The announcement this week of the American Health Care Act (AHCA) by the House Republicans marks an intensification of the assault on health care that was initiated by President Barack Obama and the Democrats in 2010 with the enactment of the Affordable Care Act (ACA), popularly known as Obamacare.
The legislation now making its way through various committees is expected to come up for a full vote by the House sometime this spring. The bill includes massive cuts and the de facto ending of Medicaid as an entitlement program. Medicaid, launched in 1965, is a health program jointly administered by the federal government and the states that provides insurance for the poor as well as for disabled and elderly people and pregnant women.
Under the AHCA, federal funding for Medicaid based on need would be replaced with a per capita cap, forcing states to cut benefits and deny coverage to qualified recipients.
Other measures in the bill would cut government assistance to those purchasing insurance, a key component of Obamacare, by ending government subsidies and replacing them with a minimal tax-write off based on age. It would remove requirements for large employers to provide coverage for their workers. It would also provide massive tax breaks for medical device firms and other companies and repeal the payroll tax increase on high-income earners.
The bill would prohibit federal funding for Planned Parenthood clinics for one year, limiting access to abortion and other health services to millions of women. It is estimated that as many as 15 million Americans would lose health insurance coverage in the first several years of the AHCA.
President Donald Trump repeatedly promised on the campaign trail that he would “repeal and replace” Obamacare with “something better.” Obamacare was demagogically presented as a “left” or even “socialist” program by Trump and the Republicans and upheld as a great social reform by the Democrats, when in fact there is nothing remotely progressive about the program.
Obamacare was designed by and for the insurance giants, hospital chains and pharmaceutical corporations, with a focus on driving down health care costs for big business and the government, rationing care, and increasing corporate profits. It is aimed at undermining the system of employer-provided health insurance established in the aftermath of World War II, forcing workers onto the private market to purchase insurance on an individual basis.
It directs billions of dollars to the insurance companies by mandating, with the threat of a tax penalty, that individuals who do not receive health insurance from their employer or through a government program buy insurance from private companies. The most affordable plans available provide substandard coverage, with narrow networks of providers, skyrocketing premiums and high deductibles and co-pays.
Even with the mandate and other provisions, Obamacare has left at least 20 million Americans completely uninsured. It has been used to phase out the principle of “fee for service” in favor of so-called “cost-benefit,” a euphemism for denying more expensive procedures, drugs and treatments to ordinary working people. The ultimate aim was to cut costs by reducing life expectancy for workers and their families.
As the World Socialist Web Site has insisted from the start, Obamacare is a counterrevolution in health care and has nothing in common with providing the “near universal” and “affordable” health care promised by Obama. As is now clear, its main function was to create the framework for an even more ferocious assault under the auspices of the Republicans.
Under the Trump administration, the Democrats have made the defense of Obamacare their main domestic issue, second only to their anti-Russian campaign against Trump and the defense of the CIA.
The differences between the Democrats and Republicans on health care are essentially tactical. The two reactionary camps are seeking to work out the best way to implement attacks on health care for working people and retirees in order to funnel ever larger sums of money into the pockets of the rich.
Both parties uphold the principle of private ownership and control of the health care system and its subordination to the greed of the corporations and Wall Street.
Economist Paul Krugman, a leading apologist for the Democrats and Obamacare, highlighted this fact in his New York Times op-ed column Friday, acknowledging that the House Republicans’ plan “accepts the logic and broad outline of the Affordable Care Act.”
The current debate in Congress and the media raises the urgent need for a socialist policy of universal health care to meet the needs of the entire population, not just those wealthy few at the top who dominate American society.
Obamacare has proven that there is no longer any progressive reform possible within the framework of the American capitalist system. But the attack is not limited to the United States. Health care is being relentlessly slashed in all major capitalist countries, including the UK and Canada, where government-run programs are being starved of funds and increasingly privatized.
The only viable basis for providing quality health care for all is one that rejects capitalist private ownership and control of the banks and major corporations and the subordination of social needs to private profit. The capitalist principle of for-profit health care must be ended.
Working people must take the position that health care is a social right—along with education, housing, employment, retirement and access to culture—not a privilege reserved for the wealthy, and must be provided to all free of charge.
The only way to ensure this right is through the nationalization of the health care industry and its transformation into a publicly owned institution under the democratic control of the working class. On this basis, conscientious health care professionals, scientists and administrators will be empowered to marshal the resources created by the labor of the working class to meet the needs of the entire population.
The fight for universal, quality health care is a political fight against the ruling elite and all of its political representatives, beginning with the Democrats and Republicans. It requires a complete break with the two-party system and the establishment of a mass independent political movement of the working class based on a socialist program.