Palestine:

Washington's position was presented most strongly in Hillary Clinton's much-quoted statement rejecting "natural growth exceptions" to the policy opposing new settlements. Netianyahu, along with President Peres and in fact virtually the whole Israeli political spectrum, insists on permitting "natural growth" within the areas that Israel intends to annex, complaining that the US is backing down on Bush's authorization of such expansion within his "vision" of a Palestinian state.

Senior Netanyahu cabinet members have gone further. Minister Yisrael Katz announced that "the current Israeli government will not accept in any way the freezing of legal settlement activity in Judea and Samaria.” (Ha'aretz, May 31). The term "legal" in US-Israeli parlance means "illegal, but authorized by the government of Israel.” In this usage, unauthorized outposts are termed "illegal," though apart from the dictates of the powerful, they are no more illegal than the settlements granted to Israel under Bush's "vision."[…]

If Obama were serious about opposing settlement expansion, he could easily proceed with concrete measures, for example, by reducing US aid by the amount devoted to this purpose. That would hardly be a radical or courageous move. The Bush I administration did so (reducing loan guarantees), but after the Oslo accord in 1993, President Clinton left calculations to the government of Israel. Unsurprisingly, there was "no change in the expenditures flowing to the settlements," the Israeli press reported: "[Prime Minister] Rabin will continue not to dry out the settlements," the report concludes. "And the Americans? They will understand" (Hadashot, Oct. 8; Yair Fidel, Hadashot Supplement, Oct. 29, 1993).

Obama administration officials informed the press that the Bush I measures are "not under discussion," and that pressures will be "largely symbolic" (Helene Cooper, NYT, June 1). In short, Obama "understands." […]

[A]ll of these discussions about settlement expansion evade the most crucial issue about settlements: what Israel has already established in the West Bank. The evasion tacitly concedes that the illegal settlement programs already in place are somehow acceptable (putting aside the Golan heights, annexed in violation of Security Council orders) -- though the Bush "vision," apparently accepted by Obama, moves from tacit to explicit. What is in place already suffices to ensure that there can be no viable Palestinian self-determination. Hence there is every indication that even on the unlikely assumption that "natural growth" will be ended, US-Israeli rejectionism will persist, blocking the international consensus as before.