TO LIVE AND DIE IN AMERICA - book review

TO LIVE AND DIE IN AMERICA

Class, power, health and healthcare

Robert Chernomas and Ian Hudson

The US, by spending 15.2% of its gross domestic product on it, has the most expensive health care system in the industrialised world. Yet life expectancy is four years lower than in other comparable countries, where the historical combination of strong trade union movements and popular pressure forced the ruling class to guarantee universal access to health care.

This easy to read book is therefore a powerful antidote to anyone who feels government plans for the private sector to take over the NHS would be good for the British people or nation as a whole.

The authors argue that class and power in the United States has determined its health outcomes and the healthcare system. As in many other parts of the world, poor working and living conditions have also impacted on people’s health. Radical change is needed.   

Health care facilities in the US are largely owned and operated by private sector businesses. Their employer insures most of those under 65, with low-income families and the elderly covered by government means-tested programmes such as Medicare and Medicaid. That has still left fifty million people – 16.3% of the population – uninsured. Most are badly paid workers unable to afford the insurance premiums.

Barack Obama’s 2010 Affordable Care Act (ACA) assumed that universal coverage would never be achieved by involving a more meaningful role for government as this would have been opposed by the medical industry. Max Baucus, the senator who drafted the legislation, met industry representatives 20 times whilst granting only 12 meetings to public interest groups. 

3,300 healthcare lobbyists were employed during the reform debate to oppose any meaningful reform that might damage the industry. The hundreds of millions of $’s spent was chicken feed for the drugs and medical companies who average a very healthy 19% profit on their turnover.

The highly complicated ACA did raise the numbers insured by Medicaid but has also mandated millions of struggling low-waged American’s to take out insurance.

ACA was also predicated on the assumption it would reduce the US government’s health care costs. Yet a similar system introduced in Massachusetts in 2006 – which has still left thousands uninsured – has seen costs there rise after the introduction of additional administrative apparatus of healthcare. This has added 5% to the cost of private insurance.

Private health insurance premiums have risen nationally by 700% between 1969 and 2009. This far exceeds the 400% increase in Medicare costs and is starting to affect the hiring criteria for firms who are seeking to reduce costs by eliminating anyone they suspect may fall ill in the future.

Although Chernomas and Hudson make a powerful case for radical change they admit this “would appear to be highly unlikely.” Affordability of healthcare for families and the US government is still well out of reach. As such the US health system acts as a powerful warning against government proposals here that will increase the role of private profit within the NHS. 

Published under the Future of World Capitalism series by Pluto Press.