Declining US doctor visits: A product of social decay and the assault on health care

4 October 2012

The US Census Bureau reported this week that between 2001 and 2010, the average number of doctor visits by individuals aged 18 to 64 fell by nearly 20 percent, from 4.8 visits to 3.9 visits. The report is the latest evidence of a sharp decline in access to health care for millions of Americans.

The economic situation is a major factor in this decline. Millions of people have lost their jobs over the past decade, particularly since the onset of the global crisis in 2008. In the United States, losing one’s job generally means losing one’s health insurance, and uninsured people are much less likely to visit a doctor.

At the same time, insurance companies have been raising premiums and co-payments, making doctor visits a major expense even for those who have insurance. “It’s a widespread decline in the use of medical services,” commented the chief of the Census Bureau’s health and disability statistics branch.

These figures confirm earlier reports of falling doctor visits, fewer prescriptions and stagnant health care spending—a trend that accelerated in 2011 and 2012, years not covered by the Census report. The IMS Institute for Healthcare Informatics reported earlier this year that doctor visits fell 4.7 percent in 2011 compared to 2010, and the number of prescriptions issued fell by 1.1 percent.

The decline in access to health care for millions of people has a predictable consequence: reduced life expectancy. A study released last month in the journal Health Affairs found that life expectancy for the poorest sections of the working class fell sharply between 1990 and 2008. For white women with less than a high school education, life expectancy fell from 78 to 74 years, and for men in this category from 70.5 to 67.5.

This shocking decline is a product not simply of abstract economic forces, but a deliberate policy carried out by the corporations and both big business parties. The aim is to establish a class-based health care system in which the vast majority of the population receives bare-bones care, while the rich have access to the best coverage money can buy.

The decline in health care spending and doctor visits will be welcome news to the Obama administration, which has been working for precisely such an outcome. Behind the administration’s health care “reform” is a bipartisan effort to reduce costs for corporations and the government by restricting medical tests, procedures and drugs, and rationing care—with the inevitable consequence of eroding the health and lifespan of large parts of the population.

One of the aims of Obama’s health care overhaul is to allow corporations to scrap their employee health care programs and force workers to purchase private insurance on the market. As many as 20 million people may lose employer-sponsored coverage by 2019, according to estimates. Individuals forced to buy private insurance will either pay more or receive less coverage, and they will likely be more vulnerable to rising co-payments and cuts in services.

The New York Times, which generally tracks the positions of the Obama administration and the Democratic Party, has spearheaded the media promotion of health care rationing. The Times regularly decries supposedly unnecessary tests and procedures—from mammograms and prostate screenings to stents. The newspaper argues that “excess” health care is positively harmful.

Last April, the Times published an article on health care costs under the headline “In Hopeful Sign, Health Spending is Flattening Out.” This “hopeful” trend was a result of the fact that “millions of Americans lost insurance coverage along with their jobs.” The article continued: “Worried about job security, others may have feared taking time off work for doctor’s visits or surgical procedures, or skipped non-urgent care when money was tight.”

The Census figures released this week cover individuals aged 18-64. They do not include the elderly. Older Americans, because they are covered by the federal Medicare program, have been less affected by the economic imperatives to forego health care.

Within US ruling circles, this is considered a serious problem. As far as the financial oligarchs are concerned, billions are being wasted keeping alive people who can no longer be exploited for profit.

While they have disagreements over the best means of accomplishing the job, a principal aim of both the Democrats and the Republicans is to find ways of imposing huge cuts in Medicare spending.

Steven Rattner—a multi-millionaire financier and former Obama administration “car czar”—spelled out the basic strategy in an opinion piece entitled “Beyond Obamacare” that appeared in the Times last month. Rattner was indicted on charges of corruption and insider-dealing while head of the private equity firm Quadrangle. As the leader of Obama’s Auto Task Force he oversaw the restructuring of the auto industry based on halving the pay of newly hired workers and imposing deep cuts in health care and pension benefits.

“We need death panels,” Rattner’s column began. “Well, maybe not death panels, exactly, but unless we start allocating health care resources more prudently—rationing, by its proper name—the exploding cost of Medicare will swamp the federal budget. But in the pantheon of toxic issues—the famous ‘third rails’ of American politics— none stands taller than overtly acknowledging that elderly Americans are not entitled to every conceivable medical procedure or pharmaceutical.”

Rattner went on to criticize both Obama and Republican vice presidential candidate Paul Ryan—who has proposed privatizing Medicare and turning it into a voucher program—for avoiding stating the main issue: the need to deny medical treatment to some retirees.

“Medicare needs to take a cue from Willie Sutton, who reportedly said he robbed banks because that’s where the money was,” Rattner wrote. “The big money in Medicare is not to be found in Mr. Ryan’s competition or Mr. Obama’s innovation, but in reducing the cost of treating people in the last year of life, which consumes more than a quarter of the program’s budget.”

While Rattner presents his comments as a criticism, they point to what is, in fact, the aim of both the Democrats’ and Republicans’ proposals: reduce health care for the working class, and particularly the elderly. Obama’s proposal centers on government panels to recommend reduced coverage, while Ryan has advocated outsourcing this responsibility to private insurers.

The presidential elections are part of a general conspiracy against the American population, in which the real plans of the ruling class are concealed. Regardless of who wins the election, Obama or Romney, the financial aristocracy—which is responsible for the worst economic crisis since the Great Depression—is planning on vastly escalating its social assault on the American people.

Joseph Kishore