Of course the US auto industry could have produced greener cars in greener plants. They should have invested more in hybrid, electric vehicle and fuel cell technologies. They might have used their marketing muscle to create demand for smaller cars instead of SUVs. But why should they? Foreign automakers haven’t done much better at any of these things either, especially in the US market. And apart from health care expenses, many foreign and Canadian auto workers are paid as much or more than their US counterparts. So none of these serve to explain why foreign automakers have out-competed the US for a generation.The big difference that establishment politicians turn a blind eye to, and media pundits refuse to mention in print or on the air has always been government-paid universal health care as a human right in Europe and Japan compared to a health care system in the hands of private for-profit insurers in the US. Universal free health care is the secret competitive weapon of the Japanese, Canadian and European auto industries. Unless and until this competitive advantage is equalized, manufacturing automobiles and practically everything else will be far more expensive inside the US than outside it. No amount of money thrown at the auto industry can solve that, and without medical and retirement expenses, foreign automakers are guaranteed to have the extra cash to match and beat anything US automakers invest in innovative green technologies.
Most US politicians omit this vital contextual information because they or their parties take big money from the private insurers. The private health insurance industry eats one third of every health care dollar to finance its executive salaries, its bad investments, its marketing campaigns, and the bureaucratic machinery with which it denies needed care even to the insured. Since they are integral to the our nation’s permanent ruling elite, corporate media shamelessly speak for them and exercise remarkable discipline in keeping nearly all discussion of single-payer medical care away from the eyes and ears of the American public. But thanks in part to the internet, the mainstream media’s conspiracy of silence against single-payer health care is not working as well as it used to.
Not only that, the canard of “socialized medicine” doesn’t have quite the same scare power that it did during the height of the Red Menace. Not to mention, when you are getting charged more and more and more every year for less and less and less coverage, you start to wonder why it is that other countries, other democracies manage to take care of this with less muss and fuss, stories of long waiting times in Canada notwithstanding.
Oh, but surely it’s time for Hope™ and Change™ in Washington?
While president elect Obama has promised what he has called “universal health care”, he and his advisors have explicitly rejected single payer health care. The president elect managed to avoid practically any mention of single payer by name except for the very few unscripted instances he has been asked about it in public. As president, and with a compliant corporate press corps, the opportunities for unscripted questions will be even fewer. The “solutions” advanced by Obama and his advisors will simply make government money available to consumers to buy private health care, and will subsidize a new risk pool, no doubt through other private insurers, for those who can’t find any affordable private coverage.
The campaign web sites repeats his claim that he will lower “paperwork costs” by billions through the introduction of new computer technology. But the big “paperwork” costs are the private insurers’ bureaucracy that denies coverage, their executive salaries and bonuses, thgeir marketing and their bad investments. In fact, the Obama plan on health care does not touch the parasitic insurance companies, and can only raise the cost of health care further without providing adequate care to everyone. Certainly, it does not relieve the US auto industry or other sectors of their crushing health care debt. There is a reason that every wealthy industrialized nation on earth except this one has adopted some form of single payer health care. It works. The other methods don’t.
The president-elect just picked a man, Tom Daschle, to be Secretary of Health and Human Services, whose credentials, I keep hearing, including “writing a book on health care.” Well. That’s great! What does that book say about single-payer?
Mr. Daschle’s book about health policy “Critical: What We Can Do About the Health-Care Crisis” came out in February. In it he proposes creating a Federal Health Board, similar to the Federal Reserve System, and the merging of employers’ plans, Medicaid and Medicare with an expanded federal employee health benefits program that would provide universal coverage.
Oh. That sounds complicated. Wonder if it’s got anything to do with his lobbying clients?
A spokeswoman for Alston & Bird declined to disclose which of the firm’s health care industry clients Mr. Daschle had advised; the firm represents dozens of such concerns including pharmaceutical companies, health care providers, and trade groups for nurses and nursing homes.
Although not a registered lobbyist, Mr. Daschle, a South Dakota Democrat who was party leader in the Senate, provides strategic advice to the firm’s clients about how to influence government policy or actions. The firm’s Web site declares, “Our health care legislative and policy team has the significant advantage of including two former U.S. Senate majority leaders — Senators Bob Dole and Tom Daschle — both resident in our Washington office and champions of many health care issues in their Senate Finance Committee and leadership roles.”
As examples of the firm’s achievements the Web site lists matters involving Medicare and Medicaid reimbursements, approvals of federally regulated drugs and medical products, fraud investigations, medical waste disposal, privacy and other compliance issues.
The Mayo Clinic, where Mr. Daschle is on the board, is itself a major health care provider, research institution, and recipient of grants from the National Institutes of Health.
That, to me, does not sound like Obama has any intention of seriously challenging the health-insurance industry, not if he’s putting the fox in charge of the henhouse. (More on Daschle’s positions here and here. Looks like one of his firm’s clients is HealthSouth, which has a little fraud problem.)
However, it’s not like all is lost. As Bruce Dixon said in the first few grafs of his piece, Presidents don’t keep their promises unless they’re relentlessly pressured to, and so if we want universal single-payer health care rather than the patchwork of half-measures and gifts to the insurance industry proposed by Daschle (and, really, by Obama, who’s never come out for single-payer, even if the collapse of the economy has made it imperative to take Really Bold Steps right about now), we have to make noise:
The president elect and his party need a new plan on health care. It’s up to the base that voted them in to tell them what the new plan is. They’re smart people, it’s not that they don’t know. It’s just politics. To get it done, they need us to tell them. Loudly, insistently and without delay. Power concedes nothing without a demand, and only we can furnish that demand. If we do not furnish it, if we demand nothing, we get nothing.
Fortunately, the Medicare system was designed to be extended into a universal, single-payer system, if only there is the political will to do so. And that political will is building, but needs to be pushed by those who really want to see Change made to happen. Details on the system are at the website of Physicians for a National Health Care Plan (and see also DCBlogger’s extensive work at Corrente on the subject). Check out and support Citizens Alliance for National Health Care, who are trying to cut through the media blackout on single-payer. But most importantly, call or write your member of Congress and ask him or her to support John Conyers’ H. R. 676, Medicare For All, or to join the 90 members of Congress who have already become sponsors. And then write to Barack Obama and tell him that you want single-payer health care.
I so agree with you, and will certainly participate in writing to President-Elect Obama and the Congress. Our system is so wrong.
In one of my jobs, they do not offer any health insurance to folks lower than management, but everybody gets sick. One of my co-workers was seriously injured in an auto accident yesterday, and will have surgery today. She will be paying for it for the rest of her life. Can this be right? I don’t think so.
Great post! Thanks for laying it all out so clearly and showing us where to go next.
Our health “care” system is shameful. No system is perfect, but it is inexcusable for such a wealthy, resourceful country to have a system that leaves so many people in bankruptcy and worse because they can’t afford the care they need.
Great piece, zuzu. And thanks for the links. Leave it to John Conyers to be the one making a move on something needed and top priority in Congress–he needs to be cloned stat.
Zuzu, thanks for an excellent analysis!
I did, however, have one small quibble (and it’s not with your piece per se, as it is with something you mention):
as a Canadian I’m really sick of this meme about long waiting times, because there doesn’t seem to be a whole lot of recognition about what got us (Canada) into that position in the first place: namely, a large cadre of conservative politicians pushing for “less government” and cutting the heck out of provincial health care budgets in order to rack up surpluses and win re-election (Ralph Klein, I’m looking at you), which have led to nursing and support staff layoffs, bed closures in hospitals, and…. longer waiting lines. Unfortunately, the free market solution to this in some provinces has been to develop a second tier of private service providers that those with the money can “opt-into” at will, thus further gutting the public system of much-needed doctors and public support.
So my point is this: also crucial to any US single-payer system would have to be a massive PR program to convince people that this might look like “more government,” but that it’s the right kind (I don’t know how to sell that in the US, honestly), and that it will only work if it’s the primary system for every person’s primary care, supported by tax dollars, and not put in place with a second level of private care that will only further create divisions between haves and have-nots. (Look at how well that worked with private vs. public schools.)
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It’s great to see a long policy piece here. I agree with your view. Single payer works best, and I’m worried that Obama has written it off, either because he thinks it’s politically impossible or because he’s ideologically aligned with proponents of weak-tea reform. He has a mandate to make the economy work for ordinary people; this is a big part of that and he ought to do it right. The most popular government programs, to this day, are the most ambitious in protecting ordinary people from financial risk.
in some ways this battle was lost last year, when all three democratic candidates came out with health plans, all of them were basically the “massachusetts plan” signed by mitt romney when he was governor.
none of the three candidates embraced single payer, though there was some talk about how the edwards plan would have a single-payer type option available with the idea that it would outcompete the private plans and thus lay the groundwork for eventual single payer. but edwards himself never said stuff like that.
it’s true that “Presidents don’t keep their promises unless they’re relentlessly pressured to” the problem is that single payer was never one of obama’s promises. i agree that we should turn up the pressure on this issue, i just think that we’re probably going to end up with a health reform plan that includes existing health care companies and thus entrenches them in the system. the new system will be better than what we’ve got (it’s hard to do worse), but i fear that marginal improvement may make single payer less likely in the long run.
This is a great post. I had no idea “paperwork” was an umbrella term for a bunch of shadiness. Thanks for the “what you can do” links, too.
it’s true that “Presidents don’t keep their promises unless they’re relentlessly pressured to” the problem is that single payer was never one of obama’s promises.
True; however, he did promise to take action to fix the economy. And the elephant in the room on the economy (and frankly, it remains a mystery to me why the Big Three aren’t agitating, hard, for single-payer, especially when foreign automakers are putting plants in Canada rather than in the US because of health care costs, unless their goal is simply to break the UAW, which seems to be what a lot of the right-wing pundits want) is health care costs. Single-payer we know would be cheaper, provide better care, and would be easy enough to implement and administer because the Medicare system was designed to be extended to all.
Obama’s walked back some of his statements on Iraq because he wants to be flexible when the situation on the ground changes. But he hasn’t exhibited the same flexibility of thought on health care, even now that the economic situation has so deteriorated that it’s pretty much an imperative to Do Something Big to contain costs. And now not only is Daschle, and his really quite terrible thinking on health care going to be in charge of HHS, he’s asked for and received assurances that he will be in charge of any health care reform proposals. Doesn’t sound like much Change or Hope to me.
excellent post, zuzu–and your point about Medicare is the point to push in this argument, imo, not only because it sounds sane and feasible, but because it moves any conversation into “how we do this” instead of “should we do this” (get conservatives arguing about whether Medicare can even handle the expansion, and presto! they’re arguing outside their own turf).
“(I don’t know how to sell that in the US, honestly),”
I think the sell will have to come from many fronts, but one approach that might work is by appealing to great achievements in the American past (”We Americans used to believe we could improve on the best ideas out there–Kennedy didn’t look at the space race and say, “We can’t do better than the Russians”, he looked and dreamed and brought together the greatest minds in a generation and said: do it better. Surely we can do the same in health care…”) Jump-starting national pride, that sort of thing.
“Doesn’t sound like much Change or Hope to me.”
No–and Obama’s going to pay a stiff price if he doesn’t make good on the H&C promise especially when it comes to health care, because Americans are more than ready to have health care stop being something they worry about, and become something they can count on. If this admin doesn’t deliver on at least *that* promise, 2010 will be a repudiation.
Well written. Politically persuasive.