Capitalism and HMO's

Chris Burford :"Why does Clinton promote HMO's?"

HMO 'managed care' or 'managed delivery' places health and medical services into the hands of the insurance industry...Clinton's 'managed competition' proposal would have mandated large purchasing pools in which only a few large insurance companies would have been able to offer 'health care' packages because of the capital involved...this would have allowed AETNA, Prudential, Blue Cross & Blue Shield, & a couple of others to gain control of the almost 50% of the 'health care' market still held by smaller insurance firms...so Klingon would have completed the corporatization (for-profit 'socialized' medicine) of health care in the US...

Clinton's plan was defeated in the Congress, in part, because smaller insurance companies mobilized their policyholders to 'write their representative' (as 8th grade civics class teachers in the US tell their students is their right to do) and say that they were satisfied with their 'health care' and that they opposed another layer of 'big government'...an example of the more 'contested' arena of the legislative branch...the point is not the politics involved here because most of it came from the right, the left and single-payer advocates being at a clear disadvantage in the 'debate'...but as chief exec, Klingon was promoting the 'vanguard' interests of monopoly capital...

Bush's plan was also called 'managed competition'...some Republicans have been pushing this idea since Nixon's presidency, I think they are known as the Jackson Hole group because they meet in the resort town of Jackson Hole, Wyoming...proposal was primarily a way to offer middle strata to upper class a tax break to pay for health insurance combined while 'voluntarily forcing' people into 'managed care' plans...

Michael Hoover


Very interesting, as always from Michael Hoover.

I am ignorant about the US health reforms. I can see the argument here that HMO's are an alliance between monopoly capitalism and the middle strata.

But there is also a deeper question. I am trying to remember the remarks of Marx or Engels about how some of the *forms* of socialism start to emerge even under capitalism, although not the class content of which class is hegemonic. Can you help?

I have a hunch that the Achilles heel of the extremely adaptable capitalist system is the management of risk. One reason why it tends to monopoly (not the only one). Risk is very, very problematic in health care, and with the end of deference to professionals, potentially very expensive.

Under the Tory government reforms of our massive socialised National Health Service, in Britain, "Crown Immunity", was abolished in the early 90's. This meant all hospitals could be sued. Damages in court cases are beginning to rise but are no where near US level.

But already costs of damages in the UK against the NHS are over 2 billion pounds.

The response of the Labour Government is not to stress the internal market, but to put an emphasis on "clinical governance" - national monitoring of the clinical soundness of the different professions, especially doctors and nurses.

So on both sides of the Atlantic there seem to be powerful pressures for risks to be managed on a larger and larger scale. Whether finance capitalism with an interlocking network of insurance companies, is the best mechanism for doing this most of us would doubt. But I think it is just possible that with demands for greater "transparency" the new reformist slogan, the underlying social nature of theis question could be better addressed.

German has a crisis of costs with its atomised Bismarckian insurance system.

All developed countries have a crisis of rationing of demand for health care, and a problem of how explicit the class based nature of that rationing can be.

About the dominance of the needs of the middle strata in HMO's I would repeat my comment about the British NHS that one of the reasons why it largely survived the Thatcher years is because the middle strata see themselves as major gainers from it.

I think would-be marxists need to consider in the course of concrete analysis whether they are champions of the poor and destitute or seeking to take a stance representing the long term interests of the working class in the widest sense, and trying to overcome the antagonistic nature of divisions within the working class.

Chris Burford