The last 10 days have marked an escalation of the bipartisan conspiracy against the health care rights of working class Americans. After Congressional Republicans’ numerous failed attempts in recent months to “repeal and replace” the Affordable Care Act (ACA), the Trump administration has issued a series of executive orders aimed at undercutting the legislation popularly known as Obamacare.
The president’s first order expanded exemptions for employers who claim moral or religious objections from requirements under the ACA to provide their workers with no-cost birth control.
Next, Trump finalized an executive order to allow “association health plans” an exemption from the ACA’s requirements to provide 10 essential services in their insurance coverage.
Finally, the administration announced that, beginning next Wednesday, it would be scrapping cost-sharing reduction payments (CSRs) to private insurers that help low-income Americans purchase health coverage.
Trump made clear that he is seeking to reach out to congressional Democrats to make a deal on health care “reform,” that is, changes to Obamacare to further reduce health care coverage. In a post on Twitter Friday morning, he said, “The Democrats[’] ObamaCare is imploding. Massive subsidy payments to their pet insurance companies has stopped. Dems should call me to fix!” He went on to call the law “a broken mess.”
All of Trump’s orders will have the effect of raising insurance premiums, particularly for older, poorer and unhealthy people, and denying access to basic medical services for millions. But this is not what concerns the Democrats in Congress.
House Minority Leader Nancy Pelosi and Senate Minority Leader Chuck Schumer issued a demagogic statement Friday night scolding Trump for stopping the CSRs, stating in part: “[I]t seems President Trump will single-handedly hike Americans’ health premiums. It is a spiteful act of vast, pointless sabotage leveled at working families and the middle class in every corner of America.”
But the Democratic leaders concluded with their real point, which was to chastise the president if his actions meant he “is walking away from the good faith, bipartisan Alexander-Murray negotiations and risking the health care of millions of Americans.”
Earlier this month, following the Republicans’ failed repeal and replace attempts, Trump tweeted, “I called Chuck Schumer yesterday to see if the Dems want to do a great HealthCare Bill.” Schumer responded: “If he wants to work together to improve the existing health care system, we Democrats are open to his suggestions. A good place to start might be the Alexander-Murray negotiations that would stabilize the system and lower costs.”
Schumer is referring to the health care talks being led by Senators Lamar Alexander (Republican of Tennessee) and Patty Murray (Democrat of Washington). These bipartisan negotiations have nothing to do with expanding medical coverage to the 28 million Americans who remain uninsured, improving the already hopelessly inadequate benefits of many, or in any way reining in the profiteering and power of the insurance and pharmaceutical monopolies.
Instead, their “fixing” of Obamacare involves shoring up the insurance industry by means of various payouts. The Democrats have also agreed to a “compromise” allowing insurers to skirt the Obamacare regulations requiring insurance companies to offer a set of essential benefits by offering “skinny” plans, as well as to dodge ACA protections for individuals with preexisting conditions.
Any “compromise” between the Democrats and Republicans on health care reform is by its very nature a conspiracy against the working class. It is entirely premised on the subordination of the need for health care to the profits of the corporations and the functioning of the capitalist market.
Ohio Governor John Kasich was more transparent on what a bipartisan deal on health care would look like, stating this summer, “After two failed [Republican] attempts at reform, the next step is clear: Congress should first focus on fixing the Obamacare exchanges before it takes on Medicaid. … Once we see these repairs taking hold, Congress should then take up needed improvements to Medicaid as part of comprehensive entitlement reform.”
All of the failed Republican versions of Obamacare repeal and cut hundreds of billions of dollars from Medicaid, the government health insurance program for the poor, elderly, the disabled and pregnant women. They posed the virtual end of the program as a guaranteed entitlement program, by imposing block-granting and per-capita caps to the states, which would force states to deny benefits to people who qualify.
Through these measures, Medicaid would be starved of funds on the road to privatizing and ultimately dismantling the program. There have been no clear statements from leading Democrats opposing in principle the termination of Medicaid, which everyone in the political and media establishment knows is the first step to dismantling and privatizing Medicare, the government insurance program for the elderly, and Social Security, the government pension system.
The bipartisan plans to “fix” Obamacare in the interests of the insurance companies—further slashing benefits and raising premiums for working families, while cutting costs for the government and corporations—are not at odds with the spirit of Obamacare. In fact, they reflect its essence and objective: that workers are living too long into retirement, receiving costly and “unnecessary treatments,” and that something must be done to curb costs in the interest of corporate profit.
As early as 2009, the year before the ACA was signed into law, the World Socialist Web Site wrote:
“[Barack Obama’s] drive for an overhaul of the health care system, far from representing a reform designed to provide universal coverage and increased access to quality care, marks an unprecedented attack on health care for the working population. …
“Obama’s health care counterrevolution is of a piece with his entire domestic agenda. It parallels the multi-trillion-dollar bailout of the banks, the imposition of mass layoffs and wage and benefits cuts in the auto industry, and a stepped-up attack on public education and on teachers.”
The Democrats’ policies on health care reform are no alternative to Trump’s. Both will lead to untold suffering, misery and preventable deaths. The defense of basic social needs such as health care requires a fight against capitalism, which, in its advanced stage of crisis, is incompatible with basic democratic and social rights.
A fight in defense of health care requires a fight for socialism. The health care industry must be removed from private hands and placed under public ownership and the democratic control of the working class. This is not an unrealistic pipe dream but the only rational solution to a health care system dominated by profit and defended by an outmoded ruling elite.