The Editors - Third World Network

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H E A L T H & S A F E T Y Problems of US health care are rooted in the private sector One attempt to discredit President Obama’s health care programme has been the insidious claim that high US health care costs are the result of government involvement in the sector. Mark Weisbrot A RECENT report by McKinsey and Company was seized upon by opponents of health care reform to create a new myth: that President Obama’s health insurance reform (the 2010 Patient Protection and Affordable Care Act – PPACA) will cause huge numbers of employers to drop health insurance coverage that they currently provide for employees. The McKinsey study was soon shown to be worthless, and McKinsey itself acknowledged that it ‘was not intended as predictive economic analysis’. But the myth seems to not be completely dead yet. For a more reasonable estimate of the impact of the health insurance reform, we can look to the non-partisan Congressional Budget Office. They estimated that the number of people (including family members) covered by employment-based insurance would be about 1.8% fewer in 2019, as a result of the PPACA legislation. Of course, this is more than counter-balanced by the fact that the percentage of the (nonelderly) population with insurance would increase from 82% to 92% – the main purpose of the reform. Right-wingers, insurance companies, and other opponents of health care reform in the United States are always looking for ways to blame the government for the failures of our health care system. But the simple truth is that they have it backwards: our problems with health care are firmly rooted in the private sector. That is why the average high-income country – where government is vastly more involved in health care – spends half as much per person on health care as we do, and has better health outcomes. That is why even Medicare – which has to pay for health care services and drugs at costs inflated by our dysfunctional private health care sector – has still proven to be much more efficient than private insurance. As Nobel laureate economist Paul Krugman recently pointed out, from 1969-2009, Medicare spending per person rose 400%, adjusted for inflation; private insurance premiums, also adjusted for inflation, rose 700%. The most effective way to insure everyone and make our health care system affordable would have been to expand Medicare to everyone, while beginning the process of reducing costs through negotiation with, and restructuring incentives for, the private sector. The private insurance companies use up hundreds of billions annually on administrative costs, marketing, and other waste – which is what you would expect from companies who maximise profit by insuring the healthy and trying to avoid paying for the sick. We also spend nearly $300 billion on pharmaceuticals each year, most of which is waste due to the patent monopolies of pharmaceutical companies. We could eliminate most of this waste through further public financing of pharmaceutical research, with new drugs sold as low-cost generics. Vermont Senator Bernie Sanders has introduced legislation in the Senate to realise these savings. A distant second best reform, as compared with Medicare for all, would have been to include in The most effective way to make the US health care system affordable would have been to expand the Medicare programme to everyone. Obama’s health care reform a public option for employers and individuals to buy into. This would at least have provided some competition from a more efficient public sector to help control costs. But unfortunately, the insurance and pharmaceutical companies’ lobbies proved to have a more powerful influence on our government than the voice of the people. This is another sad result of our dysfunctional health care system: The winners – waste for us is income for them – have a veto over health care reform. It remains to be seen whether the PPACA will be a step toward more comprehensive, effective reform that gives us Medicare for all. In the meantime, the right will try to blame the government and the legislation itself for rising health care costs and other failures of our health care system. But in fact these result from the legislation not having gone far enough to rein in the private sector. ÿÿÿÿÿÿÿu Mark Weisbrot is co-director of the Center for Economic and Policy Research (CEPR) in Washington, DC. He is also president of Just Foreign Policy. This article is reproduced from the CEPR website, www.cepr.net. THIRD WORLD RESURGENCE No 251/252 2
E C O N O M I C S Filipinos to remain at the mercy of oligarchs In June this year, the Philippines celebrated the 150th birth anniversary of its national hero, Jose Rizal, who was executed by the Spanish colonialists. Rizal believed that the only justification for national liberation was the restoration of the dignity of the people, saying ‘... why independence, if the slaves of today will be the tyrants of tomorrow?’ In light of this, the following analysis of the country’s economy makes uncomfortable reading. THE Philippines, which claims to be the first democratic government in Asia, is actually ruled by oligarchs. ‘The oligarchs still rule the country, and Filipinos will forever be the victims of their profiteering,’ says political science professor Benito Lim of the Ateneo de Manila University. Lim says the oligarchs can be controlled but it will require strong political will. Asked if President Benigno S Aquino III, who continues to enjoy high popularity and trust ratings, can do it, Lim responds: ‘Mukhang hindi siya pinakikinggan. Maliit ang boses. [It seems nobody listens to him. Weak.]’ Members of the oligarchy in the Philippines have ‘little corners’ of their own and hardly get out of their own spheres of industries, apparently realising that if they resort to competition, one of them will fall. ‘In general, we see no competition among the oligarchs because the role of the oligarchs is chasing after profits,’ Lim notes. ‘There is no crossing of swords resulting in big competition except for the PLDT-Globe dispute.’ On the other hand, everybody wants to be on top. ‘Right now, Henry Sy is the richest,’ Lim relates, ‘but others continue to aspire for that position.’ Political analyst Alex Magno says oligarchy is a term in political science which applies to a government controlled by a group. Loosely used, oligarchy can apply to the dominance of the national economy by a few individuals or a group. Nick Legaspi Imperfect regulatory structure ‘With an imperfect regulatory structure and uneven access to opportunities the tendency is for a few to control the economy,’ Magno explains. He says oligarchs in the Philippines are not so different from those in other countries – ‘they are protected and nourished by an imperfect regulatory structure.’ Asiasec Equities, in a recent report, cites the situation in the domestic cement industry. According to the report, the cement industry has had little investment in new capacity for the past 15 years after the ‘Big Three’ foreign players consolidated domestic ownership and controlled practically 90% of industry capacity. ‘Instead of building, the big three cement players decommissioned several kilns and reduced domestic capacity to 14mn MT against claimed installed capacity of 22mn MT,’ Asiasec relates. ‘The current price of cement of US$110/MT is the highest among emerging markets in Asia and the average age of the Philippine cement facilities is over 40 years.’ ‘There is an apparent “controlled The Manila headquarters of San Miguel Corp (SMC). Among the conglomerates that dominate the Philippine economy, SMC retains tight control and ownership of its key business units. THIRD WORLD RESURGENCE No 251/252 3
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The Editors - Third World Network

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