The opioid epidemic in the US: A national health emergency

18 July 2017

The Washington Post recently published an extraordinary article on policies to address the spiraling drug epidemic in the United States. The article—“As opioid overdoses exact a higher price, communities ponder who should be saved”—did not feature calls for emergency health care or rehabilitation programs, but rather suggestions by some local officials that the state should just let drug addicts die.

The Post highlighted, among others, the proposal of Middletown, Ohio Council Member Daniel Picard that emergency responders should not use the drug naloxone to save overdose victims more than two times. The newspaper noted that the drug is often “the only thing separating whether an overdose victim goes to the hospital instead of the morgue,” and draws the conclusion that it is perfectly reasonable to adopt policies to ensure that many more go to the latter rather than the former.

That such fascistic measures—what might be called the “Duterte solution” to the drug epidemic in the US—are being treated as a rational and legitimate part of the political debate is an expression of the debased political psychology that dominates in the American ruling class. As far as the corporate and financial elite is concerned, if tens of thousands more people die from drug overdoses, this is not only acceptable, it is a positive good.

Such measures are being advanced amidst a national public health emergency on a scale not seen since the AIDS epidemic of the 1980s and ‘90s. In 2015, a shocking 52,000 people in the United States died from drug overdoses, including more than 30,000 from opioids alone. This compares to just under 42,000 deaths from AIDS at its peak in 1995. The figures for 2016, when finally totaled, are expected to show an increase of nearly 20 percent, rising to nearly 170 people every day of the year.

In the hardest hit regions, stories of morgues and funeral homes running at maximum capacity are commonplace. Twice already this year in Montgomery County, Ohio, the coroner’s office has been so overwhelmed with bodies that it was forced to rent extra refrigeration units.

Opioid-related deaths have jumped in states throughout the country, devastating rural areas and big cities, and affecting all races and ethnicities. In Maryland, the number of opioid-related deaths has nearly quadrupled since 2010. In Ohio, opioid related deaths jumped from 296 in 2003 to 2,590 in 2015, a 775 percent increase. In Florida in 2015, three opioids—heroin, fentanyl and oxycodone—were directly responsible for the deaths of 3,896 people.

The number of people directly impacted by the crisis—including family members, friends and colleagues, medical responders, social workers and many others—is in the millions. Many addicts have children who are forced into a resource-starved foster care system, or are left in the hands of family members who cannot provide for them. A recent study from University of Michigan estimates that one baby is born addicted to some sort of opiate every hour.

Thousands of workers who have dedicated their lives to jobs that treat drug addiction experience second-hand trauma from the hardships that come with combating the epidemic, with little to no resources. Hospital workers are forced to turn away withdrawing addicts from the emergency room without care; social workers have the task of telling children they cannot be reunited with their parents, or worse, that one or both of their parents have died; rehabilitation clinicians are expected to “cure” addicts with nothing more than additional drugs and a 12-twelve step program.

The drug epidemic is a public health crisis of incredible magnitude, and yet nowhere in the political establishment is there serious discussion on the measures needed to combat it—or who is responsible.

The underlying assumption in articles like the one in the Post is that drug abuse is a moral failing, and that those addicted deserve to face the consequence of their actions. This is a convenient explanation for those who wish to wash their hands of a problem that threatens their pocketbooks.

The drug epidemic, however, is not an individual failing but a symptom of a diseased social system. It is the product of definite actions taken by the ruling class and its political representatives, Democratic and Republican.

There are of course the pharmaceutical companies, which have for years have been given a free hand to aggressively market some of the most addictive opioids, making huge profits in the process. These drugs were recklessly misbranded as “abuse resistant” throughout the 1990s and early 2000s, despite overwhelming evidence to the contrary. Prescriptions for opioids such as Percocet, Oxycontin and Vicodin skyrocketed from 76 million in 1991 to nearly 259 million in 2012, enough to supply each American adult with a bottle of pills, and some with two.

The same pharmaceutical companies continue to profit from the crisis that they helped foster. One of the reasons that cities face growing costs for using naloxone is that some companies marketing varieties of the drug have hiked up the price by as much as 500 percent.

More fundamentally, the drug epidemic is a symptom of the devastation produced by nearly forty years of social counterrevolution. Whatever the specific circumstances behind each individual tragedy, the crisis is the product of the unrelenting attack on social programs, wages, education and health care, combined with deindustrialization that has wiped out hundreds of thousands of jobs and produced levels of social inequality not seen since the 1920s.

Obama concluded his two terms in office declaring that “things have never been better” in the United States—a proclamation that applied to the ruling elite he served, but not to the great mass of the population. Now, under the Trump administration, the political establishment is engaged in a great “debate” over the future of health care, currently centered on just how much and in what way to destroy Medicaid, which funds at least eighty percent of drug abuse services.

The outcome of the new health care bill, whatever its form, will be nothing short of social murder. In this sense, Picard, the local Ohio official, is merely channeling the general outlook of the ruling class, for which the reduction in life expectancy is a basic strategic aim.

A health emergency on the scale of the drug epidemic requires an emergency response. The Socialist Equality Party insists that billions of dollars must be allocated to fund rehabilitation centers, using the most advanced scientific methods and procedures. The health care system must be equipped with detox centers and connected to institutions to help with long-term recovery. All social workers in the field must receive a decent wage and the counseling and support needed. Children must be given the highest level of care while their parents recover.

Such elementary measures and more must be connected to the reconstruction of society to ensure that everyone has the right to a high-paying job, health care, education and quality housing. Only in this way can the underlying causes of drug addiction be addressed.

None of these measures is possible without a frontal attack on wealth of the corporate and financial elite and its stranglehold on the entire economic and political system. As tens of thousands die, the ruling class conspires to spend trillions on war and conjure up new ways to amass ever greater fortunes.

The disease of which the drug epidemic is a symptom is the capitalist system. It can be cured only through the mobilization of the entire working class in the fight for socialism.

Genevieve Leigh

http://www.wsws.org/en/articles/2017/07/18/pers-j18.html

The End of the American Experiment

It’s Over. So What Can the World Learn?

It’s safe to say, I think, that the American experiment is at an end. No, America might not be finished as in civil war and secession. But it is clearly at an end in three ways.

First, to the world, as a serious democracy. Second, to itself, as a nation with dignity and self-respect. Third, its potential lies in ruins. Even if authoritarianism is toppled tomorrow, the problems of falling life expectancy, an imploding middle class, skyrocketing inequality, and so on, won’t be.

Now, like many fallen nations, maybe America won’t learn much from the failure of its own experiment — but history and the world surely can. So what has the experiment disproven? What was the null hypothesis?

We don’t have to look very far. What does America not have that the rest of the rich world does? Public healthcare, transport, education, and so on. Every single rich nation in the world has sophisticated, broad, and expansive public goods, that improve by the year. Today, even many medium income and even poor nations are building public healthcare, transport, etc. America is the only one that never developed any. Public goods protect societies in deep, profound, invisible ways (we’ll get to that).

First, here is the really curious thing. American leaders are pretending like the relationship above is a great, confounding mystery. Like dumbfounded dinosaurs watching the mushroom cloud engulf the land, never — not once — in American media will you read a column, hear a voice, or see a face discussing the above. It has never happened a single time in my adult lifetime as far as I can remember. Yet the relationship couldn’t be any more obvious, clear, or striking: no public goods are what uniquely separates America, the uniquely failed state, from the rest of the world.

Why is that? It would be easy for me to say that public goods represent some kind of a hard-fought compromise between left and right. But I think there is a social truth greater that is far more substantial than the surface political reality.

Working societies — if they are to endure, grow, and cohere, if they are to prosper, hang together, and really mature — need moral universals. Moral universals are simply things that people believe everyone should have. In the UK, those things — those moral universals — are healthcare and media and welfare. In Germany, they are healthcare and media and welfare and higher education. And so on.

Moral universals anchor a society in a genuinely shared prosperity. Not just because they “spread the wealth”, though they do: because, more deeply, moral universals civilize people. They are what let people grow to become sane, humane, intelligent human beings. A person that is desperate for a meal will resort to whatever they must to feed their kids. A person constantly fed a stream of nonsense by Fox News will end up believing the earth is flat. Moral universals let people act morally, and acting morally is what the process of civilization is.

Democracy therefore depends on moral universals. It is probably fairly hard, in the scope of human history, to establish a democracy. But it is harder still to keep it going. A democracy requires, before it demands votes, sane, humane, civilized people to vote. A society that cannot create sane, humane, civilized people can therefore no more reasonably stay a democracy than a global economy can be powered by fossil fuels forever. At some point, without moral universals to create citizens worthy of the word, democracy runs out of gas.

So: what really went wrong in America? Moral universals civilize people, but there aren’t any moral universals. The public goods universals result in educate, inform, train, school people, let them live long and peaceful lives. But Americans — whether it is today’s extremists or yesterday’s slave-auctioneers and owners — believe that moral universals are just a “cost”, a “tax”, and so forth. They have never seen — and still don’t see — the benefits: the civilizing process that democracy depends vitally on.

Thus, in America today, there are no broad, genuine, or accessible civilizing mechanisms left. As a simple example, America’s best universities churn out…hedge-fund traders. It’s economy is largely composed of…paper gains to the .01%. It’s media debates…climate change. And so on. The natural consequence of failing to civilize is breaking down as a democracy — democracy no longer exists in the sense of “people cooperating by voting to give each other greater prosperity”. They have merely learned to take prosperity away from one another. Whether by denying one another doctors, schools, trains, and so on. That is what a lack of civilization really results in, or to put more prosaically, there is no sanity or humanity, much less reason, wisdom, or virtue in such decisions — only nihilism, fatalism, and despair.

And that is what the end of the American experiment proves. Without moral universals, there is no process of civilization, and democracy itself can no longer continue to grow and develop. The painful irony is that American intellectuals are concerned about Western civilization. LOL. The West, such as it is, will be just fine: it is America where civilization, as a verb, a process, a way of moral being in the world, has broken down.

Even prisons have moral universals. There is only one other place in the world I can think of with none. A jungle.

Umair
July 2017

View story at Medium.com

Eugene Debs and the Kingdom of Evil

Posted on Jul 16, 2017

By Chris Hedges

Mr. Fish / Truthdig

TERRE HAUTE, Ind.—Eugene Victor Debs, whose home is an infrequently visited museum on the campus of Indiana State University, was arguably the most important political figure of the 20th century. He built the socialist movement in America and was eventually crucified by the capitalist class when he and hundreds of thousands of followers became a potent political threat.Debs burst onto the national stage when he organized a railroad strike in 1894 after the Pullman Co. cut wages by up to one-third but did not lower rents in company housing or reduce dividend payments to its stockholders. Over a hundred thousand workers staged what became the biggest strike in U.S. history on trains carrying Pullman cars.

The response was swift and brutal.

“Mobilizing all the powers of capital, the owners, representing twenty-four railroads with combined capital of $818,000,00, fought back with the courts and the armed forces of the Federal government behind them,” Barbara W. Tuchman writes in “The Proud Tower: A Portrait of the World Before the War, 1890-1914.” “Three thousand police in the Chicago area were mobilized against the strikers, five thousand professional strikebreakers were sworn in as Federal deputy marshals and given firearms; ultimately six thousand Federal and State troops were brought in, less for the protection of property and the public than to break the strike and crush the union.”

Attorney General Richard Olney, who as Tuchman writes “had been a lawyer for railroads before entering the Cabinet and was still a director of several lines involved in the strike,” issued an injunction rendering the strike illegal. The conflict, as Debs would write, was a battle between “the producing classes and the money power of the country.”Debs and the union leaders defied the injunction. They were arrested, denied bail and sent to jail for six months. The strike was broken. Thirty workers had been killed. Sixty had been injured. Over 700 had been arrested. The Pullman Co. hired new workers under “yellow dog contracts,” agreements that forbade them to unionize.

When he was in jail, Debs read the works of socialist writers Edward Bellamy and Karl Kautsky as well as Karl Marx’s “Das Kapital.” The books, especially Marx’s three volumes, set the “wires humming in my system.”

“I was to be baptized in Socialism in the roar of the conflict. … [I]n the gleam of every bayonet and the flash of every rifle the class struggle was revealed,” he writes. “This was my first practical lesson in Socialism.”

Debs came to the conclusion that no strike or labor movement could ultimately be successful as long as the government was controlled by the capitalist class. Any advances made by an organized working class would be reversed once the capitalists regained absolute power, often by temporarily mollifying workers with a few reforms. Working men and women had to achieve political power, a goal of Britain’s Labour Party for workers at the time, or they would forever be at the mercy of the bosses.

Debs feared the rise of the monolithic corporate state. He foresaw that corporations, unchecked, would expand to “continental proportions and swallow up the national resources and the means of production and distribution.” If that happened, he warned, the long “night of capitalism will be dark.”

This was a period in U.S. history when many American Christians were socialists. Walter Rauschenbusch, a Christian theologian, Baptist minister and leader of the Social Gospel movement, thundered against capitalism. He defined the six pillars of the “kingdom of evil” as “religious bigotry, the combination of graft and political power, the corruption of justice, the mob spirit (being ‘the social group gone mad’) and mob action, militarism[,] and class contempt.”

Debs turned to the Bible as often to Marx, arguing “Cain was the author of the competitive theory” and the “cross of Jesus stands as its eternal denial.” Debs’ fiery speeches, replete with words like “sin” and “redemption,” were often thinly disguised sermons. He equated the crucified Christ with the abolitionist John Brown. He insisted that Jesus came “to destroy class rule and set up the common people as the sole and rightful inheritors of the earth.” “What is Socialism?” he once asked. “Merely Christianity in action.” He was fond of quoting the poet James Russell Lowell, who writes:

He’s true to God who’s true to man;
Whenever wrong is done.
To the humblest and the weakest,
’neath the all-beholding sun.
That wrong is also done to us,
And they are slaves most base,
Whose love of right is for themselves
And not for all the race.

It was also a period beset with violence, including anarchist bombings and assassinations. An anarchist killed President William McKinley in 1901, unleashing a wave of state repression against social and radical movements. Striking workers engaged in periodic gun battles, especially in the coalfields of southern West Virginia, with heavily armed company goons, National Guard units, paramilitary groups such as the Coal and Iron Police, and the U.S. Army.

Earth’s Sixth Mass Extinction Event Already Under Way, Scientists Warn

ENVIRONMENT
Researchers talk of “biological annihilation” as study reveals billions of populations of animals have been lost in recent decades.

Photo Credit: Maggy Meyer/Shutterstock

A “biological annihilation” of wildlife in recent decades means a sixth mass extinction in Earth’s history is under way and is more severe than previously feared, according to research.

Scientists analyzed both common and rare species and found billions of regional or local populations have been lost. They blame human overpopulation and overconsumption for the crisis and warn that it threatens the survival of human civilization, with just a short window of time in which to act.

The study, published in the peer-reviewed journal Proceedings of the National Academy of Sciences, eschews the normally sober tone of scientific papers and calls the massive loss of wildlife a “biological annihilation” that represents a “frightening assault on the foundations of human civilization”.

Prof Gerardo Ceballos, at the Universidad Nacional Autónoma de México, who led the work, said: “The situation has become so bad it would not be ethical not to use strong language.”

Previous studies have shown species are becoming extinct at a significantly faster rate than for millions of years before, but even so extinctions remain relatively rare giving the impression of a gradual loss of biodiversity. The new work instead takes a broader view, assessing many common species which are losing populations all over the world as their ranges shrink, but remain present elsewhere.

The scientists found that a third of the thousands of species losing populations are not currently considered endangered and that up to 50 percent of all individual animals have been lost in recent decades. Detailed data is available for land mammals, and almost half of these have lost 80 percent of their range in the last century. The scientists found billions of populations of mammals, birds, reptiles and amphibians have been lost all over the planet, leading them to say a sixth mass extinction has already progressed further than was thought.

Nearly half of the 177 mammal species surveyed lost more than 80% of their distribution between 1900 and 2015

Percent of species which have lost more than 80 percent of their range

Billions of animals have been lost as their habitats have become smaller with each passing year. (Guardian graphic | source: PNAS)

The scientists conclude: “The resulting biological annihilation obviously will have serious ecological, economic and social consequences. Humanity will eventually pay a very high price for the decimation of the only assemblage of life that we know of in the universe.”

They say, while action to halt the decline remains possible, the prospects do not look good: “All signs point to ever more powerful assaults on biodiversity in the next two decades, painting a dismal picture of the future of life, including human life.”

Wildlife is dying out due to habitat destruction, overhunting, toxic pollution, invasion by alien species and climate change. But the ultimate cause of all of these factors is “human overpopulation and continued population growth, and overconsumption, especially by the rich”, say the scientists, who include Prof Paul Ehrlich, at Stanford University in the U.S., whose 1968 book The Population Bomb is a seminal, if controversial, work.

“The serious warning in our paper needs to be heeded because civilization depends utterly on the plants, animals, and microorganisms of Earth that supply it with essential ecosystem services ranging from crop pollination and protection to supplying food from the sea and maintaining a livable climate,” Ehrlich told the Guardian. Other ecosystem services include clean air and water.

“The time to act is very short,” he said. “It will, sadly, take a long time to humanely begin the population shrinkage required if civilization is to long survive, but much could be done on the consumption front and with ‘band aids’—wildlife reserves, diversity protection laws—in the meantime.” Ceballos said an international institution was needed to fund global wildlife conservation.

The research analyzed data on 27,500 species of land vertebrates from the IUCN and found the ranges of a third have shrunk in recent decades. Many of these are common species and Ceballos gave an example from close to home: “We used to have swallows nesting every year in my home near Mexico city—but for the last 10 years there are none.”

The researchers also point to the “emblematic” case of the lion: “The lion was historically distributed over most of Africa, southern Europe, and the Middle East, all the way to northwestern India. [Now] the vast majority of lion populations are gone.”

Current and historic distribution of lions

Historically lions lived across Africa, southern Europe, the Middle East, all the way up to Northwestern India. Today their habitat has been reduced to a few tiny pockets of the original area. (Guardian graphic | source: PNAS)

Prof. Stuart Pimm, at Duke University in the US and not involved in the new work, said the overall conclusion is correct, but he disagrees that a sixth mass extinction is already under way: “It is something that hasn’t happened yet—we are on the edge of it.”

Pimm also said there were important caveats that result from the broad-brush approach used. “Should we be concerned about the loss of species across large areas—absolutely—but this is a fairly crude way of showing that,” he said. “There are parts of the world where there are massive losses, but equally there are parts of the world where there is remarkable progress. It is pretty harsh on countries like South Africa which is doing a good job of protecting lions.”

Robin Freeman, at the Zoological Society of London, U.K., said: “While looking at things on aggregate is interesting, the real interesting nitty gritty comes in the details. What are the drivers that cause the declines in particular areas?”

Freeman was part of the team that produced a 2014 analysis of 3000 species that indicated that 50 percent of individual animals have been lost since 1970, which tallies with the new work but was based on different IUCN data. He agreed strong language is needed: “We need people to be aware of the catastrophic declines we are seeing. I do think there is a place for that within the [new] paper, although it’s a fine line to draw.”

Citing human overpopulation as the root cause of environmental problems has long been controversial, and Ehrlich’s 1968 statement that hundreds of millions of people would die of starvation in the 1970s did not come to pass, partly due to new high-yielding crops that Ehrlich himself had noted as possible.

Ehrlich has acknowledged “flaws” in The Population Bomb but said it had been successful in its central aim—alerting people to global environmental issues and the the role of human population in them. His message remains blunt today: “Show me a scientist who claims there is no population problem and I’ll show you an idiot.”

Earth’s five previous mass extinctions

End-Ordovician, 443 million years ago

A severe ice age led to sea level falling by 100m, wiping out 60-70 percent of all species which were prominently ocean dwellers at the time. Then soon after the ice melted leaving the oceans starved of oxygen.

Late Devonian, c 360 million years ago

A messy prolonged climate change event, again hitting life in shallow seas very hard, killing 70 percent of species including almost all corals.

Permian-Triassic, c 250 million years ago

The big one—more than 95 percent of species perished, including trilobites and giant insects—strongly linked to massive volcanic eruptions in Siberia that caused a savage episode of global warming.

Triassic-Jurassic, c 200 million years ago

Three-quarters of species were lost, again most likely due to another huge outburst of volcanism. It left the Earth clear for dinosaurs to flourish.

Cretaceous-Tertiary, 65 million years ago

An giant asteroid impact on Mexico, just after large volcanic eruptions in what is now India, saw the end of the dinosaurs and ammonites. Mammals, and eventually humans, took advantage.

Study shows US has poorest health, widest health care gap between rich and poor

As Senate health plan calls for gutting Medicaid

By Kate Randall
15 July 2017

A new study reveals findings that will come as no surprise to most American workers and youth: In the United States, your level of income defines your access to health care, the quality of care you receive, and whether you will meet with an early death because of it. The US also has the poorest health overall among high-income countries.

Using survey data to measure and compare patient and physician experiences across 11 countries, the Commonwealth Fund’s “Mirror, Mirror 2017: International Comparisons Reflect Flaws and Opportunities for Better US Health Care” finds that the US ranks last overall on providing equally accessible and high-quality health care, regardless of income.

The report compares health care system performance in the US with that of 10 other high-income countries, ranking them in five areas: care process, access, administrative efficiency, equity and health care outcomes. The US ranks last overall, and last in all but one area studied, care process, in which it came in fifth.

If the United States were a politically healthy society, the release of this report would sound alarm bells in the White House and on Capitol Hill. Why, in “the greatest country on earth,” is the health of its citizens in such a deplorable state? What can be done to remedy what can only be described as a health care emergency of crisis proportions?

Instead, the study’s release follows the unveiling Thursday of the Senate Republicans’ latest version of their Better Care Reconciliation Act (BCRA), which proposes to slash $772 billion from the Medicaid program for the poor, and the Affordable Care Act’s expansion of Medicaid. The Congressional Budget Office estimated that an earlier version of the bill would leave 22 million more uninsured by 2026 than under current law.

The Commonwealth study points to factors contributing to this appalling US health report card, which will only be worsened under whatever health care “reform” is hatched in Washington. Life expectancy, after improving in recent years, has been aggravated by the opioid crisis. As the baby boom population ages, more people in the US are living with age-related disease, placing increased pressure on the health care system.

These are problems that could be confronted with timely and accessible health care, but these services are woefully inadequate. In particular, poor access to primary care has contributed to inadequate prevention and management of diseases. And in the US, far more than any other country studied, lower-income people are far more likely to lack access to affordable care, and to suffer and die because of it.

Forty-four percent of lower income people reported financial barriers to care, compared to 26 percent of those with higher incomes. By comparison, in the UK only 7 percent of people with lower incomes and 4 percent with higher incomes reported that costs prevented them from getting care.

According to the study, in the US population as whole in the past year:

• 33 percent had cost-related access problems to medical care.

• 32 percent skipped dental care or check-ups due to cost.

• 27 percent were denied insurance payment for care or did not receive as much as expected.

• 20 percent had serious problems paying or were unable to pay medical bills.

• 60 percent of doctors reported patients often had difficulty paying for medications or out-of-pocket costs.

• 54 percent of doctors reported time spent on insurance claims is a major problem.

• 54 percent of doctors reported a major problem getting patients needed medications or treatment because of insurance coverage restrictions.

These problems are worse in the low-income segment of the US population. For example, 44 percent of this group had a cost-related access problem to medical care, and 45 percent skipped dental care or a check-up due to cost. There is also a 24 percent gap between those in the above average and below average income groups who skipped dental care due to cost.

The study uses “average” income, which was about $75,000 in 2016, as the dividing line between upper and lower income. However, multimillionaires and billionaires skew this average upwards, and due to the growing income inequality in the US, the health care problems of those living in poverty in the “below average” group are most likely underrepresented.

Some of the most shocking statistics presented are on population mortality, in which the US ranked last in every category studied compared to the other 10 countries.

• Infant mortality: 6 deaths per 1,000 live births, compared to Sweden, with 2.2 (the lowest)

• Life expectancy at age 60: 23.5 years in the US, compared to 25.7 in France (the highest)

The study also examined “mortality amenable to health care,” or deaths considered preventable by timely and effective medical care. The US had 112 deaths per 100,000 people that could have been prevented with timely and effective care. This is more than twice the rate in Switzerland, at 55 per 100,000.

The US also had a much lower decline in these preventable deaths over 10 years, falling by only 16 percent compared to 34 percent in the Netherlands.

The US spent $9,364 per person on health care in 2016, compared to $4,094 in the UK, which ranked first overall in health care. In other words, while spending far more per person, the US population has poorer health than the other 10 countries studied.

Such figures evoke howls from both big business parties for spending to be slashed. Typical were the recent comments of Trump’s Health and Human Services Secretary Tom Price who said, while claiming to be committed to fighting the opioid epidemic that killed 60,000 people in the US last year, “We don’t need to be throwing money” at the crisis.

What goes unmentioned in such statements is the root cause of the health care crisis in America: a health care system based on capitalist profit. The for-profit insurance companies, pharmaceuticals and giant health care chains are not in business to promote the health of the American people, but to boost their bottom lines.

Whatever health care legislation is passed in Congress—either by the Republicans, or in a bipartisan “compromise” with the Democrats—will be based on this capitalist model. The Republicans’ House and Senate health bills are, in fact, based on Obamacare, incorporating the structures set up under the Democratic legislation.

The central purpose of Obamacare was to shift costs from the government and corporations to the working class, with health care increasingly rationed on a class basis. The Commonwealth Fund’s findings on the state of US health care, particularly those on mortality, are an indication of the preliminary results of this bipartisan strategy.

Behind the BCRA’s proposals to gut Medicaid, and to give the private insurers even more latitude to boost profits through offering shabby, high-cost coverage, lies a calculated effort to reduce life expectancy for working people, and to send many of the old, sick or disabled to an early grave.

http://www.wsws.org/en/articles/2017/07/15/care-j01.html

Health Care in America: Where is the Socialist Solution?

Photo by Molly Adams | CC BY 2.0

The introduction of the Republican legislation to “repeal and replace” Obamacare is no more than latest scrimmage in the ongoing one-sided war against the poor and working class. The “Affordable Care Act” (ACA, better known as Obamacare) proved to be both unaffordable and unable to provide comprehensive care for millions. Nevertheless, with the ACA being one of the only tangible “victories” Democrats could claim for an administration with a dismal record of noteworthy accomplishments, neoliberal Democrats and the party’s liberal base led by Bernie Sanders are now coalesced around the ACA and have vowed to defend it to the bitter end.

Yet, camouflaged by the hot rhetoric of confrontation and the diversionary struggle of the duopoly, the common agenda and objective interests being protected in this healthcare battle are quite clear. No matter what version of the healthcare bill passes or if the ACA remains in place, it will be a win for the market-based, for-profit beneficiaries of the U.S. system. As long as healthcare remains privatized, the real winners of healthcare reform will continue to be the insurance companies, hospital corporations and pharmaceutical and medical device companies.

That commitment to the interests of the insurance/medical complex ensures that the interests of healthcare consumers, the uninsured, the elderly and the sick will continue to be sacrificed to maintain a healthcare delivery system in which thousands suffer premature deaths from inadequate preventative treatment, millions are unable to afford coverage and millions who have private insurance fear using it because of prohibitive co-pays and deductibles.

That is why during the current debate the insurance companies have been largely silent. There is no need to engage in public debate because having largely written the ACA they are again deeply involved in the construction of the current legislation. Their interests will be protected even if it means forcing Republicans to embrace policies that are at odds with their professed philosophies – like including government subsidies for low-income people to purchase insurance. In fact, the only comments from insurance companies in this debate were related to their supposed concern that the Senate bill might not provide enough assistance to those who need help to pay for healthcare. They want what is being called a “stabilization fund” to reduce the numbers of people who might opt out of coverage because they can’t afford it.

The Senate bill provides those funds, but they are temporary and are scheduled to end after 2019. Which means that people will be forced to make an unpalatable decision after that – purchasing insurance with higher out-of-pocket costs like $10,000 deductibles or electing to go without insurance altogether. If history is a guide, many will opt out. In fact, the Congressional Budget Office predicts that the current bill will push 22 million people back into the ranks of the uninsured with the potential loss of millions of customers and potential profits for healthcare corporations.

But the companies have a plan should those funds prove inadequate to hold substantial numbers in the system: Increase individual premiums by at least 20 percent more than the double-digit increases already under consideration.

Coming to the aid of the Insurance/Medical complex: Ted Cruz and the Consumer Freedom Amendment

Insurers need large numbers of healthy people on the rolls, as their premiums help defray the cost of care for those who are sick. Because insurance companies are for-profit operations they set rates based on the risk pool in a market. With the potential loss of customers if the government does not provide adequate long-term subsidies, middle-class consumers who earn too much to qualify for temporary premium assistance will bear the brunt of any premium increases.

The Cruz amendment to the legislation has a solution to the possible increase in premiums and healthcare costs in general. The so-called “Consumer Freedom Amendment” represents the typical extreme individualism and anti-social sentiments of the right wing. It essentially advocates for reducing the burden on healthy consumers paying into system to help cover higher-risk fellow citizens.

The Washington Post’s analysis of the Cruz amendment suggests:

“Under Senator Cruz’s plan, insurers could sell cheaper, stripped-down plans free of Obamacare coverage requirements like essential health benefits or even a guarantee of coverage. These sparser plans would appeal to the healthiest Americans, who would gladly exchange fewer benefits for lower monthly premiums.

But insurers would also have to sell one ACA-compliant plan. The sickest patients would flock to these more expansive and expensive plans because they need more care and medications covered on a day-to-day basis. As a result, premiums for people with expensive and serious medical conditions like diabetes or cancer would skyrocket because all those with such serious conditions would be pooled together.”

And how would the elderly and people with pre-existing conditions pay for the increased premiums that they would face under the current Senate bill and Cruz’s amendment? “The $100 billion stabilization fund for states could help cover costs for the resulting pricier coverage for those with preexisting conditions under this amendment.”

In an ironic twist that both exposes the class interests of this initiative and its hypocritical approach to the question of the role of the government, Cruz’s amendment affirms that role in the form of subsidies for the sickest citizens and calls for an expansion of government resources to cover them.

The Cruz plan would segment the insurance market into healthier and higher-risk segments. High risk individuals along with the already-sick and the elderly would be pushed out of the market because those premiums would soar even with state subsidies, since insurance companies would still set premium rates to maximize profits.

Given the lose-lose options for consumers now being debated in Congress, the only rational objective for the majority of the people in the U.S. is to move toward the complete elimination of the for-profit healthcare system.

Socialization of Healthcare: The Only Solution

The ideological and political opposition to state-provided healthcare is reflected in the ACA and the various repeal-and-replace scenarios. Through mandates, coercion and the transfer of public funds to the insurance industry, the ACA delivered millions of customers to the private sector in what was probably the biggest insurance shams in the history of private capital. And that gift to the insurance companies is only one part of the story. The public monies transferred to the private sector amounted to subsidies for healthcare providers, hospital chains, group physician practices, drug companies and medical device companies and labs as well.

The Republican alternatives to the ACA variably supplement the corporate handouts with more taxpayer-funded giveaways. And once the private sector gains access to billions of dollars provided by the state, they and their elected water-carriers fiercely resist any efforts to roll those subsidies back.

The subsidies coupled with the mergers and acquisitions of hospital corporations and insurance providers over last few years and a general trend toward consolidation of healthcare services in fewer and fewer hands underscored the iron logic of centralization and concentration of capital represented by the ACA and was a welcome development for the biggest players in the healthcare sector. The movement toward a monopolization of the American health-care market means that rather than the reduction in healthcare costs that is supposed to be the result of repeal and replace, the public can instead expect those costs to escalate.

Many on the left have called for a single-payer system similar to those that work well (if not perfectly) in Britain, the Netherlands, Finland and elsewhere in Europe. But even with an “improved Medicare for all” single-payer system, costs will continue to increase in the U.S. because they cannot be completely controlled when all of the linkages in the healthcare system are still firmly in the hands of private capital.

The only way to control the cost of healthcare and provide universal coverage is to eliminate for-profit, market-based healthcare. Take insurance companies completely out of the mix and bring medical device companies, the pharmaceuticals companies and hospitals chains under public control.

The ideological implications of the Cruz amendment are that it reflects a growing public perception both domestically and internationally that healthcare should be viewed as a human right.

Putting people at the center instead of profit results in healthcare systems that can realize healthcare as a human right. This is the lesson of Cuba where the United Nations World Health Organizationdeclared that Cuba’s health care system was an example for all countries of the world.

That is the socialist option, the only option that makes sense and the one that eventually will prevail when the people are ready to fight for it.

Ajamu Baraka is the national organizer of the Black Alliance for Peace and was the 2016 candidate for vice president on the Green Party ticket. He is an editor and contributing columnist for the Black Agenda Report and contributing columnist for Counterpunch magazine. 

Latest Republican health care tactic: A sneak attack on people with pre-existing conditions

In the fine print, GOP bill guts coverage of “essential health care benefits,” with devastating consequences

It’s becoming clear that Senate Majority Leader Mitch McConnell’s plan to decimate the American health care system is to tinker around the edges of his bill until, as Charles Pierce of Esquire argued, “you get a CBO score you can plausibly use to con the country, the elite political press, and the mind of Susan Collins into thinking you’re ‘moderating’ the bill.” McConnell is counting on the fact that the press is easily bored and always eager to move onto the next new thing — often meaning whatever President Trump has just said on Twitter — and all he needs is a week of such distractions to pass this stinker under the cover of darkness.

But don’t let the tinkering or assurances that the health care bill is somehow becoming more moderate fool you. Republicans still plan on passing a bill that will lay waste to the protections offered ordinary Americans in the Affordable Care Act, leaving people vulnerable to financial ruin or even death from illnesses or conditions that are covered under existing law.

One of the ways Republicans plan to do this is to gut the part of the Affordable Care Act that guarantees coverage of what are deemed “essential health care benefits.” That sounds like a minor bureaucratic adjustment, but in reality it’s a back-door way to deny coverage to people with pre-existing conditions, limit important and life-saving health services, and force people with expensive conditions to go bankrupt rather than rely on insurance to cover them.

The essential benefits that the Affordable Care Act delineated include 10 categories of care that every insurance plan has to cover. Some of these categories are straightforward things that most insurance plans, whether purchased on the individual market or provided by employers, already covered, such as hospitalization or doctor’s visits. But, as Timothy Jost, a professor at the Washington and Lee University School of Law and an expert on health care law, explained in an interview, prior to the passage of the Affordable Care Act many individually purchased plans skipped major categories of coverage.

“What they didn’t cover was maternity care, mental health and substance use disorder care — and often prescription drug coverage was quite limited,” Jost said. “The ACA also added habilitation care for special needs children.”

Under various versions of the Republican plan, states would be able to apply for waivers to exempt plans sold in their state from this mandated list of essential health care benefits. Republicans have repeatedly insisted that their bill bars discrimination against patients with pre-existing conditions. But as Jost explained, ending essential health care benefits creates a mechanism that allows insurance companies to deny coverage of those pre-existing conditions. You’d be allowed to buy insurance, but it might not pay for the things you really need it for.

“So you got a mental health problem, sorry, we’re happy to insure you, but we don’t cover mental health problems,” Jost said, describing the logic. “You’ve got cancer? We’re happy to insure you. We don’t cover any chemotherapy drugs or we don’t cover radiation therapy.”

Presumably, the reason Republicans want to cut essential health benefits is to lower premiums — which is why we get to hear Republican politicians making cracks about how men don’t need maternity care — but Jost said he believes the mandatory benefits “are really a very small part of the total cost of coverage.”

For instance, as Jost has argued on the Health Affairs blog, ending mandatory maternity coverage “might lower premiums by $8 to $14 per month,” but would force women who are giving birth to pay as much as $30,000 to $50,000 in out-of-pocket expenses.

Most of these effects would be felt by people who buy insurance on the individual market, or who work for small companies employers that offer less expensive plans with skimpier coverage. As Matthew Fiedler, a fellow with the Center for Health Policy in the Brookings Institution’s Economic Studies Program, explained, there’s a poison pill buried in the bill that would also affect people who work for large employers that offer more generous health insurance packages. Repealing mandatory essential health care benefits would mean reintroducing lifetime limits or annual coverage caps for many people on those plans. Which means that a lot of people who thought they had generous, comprehensive insurance plans could still face bankruptcy in the event of a serious illness or accident.

Under the ACA, Fiedler explained, “Insurers can’t put lifetime or annual limits on types of care that are considered essential health benefits. But they can put lifetime or annual limits on things that aren’t essential health benefits. What that means is that when the definition of essential health benefits changes, that can substantially change the scope of the protection against annual or lifetime limits.”

Even if you live in a state that sticks with the old Affordable Care Act definition of essential health benefits, you may not be protected if you work for a large employer, defined as any company or entity with 50 or more employees. That’s because, according to Fielder, a large employer can choose any state’s definition of “essential health benefits.” It doesn’t have to stick to the state where it does most of its business, or where its employees actually live.

“Employers could choose a state that had implemented a very lax definition of essential health benefits and thereby have fairly broad latitude to impose these kinds of limits,” he explained.

So a worker in a state like California or Massachusetts, which is likely to continue to protect essential health care benefits, might find that her employer has instead chosen define essential health care benefits under the terms set by Texas or Mississippi. So while that person’s policy might still cover cancer treatments or maternity care or mental health services, she might find out that in practice her insurance company will not cover nearly as much of the cost as it would have under the ACA.

Because of the ban on lifetime and annual limits, the cap on out-of-pocket spending for patients, and the ban on discrimination based on pre-existing conditions, the Affordable Care Act was able to cut the number of personal bankruptcy filings in the United States by half between 2010 and 2016. By drafting a way for states to opt out of the essential health care benefits mandate, the Republican bill will potentially allow insurance companies to dump those costs back onto the consumer. The number of medical-related bankruptcies could well soar back to pre-Obama levels — if Mitch McConnell can find a moment when we stop paying attention and ram this bill through the Senate.

Amanda Marcotte is a politics writer for Salon. She’s on Twitter @AmandaMarcotte