Following Trump executive orders, Democrats offer Obamacare “fix”

A new stage in the bipartisan health care counterrevolution

14 October 2017

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 replace 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.

Kate Randall

http://www.wsws.org/en/articles/2017/10/14/pers-o14.html

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What’s the next step toward Medicare for All?

Sean Petty, a registered nurse in New York City and member of the board of directors of the New York State Nurses Association, makes the case that single-payer health care advocates can advance the struggle politically and organizationally.

Taking to the streets for single-payer health care in Los Angeles (Molly Adams | flickr)

Taking to the streets for single-payer health care in Los Angeles (Molly Adams | flickr)

THE PRESS conference earlier this month where Bernie Sanders announced his “Medicare for All” legislation shows both the massive opening and the serious challenges facing the struggle for truly universal health care in the U.S.

Sanders’ legislation comes after a summer of successful struggle to stop Trumpcare. The Senate Republicans’ latest attempt to “repeal and replace” Obamacare collapsed this week after a handful of both hard-right and more “moderate” Republican senators came out against it.

Donald Trump tweeted angrily about John McCain, but a very important reason for the defeat of the various Trumpcare proposals was the upsurge of protest organized by liberal organizations, unions and other health care advocates.

The angry demonstrations at events held by Republican lawmakers throughout the year, as well as actions in Washington, helped expose how the GOP plans for “repeal and replace” would have worsened an already ailing system governed by Obamacare–particularly by dismantling Medicaid and Medicare. Beyond the protests, popular opinion ran heavily against Trumpcare.

This opposition went far beyond single-payer advocates, but it helped our movement by reminding millions of people how critical federally funded health care is–and getting them to more seriously consider Medicare for All as an alternative to both Trumpcare and Obamacare.

The effect of this on Sanders’ proposal has been telling. For almost three decades, the mainstream of the Democratic Party has systematically undermined and marginalized proposals for single-payer health care. But this month, 16 Democratic senators, including most of the known hopefuls for the 2020 presidential nomination, lined up in support of Sanders’ legislation.

Of course, it’s easy for liberal Democrats to support Sanders’ bill when it has no chance in becoming law under a majority Republican Congress, with Donald Trump in the White House. The Democrats can appeal to millions of people persuaded by the case for Medicare for All, without having to face the fury of the for-profit health care industry.

But even at the level of purely rhetorical support, Sanders’ legislation is a big deal. It is a crack in the political edifice on the issue of single-payer health care, which opens up opportunities to mobilize greater pressure from outside Washington. Whether the crack gets widened or sealed up is a critical question facing our re-energized movement.

– – – – – – – – – – – – – – – –

THIS IS a useful moment to pull the lens back and look at what it will take to make Medicare For All a reality.

The first dynamic to understand is that we haven’t seen anything close to the opposition that will cohere among the health care industry and the ruling class as a whole when a Medicare for All proposal like Sanders’ gets closer to being enacted.

Health care accounts for as much as one-fifth of all economic activity in the U.S., according to estimates. There is a considerable amount of wealth at stake in the profits of the prescription drug industry, from medical supply and equipment sales, and, of course, for private insurance.

Medicare for All would allow the government to bargain with health care companies with an unprecedented leverage and economic scale–and it would be a huge blow to private insurers, even if it doesn’t totally eliminate them. Moreover, Sanders’ bill is filled with taxes on the rich and powerful–higher taxes on business, wealth taxes, a more progressive income tax structure, and even a one-time tax on offshore financial holdings.

The opposition to single-payer will manifest itself in two general ways.

The most blatant will be an extremely well-funded propaganda campaign that claims Medicare For All would produce “death panels” and financial ruin to every household in America.

The resounding defeat last year of a Colorado ballot initiative that would have changed the state constitution to permit universal coverage for every resident gives a taste of how the economic and political powers–including plenty of Democrats who claimed to oppose Trumpcare this year–would line up against single-payer.

Likewise, in California and New York, it was Democrats who did the dirty work of the insurance industry in blocking legislation to move toward a statewide Medicare for All system.

The second, less obvious way opposition will take shape is the “Trojan Horse” effect.

Right now, powerful mainstream Democrats like Elizabeth Warren, Cory Booker and Kristen Gillibrand have nothing but nice things to say publicly about Sanders’ bill. But there has been and will be intense pressure to water down single-payer legislation.

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NONE OF this means the fight for Medicare for All is unwinnable.

In fact, Sanders’ introduction of this legislation–at this political moment and with support beyond himself, at least for now–shows how easily a government-run system that guarantees universal coverage could be embraced by the majority of people.

Right now, Sanders is probably the most popular politician in the country. Certainly, he is at the federal level, where his favorability rating being higher than his unfavorability is unique. Sanders stands for a progressive political agenda that has partially filled a massive void in mainstream politics.

His Medicare for All bill isn’t perfect. Members of Physicians for a National Health Program are critical of the legislation for allowing co-payments for some medical necessities, including drugs and biologics. There are questions about how far-reaching and systematic its funding mechanisms are, and whether four years is too long of a rollout.

But supporters of Medicare for All have shaped the bill in important ways. It bars deductibles and most co-pays, fully funds abortions and covers undocumented immigrants. The pressure to reverse these important provisions will be relentless. The larger the movement–and the larger the Left within that movement–the more people we will have a bill worth fighting for.

With Medicare for All, Sanders–in stark contrast to Democratic Party leaders–is offering something concrete and popular that would change most everyone’s life for the better.

But Sanders’ popularity obviously isn’t enough. The most important factor that will determine whether we see such a program in our lifetime is whether the widespread popularity and unprecedented momentum is organized so that it becomes an active force, felt in workplaces, communities and the media.

There are many ideas about how to build from the grassroots. Do we need a national march? Do we need to focus on “base-building”? Do we need different forms of coalitions and activist organizations? The answer is all of the above–but the question of strategy and timing will take some time to figure out.

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ACTIVISTS AROUND this issue need to recognize that we won’t win this battle by continuing to do what we currently are doing, just on a grander scale. Whatever organizing we do, we need to be clear on some things.

First, this isn’t an inside game. Medicare for All won’t be won by concentrating on how many members of Congress we persuade, but on how many tens of thousands of people are convinced to take action in various forms for single-payer.

Our organizing needs to be focused on this fact. We need to figure out how to build networks and organizations that can bring in larger numbers of activists, who can then make collective decisions about how to reach the next layer of people.

One step in this direction would be to broaden our approach to the issue–which needs to center both how transformative a future Medicare for All system would be, but to highlight the suffering that goes on in the health care status quo as the price we pay for not having single-payer.

In the public mind, the health insurance industry should be no different than the tobacco industry. We need to create a climate where health insurance industry profits are seen for what they are–blood money–and any politician unwilling to do something about it is treated accordingly.

Second, health care has to become a central issue of a re-inspired labor movement. Many people currently think of health care as related to their job, so there’s a natural connection.

Unions already played a role in mobilizing opposition to Trump’s health care disaster–though not in the numbers they could have. But Medicare for All could become a main issue for labor.

One possibility would be to organize workplace committees in support of Medicare For All. This has already taken shape in National Nurses United and New York State Nurses Association, and could be built on and serve as a model for other unions.

For health care unions, in particular, the question of workplace issues and how to make the health care system accessible come together, creating the basis for a stronger struggle.

We need to think in unprecedented ways about how to use union power to win this struggle. In this context, I could see an argument for a national day of strike action for Medicare For All.

Striking for political reasons–or really striking in general–isn’t something the labor movement is very familiar with in recent decades. But the tradition does exist. Also, the unions that are strongest on Medicare for All are also unions with more experience of going on strike recently.

– – – – – – – – – – – – – – – –

THERE ARE many other initiatives being discussed to build wider and active support for Medicare for All.

One that has been discussed this year is a proposal from some members of the Democratic Socialists of America for a national march for single-payer in Washington, D.C.

If such a mobilization gave expression to the wide support for Medicare for All that has developed especially through the course of this year, it would be a major step forward in projecting the importance of this issue. But that also raises the question of organization: What forces would be involved in planning and carrying out such a march?

National initiatives like a march or a day of action in support of Medicare for All can be focus for local organizing to win wider numbers of people to activism on this issue. There will also be more statewide initiatives, as in California and New York. And possibilities for local organizing around health care develop all the time–including workplace action backed by unions, up to the level of strikes.

One opportunity for organizing will arise soon–Sanders is supposed to tour the country to build support for his legislation. Our organizations need to find ways to meet people inspired by Sanders’ proposal and bring them into organizing.

There’s a long way to go before we’ll have built organization that can express the widespread sentiment for Medicare for All. But activists can use the opportunities as they arise to build in that direction.

https://socialistworker.org/2017/09/28/whats-the-next-step-toward-medicare-for-all

Medicaid sees big price hikes for decades-old drugs

By Brad Dixon
28 August 2017

An investigation by Kaiser Health News (KHN) found that numerous decades-old drugs still have high price tags, and some remain branded despite how long the drugs have been available on the market.

Based on an analysis of Medicaid data, KHN found that spending by the program on old and commonly used drugs increased by billions of dollars in 2016 compared to the previous year. In fact, the per-unit costs of dozens of generic medications doubled or even tripled during this period.

The costs of 67 generic and non-branded drugs cost Medicaid an extra $258 million in 2016. Medicaid spending on branded drugs, including nine branded drugs that have been available for decades, increased by as much as $3.2 billion.

The costs per unit do not include drug rebates provided by drug manufacturers, but the exact size of these discounts is a closely held proprietary secret.

The report highlighted a number of drugs whose prices increased dramatically in 2016, despite some being available as far back as half a century:

• The price of fluphenazine hydrochloride, used to treat schizophrenia and approved in 1988, rose an average of 347 percent, increasing Medicaid spending by an extra $8.5 million.

• The price of potassium phosphates, used to treat renal failure and was approved in the 1980s, rose 290 percent, costing Medicaid an extra $1.8 million.

• The price of naproxen sodium, the painkiller branded asfluphenazine hydrochloridee that was approved in 1994, rose an average of 236 percent, costing Medicaid an extra $10 million.

• The price of Depo-Provera, used for birth control and approved in 1960, rose by more than 100 percent, costing Medicaid an extra $4.5 million.

In 2016, Medicaid also spent additional funds on a number of branded drugs, including $223 million extra on the arthritis drug Humira, $137 million on the cancer drug Herceptin, $117 million on the schizophrenia drug Latuda, $106 million on the arthritis drug Enbrel, and $102 million on the diabetes drug Humalog. Medicaid spending on the Epipen, the device used to treat serve allergic reactions whose price hikes sparked outrage last year, increased by $70 million.

While the cost of a drug normally declines when it goes generic, a host of factors can delay or undermine this trend. For example, patients may choose stay with the branded version and some states prevent pharmacists from automatically substituting generic for branded prescriptions.

More importantly, the price of generic drugs is related to the number of competitors producing the drug. Citing an analysis by the Food and Drug Administration, the KHN study notes that when there are five or more competitors, the price will drop to about a third of the original price; with two competitors, the price drops to about half the original cost; but when there is only one generic producer, the price only drops by 6 percent compared to the branded version.

Drugmakers have sought to limit competition by illegally colluding with “competitors” in order to keep drug prices artificially high. Since December of last year, 40 states have filed antitrust claims against six generic drug manufacturers—Citron Pharma, Heritage Pharmaceuticals, Myane Pharma, Teva Pharmaceuticals, Aurobindo Pharma, and Mylan Pharmaceuticals—alleging that the companies conspired to divide the market on an antibiotic and an oral diabetes medication, resulting in substantial price hikes.

Pharmaceutical companies also squelch generic competition by suing drugmakers that challenge their patent, or by entering into pay-for-delay deals in which generic manufacturers are compensated for delaying their entry as a generic competitor.

For example, in 2015, Concordia Pharmaceuticals and Par Pharmaceuticals settled charges with the Federal Trade Commission (FTC), which alleged that Concordia agreed to not sell generic versions of Kapvay, a treatment for Attention Deficit Hyperactivity Disorder (ADHD), in exchange for 35 to 50 percent of the net profits made by Par’s sales of the drug. That same year, Teva Pharmaceuticals settled a $1.2 billion lawsuit with the FTC, which claimed that the company it had acquired in 2012, Cephalon, had blocked generic competition against its narcolepsy drug Provigil.

A November 2014 perspective article in the New England Journal of Medicine(NEJM), also drawing on Medicaid data, found a number of similar sharp price hikes among generic drugs between November 2012 and November 2013, including a 5,330 percent increase in the price of doxycycline hyclate, a broad-based antibiotic available since 1967, a 3,780 percent increase in the price of clomipramine, an antidepressant, and a 2,850 percent increase in the price of captopril, used to treat hypertension and heart failure.

The NEJM article also noted a dramatic hike in the price of albendazole, a broad-spectrum antiparasitic medication used primarily to treat immigrants and refugees suffering from intestinal parasites and other maladies. Its price rose by more than 2,000 percent between 2010 and 2013. While the drug is off patent, no companies have sought to introduce generic versions because there is no profit incentive to do so.

This past May, the health care technology company Truveris issued a reportthat drug prices had increased by 8.8 percent in 2016 compared to the previous year—an increase that was 318 percent greater than the rate of inflation. It found that the previous three years have seen an average 10 percent increase in drug prices annually.

A report released this past February by Raymond James & Associates found that the drug industry raised the list prices of 2,353 prescription drugs at the start of 2017.

Trump administration moves to undercut Medicaid and Obamacare exchanges

In wake of Republican failure on ACA repeal

By Kate Randall
1 August 2017

Republican efforts to repeal and replace Obamacare (ACA) came to an end, at least temporarily, on Friday when the US Senate voted to reject the Health Care Freedom Act. The 49-51 vote to defeat the legislation was the third in as many days.

Three Republican senators voted against the measure: Susan Collins of Maine, Lisa Murkowski of Alaska and John McCain of Arizona. McCain, who had made an unexpected return to Washington last Tuesday after a serious brain cancer diagnosis to cast the deciding vote allowing debate on the legislation to proceed, also provided the decisive vote to quash the bill put forward on Friday.

The House version of legislation passed in May, the American Health Care Act (AHCA), and Senate’s Better Care Reconciliation Act (BCRA), along with their various versions, proposed to cut between $756 billion and $880 billion over a decade from Medicaid, the social insurance program for the poor, elderly and disabled, which is jointly administered by the states and federal government.

The House and Senate bills would also have thrown anywhere from 14 million to 19 million people off the Medicaid rolls. The legislation proposed huge cuts to taxes on the wealthy and corporations and would have raised premiums and cut services for those in the ACA marketplaces. Most importantly, however, it would have begun the process of ending Medicaid as a guaranteed benefit based on need through imposing block grants or per-capita caps on Medicaid funding to the states.

McCain’s “no” vote, however, reflected not his sympathy with the plight of Medicaid recipients and workers looking for affordable insurance, but his response to tremendous pressure from the insurance industry to oppose the legislation.

The final measure put to a vote, the so-called skinny repeal, would have rescinded the ACA’s mandates that individuals without insurance purchase it under threat of penalty and that large employers provide insurance to their workers. It did not, however, offer an alternative to shore up the private insurers on the Obamacare marketplace.

As the leading trade group, America’s Health Insurance Plans, wrote: “We would oppose an approach that eliminates the individual coverage requirement, does not offer alternative continuous coverage solutions, and does not include measures to immediately stabilize the individual market.”

In the wake of Friday’s collapse of the Senate legislation, President Trump tweeted: “3 Republicans and 48 Democrats let the American people down. As I said from the beginning, let ObamaCare implode, then deal. Watch!” Such a policy, which would be considered reckless by the private insurance industry from the standpoint of its profits, would also cause premiums to skyrocket and millions to lose their coverage.

The Trump administration, however, is not concerned about the plight of ordinary Americans under such a scenario. The Republicans have campaigned against Obamacare on a completely false premise: that they stand for patient “choice” and “freedom” in the health care market.

Health and Human Services (HHS) Secretary Tom Price appeared Sunday on NBC’s “Meet the Press” peddling the same lies. “Well I think what the president has explained and punctuates is his seriousness about this issue and his passion for turning the health care system in a direction that puts patients first, not government and not insurance companies,” Price said.

Asked by moderator Chuck Todd whether the administration would work to sabotage the ACA, through cancelling television advertising for ACA enrollment, recalling contracts to help with enrollment, and discouraging further expansion of Medicaid, Price said, “Our job is to follow the law of the land and we take that mission very, very seriously. And the role of the Health and Human Services department is to improve the health, safety and the well-being of the American people.”

Price’s statements aside, having been dealt a temporary setback, the Trump administration is already looking at ways it can undermine the Obamacare markets, as well as begin and deepen the attacks on Medicaid that were included in the failed Senate and House legislation.

Under one option, Trump HHS officials could engineer lower enrollment in Medicaid by approving applications from several Republican-controlled states looking to reduce their budgets for the program.

According to Kaiser Health News, Indiana, Arkansas, Kentucky, Arizona and Wisconsin are seeking the Trump administration’s permission to require adult Medicaid enrollees to work and submit to drug testing, as well as to demand that some of their poorest enrollees pay monthly premiums for services that have always been free.

Other states, including Maine, are expected to apply once these states get the go-ahead.

Many states had already received Medicaid waivers under the Obama administration. Officials in Iowa won authority to limit non-emergency transportation, and Indiana received approval to charge premiums and lock out enrollees with incomes above the poverty level if they fell behind on paying premiums.

In relation to the ACA marketplace, this past spring Trump threatened to withhold cost-sharing reduction payments that pay back health insurers for the increased cost of certain Obamacare plans. Without these payments, health insurers might stop offering plans, causing consumers to lose coverage, according to the Commonwealth Fund.

The health of the ACA market relies on signing up new enrollees, but enrollment is highly dependent on marketing and promotion of the exchanges. Spencer Perlman, director of health care research at Veda Partners, an investment consultancy, told MarketWatch: “The [HHS] secretary can undermine the functioning of the ACA by refusing to encourage enrollment.”

Congressional Democrats have responded to the Republicans’ temporary setback on repealing Obamacare, not by rallying popular support to extend access to affordable health care and to defend and expand Medicaid, but by offering to work with the Republicans to “fix” Obamacare.

In fact, it was Obamacare that laid the basis for Trump and the Republicans’ offensive against health care. It implemented the principle of partially subsidizing the purchase of insurance from private companies with government vouchers—the framework long advocated by Republicans seeking to privatize Medicare.

Basing itself on the for-profit capitalist market, the Obama legislation slashed health care costs for corporations and the government while increasing out-of-pocket costs for tens of millions of workers. In the process, it cut billions from Medicare, the health care program for the elderly and disabled. This opened the way for an assault on the social reforms of the 1930s and 1960s wrested from the ruling class as a consequence of great working class struggles.

The working class must advance its own independent strategy in opposition to the bipartisan conspiracy against the basic social right to high-quality, affordable health care. Human health must no longer be subordinated to corporate profit. The health care industry must be taken out of private ownership and placed under the democratic control of the working class, establishing socialized medicine.

WSWS

US House proposes over $5 trillion in cuts

(AP Photo/J. Scott Applewhite)

By Daniel de Vries
20 July 2017

Republicans in the US House of Representatives unveiled a draconian budget plan Tuesday seeking to cut trillions in funding to programs that millions of Americans depend upon to meet basic social needs. The plan introduced in the Budget Committee takes aim at Medicaid and Medicare in particular, while siphoning off huge funding increases for the military and preparing tax breaks to pad the coffers of the super-rich.

All told, the long-term budget blueprint proposes to slash more than $5 trillion from social programs over the next decade, eviscerating what remains of the social safety net. Most provocatively, it calls for $4 trillion in reductions to “mandatory” spending programs, including Medicare and Medicaid, following public uproar over attempts to dismantle portions of these health care services under the guise of repealing and replacing Obamacare.

Connected to the funding cuts are proposals to transform these so-called entitlement programs into limited anti-poverty measures. The plan would introduce spending caps for Medicaid, effectively denying service for millions of poor and disabled people who depend on it for access to health care. Medicare would transition to a voucher-based scheme and apply a “means test” to determine the eligibility of seniors.

Other programs under the ax include $150 billion in funding for food stamps, reduced support for student loans and grants, and additional constraints on Social Security disability coverage. Welfare recipients would come up against additional work requirements. Federal workers would see their pensions gutted.

Alongside these deeply unpopular cuts to social programs are increases for the US military and other “defense” spending, which already outstrips the next seven largest national military budgets combined. Over the next decade, the plan calls for an additional $929 billion to prepare for war and social unrest.

The House Republicans’ plan mirrors in most respects President Trump’s budget proposal released this past spring. In certain areas, however, it is even more extreme. It goes further in boosting the military budget, for example, and proposes attacks not only on Medicaid but also on Medicare. The architect of Trump’s plan, Budget Director Mick Mulvaney, praised the House proposal, urging Congress to move it forward.

The House plan also contains a key element of Trump’s agenda in his first year: tax giveaways to the wealthy. If passed it would rewrite both corporate and personal tax codes, consolidating tax brackets and repealing the alternative minimum tax for individuals, while cutting the corporate tax rate and switching to a territorial tax system to only tax domestic income for business.

The inclusion of the tax plan is a procedural gimmick to allow the bill to become law with a simple majority in the Senate, thereby overcoming nominal opposition from the Democratic Party. But it also requires the tax changes to be revenue neutral. The current plan uses many of the same accounting tricks and optimistic growth assumptions as the president’s plan to arrive at that conclusion. However, Trump has favored even larger tax cuts, which add to the deficit despite the mathematical camouflage.

The prospects for the current budget proposal to survive a vote by the full House of Representatives remains uncertain. Already it has generated criticism from both hard-line right-wingers and Republican “centrists” as not going far enough or going too far, respectively. Democrats have denounced the plan. House minority leader Nancy Pelosi called it a “toxic budget whose sole purpose is to hand tax breaks to billionaires on the backs of seniors and hardworking Americans.”

Nonetheless, the brutal austerity proposals prepare the way for a “compromise” to emerge that restores some of the cuts but still accelerates the dismantling of social programs. Together with the long-term concept of transferring to several trillion dollars to the wealthy, the plan contains short-term actions, including mandating $203 billion in cuts, to be determined by 11 different committees.

The general program of rolling back the social safety net and anti-poverty programs has in fact been a common one shared by both Democrats and Republicans. The current budget proposal is a somewhat more austere variation of the $4 trillion in cuts proposed by the Simpson-Bowles Commission convened by President Obama, or the $1.1 trillion sequestration cuts enacted by him.

Yet the ruling class sees now an opportunity to advance its agenda. “In past years, our proposals had little chance of becoming a reality,” House Budget Committee Chairman Diane Black said. “The time for talking is over, now is the time for action.”

WSWS

Ohio politician proposes letting overdose victims die

The policy of “social murder” behind the US health care debate

By Barry Grey
5 July 2017

At a June 20 meeting of the Middletown, Ohio City Council, Dan Picard, a council member, offered a novel proposal to contain surging costs associated with a worsening epidemic of opioid overdoses in the town. Like cities across the United States, this southwestern Ohio town of some 49,000 people is being ravaged by the explosive spread of drug addiction linked to opioid pain killers. This year it has already recorded nearly 600 overdoses, more than in all of 2016.

Picard, who is not planning to run for reelection, proposed that the City Council adopt a “three strikes” policy, under which those who make use of emergency services two times to deal with an overdose will be denied help the third time. As he told the Washington Post, “When we get a call, the [emergency services] dispatcher will ask who is the person who has overdosed. And if it’s someone who has already been provided services twice, we’ll advise them that we’re not going to provide further services—and we will not send out an ambulance.”

Defending his proposal, Picard said, “I want to send a message to the world that you don’t want to come to Middletown to overdose… We need to put a fear about overdosing in Middletown.”

This call for what amounts to state-sanctioned murder evoked an angry response from the public in Middletown and wherever else people became aware of it. Numerous health care organizations and advocacy groups involved in dealing with the drug abuse epidemic denounced Picard and his proposal.

Alexis Pleus, the founder of Truth Pharm, a nonprofit that seeks to raise awareness of the issues surrounding substance abuse, did not mince words in an open letter to Picard: “To suggest that you withhold emergency medical response to overdose patients is manslaughter at best and premeditated murder at worst.”

Most of the American population, however, never learned of the incident. This is because the establishment media, fixated on its campaign against Russia and saber-rattling against North Korea, China, Iran and Syria, along with the political warfare in Washington between the Trump administration and its ruling class opponents, did not widely report the story.

There are other political reasons for the downplaying of the story by the corporate-controlled media. Picard’s brazen suggestion that drug abuse victims be allowed to die comes uncomfortably close to lifting the lid on a basic policy question underlying the current official debate on health care “reform.”

Behind the proposals in the Republicans’ bills to cut costs and boost profits by gutting Medicaid, the government insurance program for the poor, and lifting the current requirement that insurance companies cover certain “essential benefits,” lies a deliberate and calculated effort to reduce life expectancy for working people overall and send many of the old, infirm and mentally or socially disabled to an early grave.

The effort, moreover, is bipartisan. The Democrats are pleading for negotiations on a “compromise” bill to “fix” Obamacare, a euphemism for incorporating the demands of the insurance monopolies for even higher premiums, copays and deductibles and fewer restrictions on their ability to gouge the public. Obamacare itself is a mechanism for cutting costs for corporations and the government, weakening the system of employer-provided health insurance and rationing access to health care on a more openly class basis. The Republican plans build on Obamacare to accelerate the health care counterrevolution it initiated.

The corporations, banks and hedge funds that are pushing health care “reform” and the politicians and policy experts who are doing their bidding are well aware that many thousands will die needlessly as a result of the measures being proposed. Medicaid, slated to be cut under the Republican bills by some $800 billion over ten years and terminated as an open-ended entitlement program with guaranteed benefits, provides about 80 percent of funding to treat drug abuse, which overwhelmingly affects working class and poor people.

In 2015, some 1.35 million low-income Americans had an opioid use disorder. As it is, only 25 percent of those people get treated in a year.

Last year some 60,000 people in the US died from drug overdoses, 60 percent of them from opioids. Drug overdoses are now the leading cause of death for Americans under 50. There is no starker barometer of the failure of the capitalist system and the descent of broad masses of the population into conditions of desperate social crisis.

Of the 22 million people who will lose medical coverage under the Senate health care bill, Medicaid cuts will account for 15 million of them. Moreover, both the House and Senate bills allow insurance companies to drop coverage of care for mental health and substance abuse, among other basic services.

Can there be any doubt that many will die as a result of these cuts? Lynn Cooper, director of the Drug and Alcohol Division at Pennsylvania’s Rehabilitation and Community Providers Association, told National Public Radio last month: “It is a death epidemic all over the country. The loss of Medicaid expansion will be like the bottom dropping out for thousands of Pennsylvania citizens and their families.”

The impact is so self-evident, and public opposition so pervasive, that government officials are obliged to resort to the most brazen lying when defending their proposals. Typical was the performance of Health and Human Services Secretary Tom Price, a notorious and longstanding opponent of basic social program such as Medicaid, Medicare and Social Security, in an appearance Sunday on NBC’s “Meet the Press” program. Of the Republican plan to dismantle Medicaid, he said, “We want to make certain that Medicaid is a program that can survive.”

While claiming to be committed to addressing the opioid epidemic, he declared, “We don’t need to be throwing money” at the crisis.

Ruling class strategists speak more frankly on specialized think tank web sites meant for corporate and state officials and their academic advisers. In 2013, the WSWS drew attention to two policy papers published by the Center for Strategic & International Studies (CSIS) on the negative consequences for American imperialism and the national security apparatus of lengthening life spans for ordinary people resulting from advances in medical science and treatment and government health programs.

As the CSIS experts explained, the human and social achievement of better health and longer life for many millions of Americans spells disaster for the American ruling class and the capitalist system. The authors of the studies insisted that action had to be taken to deal with the “crisis,” including increasing the eligibility age for Medicare and Social Security to force the “young elderly,” those aged 60-69, to forgo retirement and keep working.

One of the papers, titled “The Budget Crisis and the Civil-Military Challenge to National Security Spending,” was written by Anthony H. Cordesman, a longtime CSIS strategist who acts as a consultant for the US State and Defense departments. Denouncing the siphoning of money away from the military to pay for medical care for the elderly, Cordesman wrote, “The US does not face any foreign threat as serious as its failure to come to grips with… the rise in the cost of entitlement spending.”

Behind such discussion papers are systematic studies and actuarial tables calculating the likely effectiveness in shortening life expectancy for workers—a process that is already underway—of various proposals to “reform” the health care system.

In his immortal 1845 work The Condition of the Working Class in England, Friedrich Engels accurately characterized as “social murder” the horrific conditions imposed on workers by the capitalist class, which “placed hundreds of proletarians in such as position that they inevitably meet a too early and unnatural death…”

The present crisis-ridden and bankrupt state of American and world capitalism is once again bringing to the fore the incompatibility of the profit system and the rule of a financial aristocracy with the satisfaction of human needs such as health and longevity. The health care counterrevolution in the US is a case of “social murder” at the hands of the capitalist class.

 

WSWS

The emerging class struggle over health care in the US

29 June 2017

Following the announcement on Tuesday that the Republicans would be putting off a Senate vote on their health care bill until after the July 4 congressional recess, the Democrats and Republicans continued their stage-managed debate over measures that will have devastating consequences for millions of Americans.

The media’s presentation of a bitter feud over the direction of health care policy is a political fiction. The newspapers and television networks report on the statements of one or another lawmaker and his or her attitude to the plan recently unveiled by Senate Republicans as if this will have any real impact on the trajectory of ruling class policy.

The more decisive verdict was delivered on Tuesday by Wall Street, which saw its biggest one-day drop in six weeks after Republican Majority Leader Mitch McConnell put off a Senate vote this week. The message was clear: the corporate and financial elite wants its money, and it wants it now. The health care measure includes a $700 billion tax cut for the rich—a down payment on the money to be freed up by depriving the elderly and poor of their health and even their lives.

The American ruling class is engaged in a form of social arson no less criminal or deadly than the policies that led to the Grenfell Tower fire in London.

McConnell responded on Wednesday by promising that a new version of the bill will be ready by Friday for a vote sometime in July.

Charles Schumer, the Democratic Senate Minority Leader from New York, reacted to the summons of the market by reiterating his call for a “bipartisan” solution, a mantra repeated by virtually all congressional Democrats. “Democrats are genuinely interested in finding a place where our two parties can come together on health care,” Schumer said. That Schumer gets more campaign money from the hedge funds and banks than any other senator, Democratic or Republican, is sufficient to demonstrate what type of child will issue from such a union.

Schumer did not comment on the apparent contradiction between his claims to be fundamentally opposed to the Republican plan and his calls for a bipartisan compromise. His position exposes the fact that the two sides share a basic agenda.

The Democrats assert that they want to “fix” Obamacare. What does this mean? They are not talking about expanding coverage to include the 28 million still without insurance under the Democratic plan, or increasing the inadequate subsidies, decreasing absurdly high deductibles and copays, and preventing the insurance companies from raising premiums. “Fixing” Obamacare is a euphemism for incorporating the demands of the insurance industry for even fewer restraints on their profit-making and tighter eligibility requirements for consumers.

The public has seen this type of political theater countless times, and the outcome has invariably been the same. The Republicans set the marker as far to the right as possible and the Democratic “opposition” results in a deal to impose new and more drastic cuts to health care and other social programs. The most significant and fraudulent of these dog-and-pony shows was the passage of the Affordable Care Act, or Obamacare, itself.

The Republican proposal is not in fact a “repeal” of Obamacare. It incorporates the structures set up by the Democratic measure, such as the exchanges for purchasing policies from private insurers, designed to more fully subordinate the health care system to the capitalist market and encourage the demise of employer-sponsored health coverage, placing individual workers even more at the mercy of the insurance giants.

The central purpose of Obamacare is to shift costs from corporations and the state to the working class, with health care increasingly rationed on a class basis.

The so-called “health insurance” that many people now have under Obamacare is, in effect, a transfer of funds to the giant insurance companies. Deductibles for lower-priced “bronze” plans now average more than $6,000 for an individual and more than $12,000 for a family. Deductibles for so-called “silver” plans (which make up 70 percent of the market) are on average more than $3,000 for individuals. In other words, after paying hundreds of dollars a month for health insurance, workers must pay thousands more before they begin to receive any benefits.

Corporations have been systematically cutting or eliminating coverage, encouraged by Obamacare’s coming tax on more “generous” employer-provided health care plans. More than 80 percent of employer-based plans now have an annual deductible ($1,478 on average, up 2.5 times since 2006). In countless contract disputes throughout the country, health care cuts are a central demand of the companies, invariably accepted and forced through by the trade unions.

The subsidized purchase of private insurance under Obamacare has created the framework—a voucher system—for dismantling what remains of government-provided health care. The American ruling class is setting its sights on the bedrock health care programs of the late 1960s—first Medicaid, the already grossly underfunded state-federal health insurance program for the poor, which will be effectively dismantled by the Republican bill, then Medicare, the health care program for the elderly. Behind these health care programs lies Social Security, the federal pension program wrenched from the ruling class through the explosive class struggles of the 1930s.

The hypocritical criticisms of the Republican plan by the Democrats and the various middle-class organizations that orbit the Democratic Party not only cover up for the reactionary character of Obamacare, they completely ignore the central issue: capitalism.

There is no solution to the massive health care crisis that does not take on the domination of health care by giant pharmaceutical and insurance companies, which operate under the ever-present whip of Wall Street and its demands for higher profits and dividends. These giant corporations must be expropriated and the wealth of the financial aristocracy seized to finance emergency measures to address the health care crisis and establish a system of universal health care, guaranteed as a basic social right.

Whatever tactical differences the Democrats have with the Trump administration on health care are entirely subordinate to their basic objective: escalating US military aggression in the Middle East and internationally. The hysterical Democratic campaign over alleged Russian hacking and Trump collusion with Moscow has as its central aim forcing a shift in administration policy toward a more rapid and comprehensive expansion of the US war for regime-change in Syria and a more aggressive policy toward Russia.

But as the Democrats well know, military escalation abroad is inextricably bound up with the intensification of austerity and class war at home.

In asserting its right to health care, the working class cannot allow itself to be drawn behind any section of the political establishment. It must proceed with its own methods—those of class struggle. The health care counterrevolution is generating enormous opposition, which is beginning to emerge in innumerable forms. Millions confront conditions that spell death or disaster for themselves, their parents and their children.

As the WSWS wrote earlier this month, “The interaction of objective conditions of crisis, both within the United States and internationally, and the radicalization of mass social consciousness will find expression in the eruption of class struggle. The decades-long suppression of the class struggle by the trade union bureaucracy, the Democratic Party and the affluent sponsors of various forms of identity politics is coming to an end. The social counterrevolution of the ruling elites is about to encounter an upsurge of the American working class.”

Emerging struggles against all of the deplorable conditions of life under capitalism—the destruction of health care, declining wages, unemployment, brutal working conditions, the attack on public education, mass indebtedness, the witch-hunting of immigrants—must be brought together in a common political fight against the Trump administration and both big business parties, based on a socialist and internationalist program.

Joseph Kishore

WSWS