Friday, October 22, 2010

Health Reform, US Style

In March 2010, President Obama signed into law the Patient Protection and Affordable Care Act HR 3590. This historic bill for the first time extended mandatory medical care to 94 per cent of US citizens, adding another 32 million people to the healthcare system. Under this law, insurance companies can no longer deny people healthcare on the basis of pre-existing conditions. Young people are allowed to stay on their parents’ insurance until age 26. It extended coverage for senior citizens and strengthened Medicare. Still, the bill did not include a single payer system where the government would be able to provide health insurance for all. In reality, what was called health care reform in the US was a victory for the health insurance industry, biotech corporations, big pharma and the health maintenance organisations. The US is so conservative that the extreme right branded the bill as a government takeover. The bill was a desperate measure to stabilise the capitalist system in a period when the US system spends over $2.2 trillion on healthcare and yet ranks number 37 in the provision of health care for its citizens. This inefficient system of capitalist accumulation holds the citizens of the US hostage to an outmoded form of economic organisation in the 21st century. Throughout the history of capitalism in the USA, it was the capitalists who decided who had the right to live. Europeans who have always had a government health service, tongue in cheek told the US, ‘welcome to the 20th century,’ because even after this ‘reform’ there is not a universal system of healthcare coverage.


In any society, one cannot separate mental, physical, spiritual, and emotional health. And by this criterion, the US is an unhealthy society. Racism has besmirched the society so that there is the stress and strain of living under racist laws and policies. The healthcare system was one where big companies in the health business made mega-profits. In a very inefficient system, where healthcare spending was at approximately 15.2 per cent of GDP, 59 per cent of the population were covered by private capitalists (through employers), while 26 per cent was covered through the government ‘medicare’ system. Over 15 per cent – approximately 45-50 million persons – were without healthcare. The healthcare providers were making so much money that this branch of accumulation created a severe crisis for other capitalists. Hence, as a desperate measure to save the section of the capitalist class squeezed by the healthcare industry, it was urgent that the government institute a system to prop up capitalism in general. This is what Lawrence Lessig calls a broken system. In the USA, health is considered a privilege, not a right; under this kind of thinking, only the privileged should live.

In many areas of social engagement, the USA is an unhealthy society. The air is polluted. Sixty per cent of Americans live in areas with unhealthy air pollution levels. Rivers and lakes are dumping grounds for toxic materials. The food industry is organised for the profitability of the industry, making the US a ‘fast food nation’ where processed foods do great damage to the health of citizens. Most of the favourite food types in the society – hamburgers, hot dogs, french fries, cookies, pizza, Soda (soft drinks), chicken wings, ice cream, doughnuts, and potato chips – are injurious to the health of the citizens, as they are processed foods that leave citizens with symptoms like weight gain, fatigue, headaches, aches, joint pains and so much more. Unhealthy food has always been a problem, but this has been accentuated by the era of genetically modified foods and genetically modified seeds.

Yet, unhealthy food is good for profits in so far as the more unhealthy the people, the better for the pharmaceutical companies.

The health of the citizens is further being compromised by the widespread use of chemicals in society. Pesticides, petrochemicals, and fossil fuel have been so widely used that the country is polluted to the point of creating a cancer epidemic. When one adds the leading causes of death – hypertension-stress, cardiovascular disease, HIV/AIDS, diabetes, cancer and high blood pressure – it can be seen that what is needed in the US is not healthcare reform per se, but a complete change in the mode of economic organisation, so that everyone has a right to health and decent life. In essence, the health care reform debate reopens an old question in the US: who has a right to life?


The economic and social consequences of this system were so outrageous that there was a clamour in the society for complete change. Big capitalists in the automobile industries (such as General Motors) were calling for a change in the system because they complained that their competitors in Europe and Japan had government-subsidised healthcare. Small businesses called for reform because so much of their profits were taken up by the cost of providing healthcare for the workers. Doctors and healthcare providers were conscious of the waste of the system that spent the most in the world but was 37th.The trade union movement was one of the big lobbies for healthcare reform because working people wanted change in the delivery of health. Senior citizens were lobbying through their organisation the American Association of Retired Persons (AARP), and breast cancer survivors and women who termed health a gender question were clamouring for investments in healthcare. These women argued that just being a woman was a pre-existing condition. In essence, the section of the society that wanted healthcare was the vast majority of the 80 per cent of the population that suffered as a result of the cancerous society.

Yet, the three per cent of the mega capitalists could dominate the US legislative chambers to the point that, even before the healthcare bill was written, the Obama administration had acquiesced to the wishes of pharmaceutical companies. As one writer summed up the process of getting out this legislation, the Obama team bought off Big Pharma with the promise not to use market forces to force down prices for prescription drugs, and the insurance industry with the promise that it would face no new competition from a public option. So by the end, the administration succeeded in, according to Lawrence Lessing, ‘bribing and accommodating them to such an extreme degree that they ended up affirmatively supporting a bill that lavishes them with massive benefits.’

This is how conservative the society has become – that even in the face of this major compromise, the liberal language of health disparities and health care reform cannot fully explain to the people what was so good about this healthcare reform bill.

Despite the fact that conservatives have railed against this Patient Protection and Affordable Care Act, one can see from studying the fine points of this bill that it is not a system of universal healthcare. It is a system to prop up the capitalists in the health industry, because even with these ‘reforms’ 18 million people will still be left out of the healthcare system. These are the citizens who do not have the right to live.


The US was founded on a system of hierarchy, in which the First Nation people did not have a right to life. The first European settlers in the US killed millions of the indigenous peoples. Their livelihoods were destroyed, and up until this day, hazardous waste is dumped in the lands and rivers of these first nation peoples.

At the dawn of the Republic of the USA, the only enslaved Africans that were seen as healthy were those who submitted to slavery. Any enslaved African who opposed slavery was diagnosed with an illness – drapetomania; for slave masters the cure for this illness was whipping the enslaved Africans. This episode in the medical history of the US has been documented in the book, ‘Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present’, by Harriet Washington. The book traces the history of experimentation on the bodies of enslaved black men and women. Gruesome tales of mutilation, forced sterilisation, violation, and terror is to be found in the history of medicine in the US. In fact, when the US was prosecuting the Nazis in the Nuremberg trials for forced sterilisation, the US government was carrying out the same sterilisation on black people.

The story of the development of one branch of medicine – gynaecology and obstetrics – owes so much to the experimentation on the bodies of enslaved black women. The story of Dr Marion Sims, the father of US gynaecology is becoming better known. Sims took enslaved black women and carried out experiments on them without anaesthesia. After the period of enslavement, there was the era of the well-known Tuskegee syphilis experiment, when the US Department of Health experimented on a group of black men for forty years to see the impacts of syphilis on black people. This same medical experimentation continues today with illegal experimental AIDS trial that has been going on in Africa. In the book, The Constant Gardener, John Le Carré presents a fictional account on the role of pharmaceutical companies in experimentation on black bodies. When interviewed, Le Carré said that the real horror of the experimentation and testing on Africans at home and abroad is more horrendous than described in the book. It is the same medical infrastructure that worked to support the patent laws to deny medicines to people who were dying of HIV/AIDS.


African brothers and sisters still remember the pressures of the US government against the South African government when the people demanded antiretroviral drugs for the millions dying of AIDS. As in the USA, so was it in South Africa: The health of the profits of the pharmaceutical companies was far more important than the health of human beings. It required an intercontinental grassroots movement linking the Treatment Action Campaign (TAC) in South Africa to the Aids Coalition to Unleash Power (ACTUP) to shame the Clinton administration, which was defending the big pharmaceutical companies on the grounds of defending Trade Related Intellectual Property Rights (TRIPS). African people at home and abroad joined with other forces in the Third World to oppose the stipulations of the World Trade Organization to defend the big companies and bioengineering MNCs like Du Pont, Novartis, Monsanto, Pfizer, Eli Lilly and Dow Chemicals. The battle of Seattle of 1999 was a battle over the future of health.

Samir Amin has written in his book, ‘The Liberal Virus’, that under the thinking of these big companies, the planet can dispense with the lives of over 2 billion people. In short, only one section of humanity should have the right to live. The tremendous growth in capacities of the ‘scientific establishment’ to isolate and recombine genes of plants, animals and humans and ‘play God’, is being accompanied by a ‘new supporting sociology’, a ‘eugenics civilization’ and a ‘new cosmological narrative.’ One can find out about the power of these big companies in the book, ‘The Biotech Century’. The essence of these sweeping economic and social forces is a new outlook towards humans, a commodification where ‘the working unit is no longer the organism, but rather the gene’ (p.14) and respect and dignity shift from the individual to strands of manipulable chromosomal information. ‘Cell by cell, tissue by tissue, organ by organ, we may willingly surrender our personhood in the marketplace’ (p173). Ergo, when politicians, scientists and corporate leaders in the developed world sing paeans to the marvels of the biotech century, ‘they are being disingenuous in their public pronouncements’ (p36). Jeremy Rifkin’s path-breaking book, although purporting to present data and leave to the reader the choice of deciding which side one is on, is effectively an exposé of the falsity and inequity of most marvels prophesied by the promoters of unrestricted bioengineering. Rich people can spend millions on cosmetic surgeries and investing in their beauty while the poor die of hunger, environmental racism and exploitation.

The healthcare reform package of Barack Obama will not help the poor and a large section of US citizens. From the foregoing, it can be seen that health question isn’t simply one of access to care but more fundamentally as to who has right to live in the society. Universal health care will only come from bottom-up organising in the society. It cannot come from on top. When the healthcare bill was passed in the US, European newspapers commented that the US was now entering the 20th century. That is because the debate about who should have healthcare dates back to the 19th and 20th century. The USA has not entered the 21st century when it comes to valuing the lives of human beings. It was in the face of the widespread opposition from the right that progressives such as Congressman Dennis Kucinich supported the reform, looking for a new day when the reform battle will be extended. Progressives must see the healthcare reform bill as the start of the fight for universal healthcare.