Dump Your Health Insurance

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“Health is politics by other means” -Alondra Nelson

 

BY NATASCHA UHLMANN | DECEMBER 27, 2016

For all its failings (and there were many) Obamacare held promise of a radical expansion of healthcare to millions of uninsured people. Access to care in a Trump presidency looks far less certain, and people have been quick to mobilize accordingly: clinics have been swamped with requests for long-acting birth control and transgender activists are issuing a nationwide call for allies to stockpile hormones in anticipation of stringent new restrictions.

The wide repeal of Obamacare stands to leave upwards of 20 million Americans uninsured, a disastrous outcome in the midst of 45,000 preventable deaths each year stemming from lack of coverage. While it remains unclear to what degree the Republicans will push back on the Affordable Care Act (ACA), Paul Ryan’s healthcare proposal is telling: it centers on Health Savings Accounts and market-based reforms. Privatization of care means higher administrative costs and reduced leverage in negotiating prices — it also means outright denial of care. The profit imperative is irreparably at odds with quality health care.

Even so, the ACA did not fix the problem of access: as many as 29 million Americans remain uninsured. Millions more remain underinsured, with high-deductible plans that, coverage or otherwise, leave medical care out of reach. A 2009 study found that 3/4 of medically-caused bankruptcies occurred to people who were insured at the time of illness — for millions, coverage is merely symbolic.

Where can we go from here? How do we build an alternative while people are suffering now? Though single payer healthcare is touted as the obvious fix, the world can’t wait until it’s politically feasible (it will never be politically feasible in a capitalist economy), much less as the incoming Trump administration ramps up its assault on state-funded care. The time has come for a radically different approach: let’s abandon health insurance altogether.

The insurance system serves as a middleman, redirecting funds while imposing high overhead (up to 24% of total healthcare spending goes to administrative, non-treatment related costs). Why not channel those funds directly to health care providers in the way of health care cooperatives? Rather than paying into a costly, under-serving insurance plan, consumers could reroute this monthly flat fee to local medical centers. Once exempt from market pressures, medical clinics could provide their services for free or at-cost. The cooperatives could work in tandem, subsidizing costs where necessary so that clinic quality was disconnected from the socio-economic status of the neighborhood it served.

It’s not a novel concept: the Black Panther Party employed this tactic to great effect. Organizing against systemic medical neglect in black communities, the Panthers deployed free medical clinics that provided not only comprehensive medical care, but patient advocacy, social welfare programs, and political education courses. Beyond the courses, the very existence of these clinics was political: for if they were able to achieve so much while sustained only through community donations and volunteers, how could the State, with a monumental array of resources at its disposal, not achieve more? For the Panthers, discourses around health fundamentally required a look at broader social ills that rendered care inaccessible or deadly to vulnerable communities.

The overwhelming success of Cooperative Home Care Associates (CHCA) speaks to the viability of such an approach even in today’s tough economic times: at America’s largest worker-owned cooperative, wages for healthcare workers are nearly double the market rate, with full benefits and guaranteed hours. The CEO to entry-level worker pay ratio is 11:1 (the statewide ratio is 405:1) and the cooperative is primarily owned by women of color. Spurred by the model’s accomplishments, Bill de Blasio allocated 1.2 million dollars to the development of further NYC cooperatives.

These cooperatives present a coherent vision of what a radically new medical system could look like: one that centers accessibility and cost effectiveness, and exists fundamentally to serve the people. Such a program is within grasp — a coordinated pooling of resources could upend the insurance system and provide quality care to those in need, now.


Natascha Uhlmann is an activist from Sonora, Mexico with the Nos Faltan 43 movement. Follow her on Twitter: @nataschaelena

Showing 12 comments

  • commented 2017-01-07 01:40:44 -0500
    Please add this to your post if you’d like to spread the word:
    An existing model of this is “Patient/Physician Cooperatives” (first link below – check out the videos to learn more). Founded in Houston, residents in Portland decided to start their own. The original founder has made a wealth of resources available. On his other site (2nd link a non profit which sponsors the co-op), he has posted his book (third link) on how to start a healthcare co-op for free in a blog post (second link below). Let’s launch these everywhere! The strategy was been defined and already implemented in 2 cities. We just need to scale up the infrastructure elsewhere now.

    https://www.patientphysiciancoop.com

    http://tbt.org

    http://tbt.org/wp-content/uploads/2016/09/Development-of-Physician-ACOs-2-16-16-final.pdf
  • commented 2017-01-05 02:17:37 -0500
    Come on MC. That is casuistry ! Of course the process is exactly as you describe and much worse. It was a scam. Of course, Obama was the person in charge of this scam. He negotiated the basic parameters with the healthcare insurers, agreeing that the scheme would be mandated, and that there would be no regulation. After that the vultures moved in and worked out the details and introduced more tricks. That is always how it happens. Obama welcomed the mess of pottage they delivered, and made it a symbol of his narcissistic heroism. I really detest the constant liberal effort to excuse Obama for behaviour they damn in other failed presidents. This attitude remains a strong obstacle to change. You can see it all around you right now. Look at the way Obama’s lies about Russian hacking have bewitched the liberal media. I guess you dont think he carries any responsibility for the obsessive crusade against Russia, based heavily on manufactured lies and fake news.
  • commented 2017-01-04 16:57:11 -0500
    Blaming Obama administration for the the mess that has become the ACA is entirely ignorant. The Republican (and lobbyist) controlled congress let the insurance companies put thousands of addendums and stipulations on the ACA bill and then they were given the right to opt out any area that would not be profitable. Insurance companies are using high paid analysts and stat technicians to find the profits in the system, decline care by many means and leave the citizens hanging with the bill. They have many tools at the disposal. Like making many treatments unattainable through dozens of back handed schemes and cherry pick what clients they did not want to insure. Obamacare has proven in a 100 different ways, that the problem is 1st the insurance companies and 2nd the lack of any real representation by our elected officials. Or more concisely the point, there is no way to provide decent care for all AND to strive for MAX corporate profits. They are completely and utterly at odds with maximizing our healthcare resources as a nation.
  • commented 2017-01-04 10:40:43 -0500
    Yes, there are two views here which are not meshing. First view: there are a bunch of bad things and unknowns coming down the pike. No one is clearly in charge, and the tendency will be for people to panic, do desperate things, and look after number one. And no one has any idea what should actually be done. Almost all courses of action could make things worse or not make any difference.

    Second view: coops are a way of organising work, which brings democracy in the work-place, and ends the capacity of the capitalist to appropriate the surplus created by workers’ labour.

    It is hard to see how these two different views influence on another. They are at different planes of reality. Understandably, most people are more worried about view one, which is the reality they are experiencing, and although coops are undoubtedly the best available way to organise work, I cant see how they are a response to what is coming down the pike.
  • commented 2017-01-04 07:33:20 -0500
    It’s been a while since I read The Pig In The Python by some stock broker type. The reckoning called for in that book along with China’s and Russia’s rapid growth and/or awakening to the steak that capitalism can supply, is upon us now. There is going to be a call for a global currency. Either that , or the dollars saved by those “in the gut of the python” will evaporate. What a happy accident that would be for those owing on the debt represented by the dollars! It will highlight the fact that “there aint no free lunch” even for corpuses of money. The corporate imperative to make profits at all costs has finally realized the cost of profits at the expense of fair worker compensation.
    ..-.-.-
    We should begin thinking of how our children must be able to cope at two economic extremes. One extreme of very limited technology and another that is currently reaching for Mars and driver-less cars. Cars used by the wealthy to be able to better ignore the poverty all around them as they go to some “party”.
    ..-.-.-
    Store clerks are going the way of the Gas station attendant.
    Truck drivers will be soon to follow.
    ..-.-.-
    Co-ops to do what?
  • commented 2017-01-04 05:04:33 -0500
    Yes Dan. Obama isnt the worst President America has had, but he is pretty bad. He is protected in part by liberal racist guilt (thou dare not criticise a black president !). Its what Trump correctly attacked as political correctness, designed to make people blind.

    Sadly, until progressives are willing to understand and talk about the harm Obama has done, it will be very difficult to move forward.. like a love affair that is over, but you refuse to accept it. Richard occasionally refers to American love of myths. Americans believe all sorts of rubbish that has been forced down their throats by their school, their friends, the media, hollywood. The country has been a fake news bonanza since the founding fathers. You cannot move the masses to fight for their own liberation while they are in the grip of that great opiate, “The American Dream”
  • commented 2017-01-03 07:05:41 -0500
    Wow Lee Roberts; Now I understand why the second Dr. in Dec. has refused to see me after over 20 years loyalty. All we could afford was the “Bronze” policy on our insurance renewal. Now I have no doctor; and I take 10 meds to stay alive! and it only costs about 20K/yr. One of Norman V. Peal’s books described how the largest employment union was the AMA. Now I understand better. The Insurance companies have a large anti-trust problem on their hands.
  • commented 2017-01-03 03:56:30 -0500
    Natascha: You do not give adequate attention to the defects (I dont believe they were unplanned) in the ACA.

    Claims are made that “at least” some millions now had health care. What does “health care” mean ? It isnt just health insurance. Obama allowed/agreed with the insurance industry’s scam of introducing an apartheid system of health care. The most affordable insurance does NOT deliver health care. These lower class policies have high co-pay, low ceilings, and all sorts of other tricks. For a black president to introduce an apartheid health system, is stupefying ! What he introduced is the equivalent of the Republican motto, that you get what you can afford.

    Secondly, Obama refused to regulate the health insurance industry. It was blatant, and obvious what was going to happen. Once Obama delivered a captive market to the companies, the companies used the renewal to massively increase premiums, to increase co-pay, and claw back whatever they lost by not being able to deny prevailing conditions. Its been a massacre, and the act was a disgrace.

    I am sure what the Republicans introduce will be awful. But that doesnt make Obamacare virtuous. It was a scam, built on a fake message of compassion, like most of Obama’s timid remedies.
  • commented 2017-01-03 02:17:23 -0500
    Natascha: Do you have any real examples of the economics and financial accounting os such health coops ? If so, please respond with links. Thanks
  • commented 2017-01-01 13:08:14 -0500
    I wouldn’t use PayPal at all. Not only are you subjected to countless forms of surveillance, but PayPal’s co-founder is a major contributor to extreme rightwing causes and PayPal cut off WikiLeaks.
    Checks may be mailed to address supplied: Democracy at Work, PO Box 1516, New York, NY, 10276.
  • followed this page 2016-12-28 04:31:40 -0500
  • commented 2016-12-27 17:36:44 -0500
    Tried to make a donation with PayPal and it wouldn’t accept. What gives?
    ..-.-.- This medical issue is extremely important and especially with our declining educated population and specialized professionals. Adam Smith said having a repetitive job was the most assured way to make a population as stupid as it could become. I submit that we need to look at future workers as police/carpenter/plumber/doctor to be a new singular utility personnel. Just as Nurse/cook/counselor/mechanic might be another one; and, Banker/bookkeeper/farmer/doctor, yet another. C.F. Adam Smith as discussed by R. Hielbroner The Worldly Philosophers.
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