What the US health care reform bill tells us about Internet politics

At a first sight, it may seem that health care and the Internet have, except for eHealth applications, not much in common. But I will argue in this contribution that there is an important link.

On March 23rd, 2010, Barack Obama signed the health reform bill. Some of the most important aspects that will be realized in the coming ten years are:
* Low wage earners will become eligible for the Medicaid programme. Other uninsured persons, who earn less than four times the poverty threshold, will receive state subsidies for buying health insurance on the private health market.
* Children, adolescents, and young adults can be insured by their parents’ health plan up to an age of 26.
* It will be banned that insurance companies drop health coverage for a person who becomes ill or to deny coverage for people with pre-existing illnesses or to deny coverage in general. Health insurance companies will face restrictions in making coverage prices dependent on individuals’ health status.
* Patients who fall into the doughnut hole coverage gap (prescription drug costs are not covered in the spending range of $US2700-$6154), will receive a $US250 discount. People in the Medicare programme, will receive a 50% rebate for the doughnut hole.
* For the financing of Medicare, also individual incomes above $US200 000 and family incomes above $US250 000 will be taxed.
* Companies that have more than 50 workers, have to provide health care plans for their employees. Otherwise they are fined.
* Companies that have 25 or less workers, can receive tax credits for providing health plans to their employees.
* It is expected than 30 million US people, who are uninsured now, will be covered by health care in the future.

Approximately 50 million people in the United States do not have access to health insurance today. This is more than 15% of the population. If the plan of getting 30 million more people insured is successful, this will definitely be a huge progress for US standards, but even then 20 million people, more than 5% of the current US population, will remain uninsured. Therefore there will be no universal health care coverage in the United States in the coming years, the number of people who will die from curable diseases because they cannot afford treatment, will definitely drop by a significant number, but the phenomenon will not vanish, which is in my view a shame for a country that is making the claim to be one of the leading industrial nations. The United States is definitely not a leading country in health care and welfare and also will not become one in the coming years, although important progress will be achieved.

Universal health care with 100% coverage can only be achieved if there is a government-run compulsory health care and social security system, in which all individuals have to be insured and health insurance institutions are owned, controlled, and operated by the state. Compulsory universal health care systems are the standard in many European countries, including for example Nordic countries such as Norway, Sweden and Iceland. The US health care reform brings more state regulation of health care and will thereby eliminate the most severe illnesses of the health care system. It will unfortunately not, however, fully cure the American health care system so that it becomes a system with universal coverage. Republican National Committee Chairman Michael Steele called the Democratic health care reform socialist after Obama signed the bill. The implication of Steele’s claim is that Europe is dominated by health care socialism. If health care in European countries is socialist, then what are the effects of it in comparison to the US health system?

The following statistics allow such a comparison for the United States, Sweden, Norway, and Iceland:

life expectancy at birth: US 78.1, Sweden 81.0, Norway 80.6, Iceland 81.2
physicians per 1000 population: US 2.4, Sweden 3.6, Norway 3.9, Iceland 3.7
(OECD Health Statistics, latest available data, accessed on April 3, 2010)
hospital beds per 10 000 population: US 32, Sweden N/A, Norway 41, Iceland 75
age-standardized mortality rate for cardiovascular diseases per 100 000 population: US 188, Sweden 176, Norway 181, Iceland 164
maternal mortality ratio per 100 000 live births: US 11, Sweden 3, Norway 7, Iceland 4
under-5 mortality rate: US 8, Sweden 4, Norway 4, Iceland 3
share of male adults who are obese: US 31.1%, Sweden 10.4%, Norway 6.4%, Iceland 12.4%
share of female adults who are obese: US 33.2%, Sweden 9.5%, Norway 5.9%, Iceland 12.3%
(WHO Statistics, latest available data, accessed on April 3, 2010)

If this is what health care socialism looks like, then goodbye Mr. Healthcare Capitalism and welcome Healthcare Socialism!

How is the US health care reform connected to the Internet? Just like US health care was for a long time almost purely dominated by market forces and large corporations, also corporate interests and large corporate players dominate the Internet. You can easily produce information and make it public, but it is much harder for this information to be recognized by millions, if your name is not New York Times or CNN. Economic surveillance for the purpose of accumulating capital with the help of targeted advertising is prevalent on the Internet. But it is unknown to most of us, which personal data and usage behaviour data is exactly stored about us by which Internet platform operators, with whom exactly these data are directly or indirectly shared, and for which economic purposes these data are exactly used. These are just two of the shadow sides of an Internet that is dominated by corporations. The US health care reform shows that it is possible to move from a strong market-based system more towards a public, common, and universal system, in which market forces and its negative effects are curbed by political regulation. In analogy, for the Internet this could mean that it is desirable that public subsidies are given to non-profit Internet projects in order to establish advertising-free platforms that do not use user data for economic ends and to pluralize the number of voices that are heard in the online public sphere. I am convinced that an alternative Internet is needed, that the commodification of everything on the Internet should be driven back, and that for advancing this task public subsidies and regulation that limits the power of Internet corporations is needed.

Health and communication are two basic needs of all humans. They are part of the commons of sociey. Nobody should be denied access to basic needs because otherwise the quality of their lives will be severely impaired. Therefore the access to health care and communication capacities should be free and universal. The more the access and the availability of the commons are commodified, the more likely it is that high inequality characterizes a society. Establishing a great information society requires to guarantee basic human needs for all. Health and communication are two important aspects of basic needs, therefore the commodification of these realms should be rethought.

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