by Scott McLarty
Common Dreams, October 6, 2013
Sure, the government shutdown and Republican demands regarding the Affordable Care Act (ACA) are reprehensible, but let’s not delude ourselves about the ACA itself.

It’s needlessly complex. It preserves medical treatment as a commodity rather than a right: low-cost policies will provide low-quality insurance. It imposes a direct public subsidy to feed the insurance industry, which helped write the legislation. It isn’t universal.

Millions of people who lacked it will now have health insurance, but the coverage they get won’t approach the level of health-care access guaranteed to every citizen in every other democratic nation.

Obamacare is a Republican idea. It’s based on the individual mandate, an idea introduced by the conservative pro-business Heritage Foundation, promoted by Republican leaders, and enacted in Massachusetts by Gov. Romney. Republicans only began to detest it circa 2009 when President Obama and Democrats made it part of Obamacare.

Conversely, progressives only began to support it when the ACA was introduced. Barack Obama opposed it during his presidential campaign but changed his mind in 2009.

Is it obnoxious to suggest that the dispute over Obamacare was always more about partisan loyalties than substance?

The shutdown will probably end when establishment Republicans convince Sen. Ted Cruz (R-Tex.) and his fellow Tea Partiers that they’ve had their fun and now it’s time to let adults run the show again. The main GOP objection to Obamacare is the “Obama” part. The legislation’s real defects aren’t important to the GOP.

GOP Agenda and Obamacare

Republicans are expert at aggravating crises and using instability to ram through their agenda: destroying social programs, privatizing resources and services, deregulating big business, recreating the dismal economic conditions of the Robber Baron Era. (Naomi Klein described this in her book “Shock Doctrine“.)

Republicans can usually count on Democratic presidents and congressional leaders (who are subject to the same lobby and campaign-contribution influences as the GOP) to capitulate or compromise, sometimes without a fight, as President Obama did during the summer 2011 budget talks that resulted in sequestration.

They often rely on Dems to pursue GOP agenda without GOP help. President Obama’s secretly negotiated Trans-Pacific Partnership trade pact, proposed Social Security reductions, and debt-expanding military actions would have been recognized as Republican ten years ago — as would the ACA.

The ACA became a capitulation from the moment Sen. Max Baucus (D-Mont.), Chair of the Senate Finance Committee, declared single-payer national health care “off the table” during health-care reform panels in 2009. Single-payer advocates were barred from the panels, while insurance and other health-care industry representatives were invited to make sure their own interests were protected in the new legislation. Even the public option was dropped.

The capitulation has serious consequences, few of which I mentioned above. One consequence was reported in the New York Times on October 2: “A sweeping national effort to extend health coverage to millions of Americans will leave out two-thirds of the poor blacks and single mothers and more than half of the low-wage workers who do not have insurance, the very kinds of people that the program was intended to help.. Because they live in states largely controlled by Republicans that have declined to participate in a vast expansion of Medicaid, the medical insurance program for the poor, they are among the eight million Americans who are impoverished, uninsured and ineligible for help.” (http://www.nytimes.com/2013/10/03/health/millions-of-poor-are-left-uncovered-by-health-law.html)

By sacrificing universal health care, the new law accommodated Republican disregard for the poor in the 26 states that have rejected Medicaid expansion. The ACA isn’t a victory for the millions, maybe tens of millions of Americans for whom insurance and medical costs will remain beyond reach or require a hefty percentage of their income. Or for those who will still face financial ruin over a medical emergency. (For a more detailed critique, see Scott Tucker’s interview with Dr. Don McCanne of Physicians for a National Health Program, http://www.truthdig.com/report/print/health_care_for_all_why_we_need_a_new_prescription_20131001

These consequences won’t be disturbed when the shutdown ends and immediate funding for the ACA prevails. The ACA was designed to be partial solution to the crisis of skyrocketing medical costs that bankrupt working Americans, even those with insurance, and the lack of insurance for millions more.

Useful Idiots

The context of the government shutdown is a dispute within the GOP between traditional types and “kill the government” fundamentalists associated with the Tea Party.

Are we witnessing an implosion of the GOP? We can only hope so, but it’s more likely we’ll see a return to bipartisan business as usual: two factions of a corporate-money party arguing over the best way to satisfy the country’s One-Percenters. (See “The Shutdown Game” by Glen Ford in Black Agenda Report, Oct. 2, http://blackagendareport.com/content/shutdown-game)

The One Percent aren’t really interested in shrinking government. They prefer laws and government that more efficiently and generously serve their interests. They want Washington to remove barriers to markets, profits, and consolidation into monopolies and cartels, even when it means destroying the middle class and plunging working Americans into helplessness.

Plutocracy’s sole interests are money and power. Ideologies and economic theories are for little people, endowed academic seats, bow-tie wearing newspaper columnists, and other suckers.

To the plutocrat, the Tea Party libertarian is a useful idiot. The plutocrat is grateful that the libertarian supports Walmart as a beacon of free-market competition and prosperity, while Walmart crushes small-business competitors and hires employees at wages that force them to rely on social services.

The plutocrat thanks the libertarian for demanding deregulation of Wall Street derivatives in the name of free movement of capital, while ordering pet politicians to insure derivatives trading with taxpayers’ money against multi-billion and multi-trillion dollar losses.

Plutocrats (with some exceptions, like the Koch brothers) transcend party and can live with any law or policy that allows them to boost the bottom line. The health-care debate between Dems and Repubs was rigged from the beginning by the One Percent, which made sure that insurance companies would continue to make a killing whether the ACA was passed or defeated.

What About Medicare For All?

Let’s imagine another scenario. A bloc of Democratic Congress members is willing to shut down government rather than vote yea on a budget with funding for another war like the 2003 invasion of Iraq. Good or bad?

What if several Congress members had risked a shutdown in 2009 over the declaration that Medicare For All was “off the table” and that pro-single-payer physicians and consumer advocates would be banned from the health-care reform panels?

These are fantasies. Anti-war and progressive Democrats in Congress are too timid to consider such actions.

In contrast, Tea Partiers in Congress, fueled by the generosity of billionaire plutocrats (http://truth-out.org/opinion/item/19199-there-is-no-such-thing-as-the-tea-party-there-is-only-a-collection-of-billionaires), have no reservations about how they accomplish their goals.

The only solution for America’s dismal health-care delivery system is Medicare For All — a single-payer plan that guarantees universal care. We’ll only win Medicare For All with a movement that goes beyond polite lobbying, with street protest as vigorous as Occupy Wall Street and a concerted effort to replace politicians in office.

The latter requires a voter rebellion and campaigns that are independent of the two corporate-money parties.

It means resisting the predictable claim of Democratic leaders, after the shutdown ends, that the GOP’s retreat on the ACA is a victory for everyone who opposes the Tea Party and we shouldn’t complicate that victory by demanding Medicare For All.

If we lose sleep during the government shutdown, I hope it’s because we’re pondering ways to surpass the Tea Party in asserting our own political power.