Form follows function. – Frank Lloyd Wright
You can see the truth of the great architect’s maxim all around you. A brazen example, though slowly being replaced, is still very much in evidence in the City of San Francisco. Over twenty years ago, the City decided to replace its bus shelters. The then-new models had “seats” that were more like lean-tos.
They are difficult for children, the elderly, or anyone with a disability–picture someone in a leg cast–to sit in properly. These “seats” are uncomfortable for everyone, even athletic types, especially if the wait for the bus is a long one.
That is because the shelters were designed first and foremost to NOT be a place where the homeless could sleep. This priority destroyed the function of the “seats” as places where people waiting for a bus, or needing to rest while walking, could sit comfortably. Form follows function.
The maxim applies in the world beyond built structures. It applies to processes and laws. The Affordable Care Act, informally known as Obamacare, is a prime example of the Wright maxim. Is the primary function of the Act to provide everyone with health care access, or it is a way to protect the profits of the private health insurance industry, disguised as a method of reducing the pool of America’s uninsured? The fact that I have nicknamed this program The Greater Health Insurance Industry Profits Act lets you know where I come out on this issue. Here’s why.
Many people called for President Obama to give everyone health care access in an easy to implement package devoid of uncooperative Republican governors–are there any other kind?–buggy websites, and IRS penalties for being unwilling to be a captive of the private health insurance industry. They called on President Obama to extend Medicare to all by Executive Order. Logically, what then should have followed would have been the abolition of Medicaid as a separate program. Everyone would have been covered under one program that has been proven popular and much more administratively efficient than private health insurance. From an actuarial perspective, this would have made the most sense as everyone, young and old, healthy and not, would have been in the same pool. The federal government would have paid with our tax funds—a far better use of tax revenues than war-making and massive surveillance. It would have also negotiated lower prescription drug prices.
Businesses would get what they clearly want: a chance to dump the burden of rising health care costs. Considering how little so many people are paid, and how many jobs have turned into part-time, precarious positions with no benefits, Medicare for All would be good for the people.
The reason that Obama did not go for this, or push in 2009 for HR 676, Michigan Rep. John Conyers’ Medicare for All bill, when the Democrats controlled Congress and the White House, goes far beyond electoral politics. To have Medicare for All would render the private health insurance industry obsolete. The government essentially would have put a whole industry out of business, or left, at most, a rump industry that would fill a niche if the government decided not to cover cosmetic surgery. This would set what capitalists regard as a most dangerous precedent: the government could put industries that heretofore had been legal, out of business with the stroke of a pen.
Professor Gerald Friedman PhD., who teaches economics at the University of Massachusetts—Amherst, released a study last summer showing that Medicare for All in the form of HR 676, “could save an estimated $592 billion annually by slashing the administrative waste associated with the private insurance industry ($476 billion) and reducing pharmaceutical prices to European levels ($116 billion). In 2014, the savings would be enough to cover all 44 million uninsured and upgrade benefits for everyone else.”
But that legislation could never pass the now-Republican-dominated House. Why? Because it would be (shudder!) “socialized medicine!” <scream>.
Just what does that mean? Under HR 676, it means “phasing out investor –owned [healthcare] delivery systems”, e.g. for-profit hospitals would be converted to non-profit status. The investor class would no longer be able to profit from the illness or injury of their fellow human beings. Aww!
According to the Friedman study, funding for the program would be achieved in part from:
- Increasing personal income taxes on the top 5% of income earners
- Instituting a modest tax on unearned income
- Instituting a modest and progressive tax on payroll, self-employment
- Instituting a small tax on stock and bond transactions
“Augh! Taxing the rich is punishing success! Taxing stock and bond transactions will discourage investment and kill jobs!” (Considering how poorly many of today’s jobs pay, they should be killed.)
The values—and I use that term loosely—of the capitalists, who uphold their alleged right to profit over the welfare of the people, reek of class warfare. Which term is in the Constitution, by the way, profit or welfare?
Former Rep. Ron Paul (R-TX) believes people must earn their health care and should rely on private charity—the kindness of strangers—if they can’t afford care. He thinks no one should be forced, through taxes, to pay for someone else’s needs; that’s tyranny.
But why should you have to be profitable to someone else before you can see a doctor? Everyone needs healthcare at some point in their lives because it is the nature of the human body to get ill and injured. Why should the type of job you have, if you have one at all, determine your access to health care? Given all the health-damaging stresses that accompany unemployment, unemployed people may need more healthcare. Likewise, why should a for-profit health care “plan” limit the type or location of the care you get? You shouldn’t go bust because you need cancer surgery in New York but you live in Maryland, or, as happened to me, they treat medical indigents in county hospital A but treat heart attacks in private hospital B and I, working part-time and uninsured, ended up having a heart attack at work. I fought off bill collectors for a year, not exactly a prescription to relieve the stress that was at least in part the cause of my heart problems.
Paul’s son, Rand, the junior senator from Kentucky, thinks free health care would be slavery. He is afraid that, under free national health care, the police could knock on his door and order him to treat a patient without compensation. If I were a doctor and the police knocked on my door saying that they had shot a suspect or that there was a three-car pile up down the road and they needed a doctor right away, I would say “Let me get my coat and medical bag. Can I ride in your car?” Rand Paul would ask, “Who can I bill, if I go?” I would be glad of the opportunity to serve, he would focus on the intrusion on his time, calling it a government limit on his freedom. Freedom to people like the Pauls is the freedom to be entirely selfish.
Capitalism is designed to provide goods and services according to market demand by those who can pay. It was never designed to provide goods and services according to need regardless of ability to pay. Attempts to provide for everyone’s needs within the capitalist framework end up often like Obamacare, a political compromise that will help some people, but that will leave out or hurt others also in need. Many government programs are like that because, to get something passed at all, certain disfavored groups, most notably African Americans, have to be left out. It is notable that the only part of Obamacare that was struck down by the Supreme Court was not the individual mandate, which should have been killed, but the mandatory Medicaid expansion, even though the Federal government was planning to pick up the tab for years. The result is that none of the states with Republican governors have expanded Medicaid and a lot of people, especially African Americans, make too little to qualify for the Federal subsidies for private insurance. To make matters worse, the Federal subsidies to hospitals that care for indigents was cut in anticipation of people going on Medicaid. And with the obstreperous Republicans in control of the House, there is no getting that subsidy back into the budget.
Obamacare’s primary function is to preserve the primacy of profit in the healthcare system. If the priority were really health care access, Medicare for All would be the law of the land. Form follows function.
About the author: Kellia Ramares-Watson is an independent journalist in the San Francisco Bay Area. She is the author of the e-book Eating Poison: Food, Drugs and Health. Her next major project will be an e-book called Demonetization: Ending the Cult of Commodity. She can be reached at theendofmoney[at]gmail.com.