Unfortunately, the big winner in this battle has been the health insurance corporations. Corporations don’t exist to provide products or care. Their primary purpose is to produce profit and most preferably increased profits. The only way to do that is to either deny care to the sick or increase the cost of coverage. The health insurance industry has chosen to do both – and no one has stood in its way.

Physicians for a National Health Plan (PNPH) likened the new plan to an “aspirin dispensed for the treatment of cancer.” As Dr. Marcia Angell from PNHP put it, it’s hard to find a solution if you lose sight of the cause of the problem and attempt only to cure the symptoms. The cause, the cancer, is the for-profit system which dispenses health care as a market commodity according to the ability to pay.

The symptoms are millions of uninsured, uneven coverage, sky-rocketing costs, lower life expectancy, and tremendous waste. More than 1,200 insurance corporations are involved in this industry, each with its own staff and operating costs – not to mention its own insatiable appetite for profit. On the other side, health care providers need to keep an army of office personnel just to deal with the insurers. These add nothing to the quality of care, but add plenty to the overall costs.

So how much of the problem will be cured by the Act? Not much.

Lost in the hype are facts such as:

• 23 million people will remain uninsured for the next nine years.
• Mandated individual coverage will force people into buying policies from private insurers, but with no provisions for cost control. There are also no guarantees that policies will cover 100% of the cost of care, leaving families open to impoverishment in case of catastrophic or serious illness.
• Companies with 50 or more employees are mandated to provide health insurance. Failure to do so carries penalties of $2,000 annually per employee. Considering the average annual cost of over $13,000 for family coverage, employers actually have an incentive to deny health benefits, pay the penalty and still be $11,000 richer. Their workers then will have to comply with the individual mandate or face a penalty. But beyond the penalty, they will be facing the prospect of lack of care when they need it.
• Insurance companies won’t be allowed to deny coverage to children with an illness or pre-existing conditions (this will apply to adults in 2014). But there is nothing in the bill prohibiting them from raising premiums for these patients beyond their ability to pay. If these patients drop their coverage, they pay a penalty or get covered by state subsidies. Either way, the insurer stands to gain.
• Insurance exchanges will be established in which the state will actually be the broker, directing clients to the private insurers. In Massachusetts, where these exchanges were instituted in 2006, it’s estimated that they add 4% to the overall cost of health care.
• The bill includes a provision that “demands that women receiving federal subsidies for health insurance write a second check to their insurer for policies purchased through the government-administered exchanges for any portion of their policy that covers abortion.” That would also apply for employer-based insurance. It’s a devastating blow to women’s reproductive rights.

The few progressive elements of the bill, such as extending the age parents can cover students under their insurance to age 26, or extending Medicaid to more people, which will benefit some people, do not constitute a fundamental transformation of the health care system, and are countered by other regressive aspects of the bill. These could easily have been passed as stand-alone laws.
The Act not only fails to address the underlying problems, but it expands the role of the insurance companies. For the first time, there is legislation that establishes for-profit health insurance as mandatory for the majority of the population.

Obama and the DemocratsFrom the beginning of the health care debate the Republican strategists prepared to go on the offensive and hit the ground running. The insurance lobby opposed reform, even when it was obvious it would actually enrich them. Republicans lined up behind them, denouncing “government-run insurance” as un-American, socialist, treacherous, etc. They organized grass-roots campaigns, tea parties and dominated town hall meetings. Their message, reactionary and at times plainly racist, was heard loud and clear.

By contrast, the Democrats - who controlled both the legislative and executive branches - allowed the Republicans to dictate the agenda. Obama took a hands-off approach and let the conservative Democrats and Republicans set the scope of the discussion. “Single-payer” advocates were kept away from discourse. Insurance industry representatives were given prominent seats at the table. Universal mandate was the corner stone of the plan that started to emerge from the deliberations. The most “radical” proposal was the possible inclusion of a “public option”, which kept getting weaker and weaker until it was totally dropped, despite Obama’s assurances to defend it. The proposal that emerged included universal mandate, no “public option”, and taxes imposed on those with workplace benefits - something that would hit unionized workers who have won better health care provision from their employers.

In the last few weeks Obama himself stepped forward, proposed a slightly modified but nevertheless industry-friendly bill and campaigned vigorously for it. He held rallies and town hall meetings, he made speeches and used the media. He was reportedly working the phones till the last minute, assuring conservatives that his bill would continue to deny poor women the right to safe abortions. He made it clear that no threat to the domination of private insurance industry was included in the plan.

Most of the “progressives” in the Democratic Party folded, one by one abandoning single-payer or even the meager public option. The last man standing was Dennis Kucinich, who flipped two days before the vote after Obama personally appealed to the voters in his district. Obama had no concessions to offer to the liberals but got their vote. From the Republicans he failed to secure a single vote, despite the concessions. So, the Democrats managed, once again, to single-handedly pass legislation tailored to the needs of big business, much like the stimulus package of 2009, the bailout of 2008 and the credit card industry reform of 2010.

Obama showed that he is capable of using his position and his popularity to campaign for change, but he chose not to until he had a totally ineffective bill to fight for.

Why Insurance Industry Opposed Bill?
The economic crisis accentuated the problems high insurance costs were causing not only for families, but for whole industries. Polls showed the vast majority of Americans were in favor of reform. A majority even favored a “single-payer” system. The demand for radical reform was getting stronger.

The Obama administration allowed the insurance industry a prominent voice in the debate. By the end of the process the proposals did not pose much of a threat to the industry. As long as they managed to avoid competition by government-run non-profit alternatives, they were in the clear.
But if the insurance industry had embraced any of Obama’s proposals and called off the bitter campaign of resistance, they would have allowed proponents of real change enough room to organize and strike back. The only way to avoid that was to keep the “other side,” i.e. progressive forces, on the defensive by denouncing even the most moderate change. The strategy worked wonderfully. The louder their voice, the more the leaders of the Democratic Party were trying to appease them. The Democrats did what they always do best: They silenced their left flank and kept moving the agenda to the right.

The media played their part too: Fox News set the pace and the rest of them followed. They gave the tea partiers and the lunatic right their full attention, while they virtually ignored calls for radical reform – much like they had ignored the anti-war movement for the last seven years. Every stunt the Republicans staged was blasted in the news and amplified, whether it was disruption of town-hall meetings or teary-eyed TV show hosts.

A Socialist Approach to Health Care
From the start, Socialist Alternative characterized this bill as inadequate compared to what is needed - a single payer system. How would working people be motivated to organize support for a bill that included taxes on their existing health insurance coverage?

The only proposal that could bring about meaningful reform was the demand for a “single-payer” system, or Medicare for All. Unions and community organizations could have mobilized their members, much like they did during the 2008 presidential campaign. With a proposal for real change, millions of workers and their families in thousands of communities around the country could have been inspired to build a grass-roots campaign for fundamental transformation of the health care system in the U.S. A movement could hold rallies and educational meetings, go door-to-door to raise the consciousness of their fellow workers and their neighbors and recruit more activists to the cause.

Some argue that this measure is a step in the right direction and that improvements can be made as this law comes into effect in stages over the next eight years. Certainly this is not the end of the matter. This law’s attempts to entrench a profit-run health care system will be undermined.
Experience and disappointment will mean that demands for profit to be totally taken out of health care and for public provision will increase.

A lesson to be learned from this is we can’t depend on the Democrats to affect change. At best they are ineffective, at worst they are the same as the Republicans.

But we should not allow the Republicans to benefit electorally in November. It’s not too late to form a coalition of unions and communities and stand independent candidates determined to fight among other issues for single-payer health insurance, an end to corporate subsidies and an end to the war. We need candidates that will defend the rights of working people against those of big business.

The Democrats control the State House, the entire legislature and Boston’s City Hall. Nobody alive can remember a time when there wasn’t full-scale one-party control of these institutions. Now, on top of that, they have the Governor’s mansion. In power, local Democrats have attacked the teachers’ unions, attacked the fire fighters and cut budgets to other social programs. For a fuller view of Deval’s Massachusetts Democrats, see the Boston Organizer archives at boston.socialistalternative.org.

Massachusetts has been hit hard by the financial collapse. Construction in particular has bore the brunt of job insecurity with over 30% of workers “on the bench” without a job. There is no end in sight with further budget cuts being planned and no major building projects in the works. In this context, Scott Brown’s decision to have his campaign run out of a GMC pickup truck was a clever populist ploy.

The winter shocker was about more than just “Obamacare.” Still, it must be acknowledged that Brown rose from obscurity with a campaigning focus on the new health bill. This is in the state that has been seen as the partial model for the bill going through Congress. Massachusetts voters have seen this health care “deform” already, and they are not happy with it. Low-paid workers have been forced to buy inadequate health plans they don’t want, and state subsidies are handed to the health industry; more per capita than in any other state. This is a warning that the only friends the Democrats will make with a new health bill are corporate lobbyists, no matter how eloquently Obama talks about “historic reform.”

If the national bill had been seen as different by having a single-payer “free quality health care for all” position or even just a strong national “public option,” then it would’ve been much harder for Brown to attack heavily and gain traction. The New York Times in February of 2009 conducted a poll which found that 59% of Americans felt that the government should provide comprehensive health care, while only 32% wanted health left in the hands of private investors. This is despite the media blackout of a single-payer system and the attention given to obnoxious Tea Party lunatics in the town hall meetings.

Two Very Different Campaigns
Brown conducted a national campaign of fund-raising. He sounded like a broken record about being the potential 41st Republican Senator, a defining seat in Congressional voting patterns along partisan lines. His money came primarily from conservative Republicans outside of the Bay State. He got financial backing which skyrocketed from just over a million to well over 12 million after going national.

This money was used to conduct a grassroots campaign of rallies attended by registered independent voters. The orientation of the campaign, through phone calls and mailings, was almost exclusively to independent voters. This is despite the fact that independent voters do not traditionally even turn out for “special elections” like this. A seemingly desperate strategy caught fire in the economically parched Commonwealth of Massachusetts, and anger turned to shock on election day. Near-record turnouts occurred in an election with only one contested seat on a day with abysmal weather switching from snow to rain and back again.

This should not be interpreted as a vote of confidence in the status quo for-profit health industry. It is a vote against the questionable aspects of the bill; Brown’s ads continuously attacked the fact that ordinary Americans will have their health plans taxed under the new law. Brown’s ads showed Coakley in Washington meeting with insurance and pharmaceutical lobbyists.

While Brown ran as an “outsider” and an “ordinary citizen” without connections to “politics as usual,” Coakley ran a sloppy insider campaign. She enlisted the help of Ted Kennedy’s widow, and in a last gasp of Coakley’s campaign, Obama was brought to Massachusetts, having no impact on polls. This is a significant indicator that enthusiasm for Obama has waned, and the honeymoon is over for the candidate that once inspired unparalleled political euphoria.

At first dismissive of Brown, Coakley began to run vicious attack ads constantly in the final weeks of the campaign. In a state known for dirty political campaigning, Coakley’s was considered the worst mudslinging ever, even distorting Brown’s record. The ads, a signal that the ruling machine had no idea how to confront challengers, resulted in some quite funny parodies on sports talk radio.

Of course, a conservative Republican moving to Washington should not be considered in any way a step forward or be taken lightly. Brown will be perfectly happy to rub elbows with high-ranking right-wing lobbyists and Republicans. This shows the dangers present in the situation. The widespread anger at the status quo and vacuum on the left that exists is already being exploited by right populism. Isolation, desperation and anti-social behaviors could become more prominent. Growing support for “outsider” Republicans is taking place, which could even lead to growing electoral viability for the hard far-right like the Minutemen or the Tea Parties, who could gain an echo with thinly-veiled racist scapegoating.

These dangers also have opportunities inherent within them. Dissatisfaction with the establishment is rampant. Big business in unpopular, and class anger is mounting. If given a lead and well-organized, working people will be ready and able to fight back. The battle against education cuts in California shows this. The occupation at Chicago Windows and Doors about one year ago again illustrates this point and shows the public sympathy that can be won for workers fighting back. The war, bailouts and health “deform” show that Democrats are not representatives of working people, and if we fight without political representation, then we are entering the ring with one hand tied behind our backs.

We need candidates independent of the two parties who will take no donations from corporate America. These candidates should stand on a clear program against budget cuts, against the war funding, against the big bank handouts and for single-payer health care. Independent candidates against cuts in 2010 should be strengthened, and the results should be built upon with an initiative to form a working class party including fighting unions, anti-war campaigners, Green activists and community groups. Without a left alternative, we will be stuck in the cycle of corporate politics that got us into this mess.

Socialists stand against the bailouts of the big banks, the troop surge and the budget cuts. We want to tax big business and the rich to provide a mass public works program. This way, millions of jobs could be created to provide ecologically-friendly mass public transport, adequate affordable housing, first-rate guaranteed health care and free kindergarten to university education. This will of course take a struggle against the rich and powerful with pickets, mass demonstrations, strikes and a workers’ party to fight in our interests. Instead of giving handouts to banks or accepting layoffs in failing industries, the commanding heights of the economy should be put under the democratic control and management of working people and their communities.

What Does this Mean for the 2010 Elections?
Many Democratic strategists, in the pockets of big business, will claim that working class voters have moved in a right-wing direction, and that the Democrats must move rightward as well in order to win seats in 2010, but this is a distortion of the real situation. The anger that Brown capitalized on could to a large extent have been won by an independent alternative to corporate domination. Problem is, the mainstream Democrats are beholden to their corporate masters and will never break with the big business hand that feeds their campaigners and bludgeons workers and youth.

The right-wing Republican agenda has been soundly defeated in the previous elections with the rallying cry of “change.” Young people grew up with an intense hatred of Bush. The country is becoming more racially diverse and more accepting of LGBT people. The corporations, the executives and especially the big banks are widely hated. Environmental concerns are widespread. Polls indicate these facts over and over, yet the Democrats will not represent these trends.

Drew Westen in The Huffington Post commented, “Americans were tired of hearing Obama ‘exhort’ bankers and speculators to play nice as they collected their record bonuses for a heckuva job in 2009. It took him a year to float the idea of making them pay for a fraction of the damage they had done, and at this point, few Americans have any faith that a tax on big banks will ever become law or that the costs won’t just be passed on to them in new fees.“

Parallels could be drawn to the 1994 mid-term election Republican landslide after two years of Democratic domination achieving nothing but NAFTA’s attack on living standards. Cue the lesser-evil apologists saying that Brown’s election cost the Democrats a “filibuster-proof” majority that tied their hands. Since when did parties need a guarantee against filibusters to achieve anything? After all, the Democrats allowed Bush to do pretty much whatever he pleased without the Republicans ever having the oh-so-necessary “filibuster proof majority.”

On Counterpunch, Alexander Cockburn correctly says, “The independents see no trace of the invigorating change pledged by Obama. Working people in the labor unions who supplied the footsoldiers for Obama’s campaign see no improvement in their economic condition. Everyone knows that Obama is the champion of bankers, not bankrupts. The liberals morosely list twelve months of disasters, from a wider war in Afghanistan, to major betrayals of pledges to restore constitutional restrains after eight years of abuse by Bush and Cheney.”

So, much of the anger could continue to be directed at the Democrats, and the Republicans could pose as outsiders in 2010. In close elections, there is tremendous pressure from the liberal left and many union leaders to support the Democrats. Socialists and other activists will need to withstand this tide in order to lay the basis for a working class resistance to both right-wing parties.

Socialist Alternative has been out campaigning alongside other union members and activists in Massachusetts against layoffs and budget cuts over the past few weeks. More than once, we have encountered people enthusiastic about Brown’s campaign. By no means were they “fiscal conservatives”; they actually would say that the best way to stop cuts was to vote Brown! Meanwhile, nearly every Coakley voter started with “I don’t like Coakley, but…”

With no credible left alternative in the special election, we could only say that struggle will stop layoffs, not corporate politicians. If there was an independent left candidate, then we could have pointed voters in the direction of an electoral engine for their anger. There is an openness to the need for real, fundamental change, and more people are examining socialist ideas. A fight against public sector cuts can focus this aversion to corporate greed, and we need independent candidates to emerge from the battle against cuts and war to challenge both parties in 2010. Otherwise, there will be more Martha Coakleys and more Scott Browns.