Insurance company profiteering has laid waste to the U.S. health care system and sparked a wave of protest throughout the U.S. But the response of Congress to the crisis suggests that the battle is just beginning.

Through the month of October and the first weeks of November, hundreds of people across the country volunteered for civil disobedience, calling for a single-payer system which guarantees access to health care for everybody and pays for it with tax dollars instead of insurance premiums.

Close to 200 were arrested in sit-ins at insurance company offices in over a dozen cities. The wave of direct action climaxed with mass arrests at the San Francisco office of House Speaker Nancy Pelosi. Protesters demanded that Pelosi allow a floor vote on Rep. Anthony Weiner’s single payer amendment to the House health care reform bill.

Weeks earlier, Pelosi had promised Weiner that she would let his amendment come up for a vote in return for his support getting the main bill out of committee. When she appeared ready to break her promise, angry protesters filled her office and she backed off.

But the victory proved short-lived. The next day, Weiner voluntarily withdrew his amendment. He told single payer supporters he was afraid that if the floor were opened up for amendments, the main bill would be held hostage by abortion foes.

Weiner’s concession achieved nothing. A provision was still added to the bill making it nearly impossible to buy health insurance that covers abortions, even with your own money. All but two members of the House Progressive Caucus, determined that some bill pass, went along with it. And the main winner in the months of congressional debate over health care reform appears to be – you guessed it – the insurance industry.

In this country, health insurance is the price of medical treatment. Without it, there is nowhere to go when you’re sick but the emergency room of public hospitals.

But most U.S. residents get health insurance through their jobs, so double-digit unemployment has cut deeply into the industry’s customer base. Meanwhile, with premiums rising three times faster than the cost of living, cash-strapped employers are dumping the own plans or cutting them back drastically. Right now an estimated 14,000 people are losing their health coverage every day – effectively cutting off their access to care.

Unfortunately, Congress has chosen to define the problem as one of universal insurance coverage rather than universal health care. As a result, both the Senate and House bills look less like reform than a federal bailout of an insurance industry which has all but priced itself out of the market.

While we don’t yet know what the final legislation will look like, certain things are clear enough. Instead of guaranteeing access to care for everyone, everyone will be required by law to buy insurance, whether they can afford it or not. Those who don’t will be subject to stiff fines. Government subsidies are supposed to be available for all who can’t afford the premiums – in effect, funneling tax dollars that could pay for actual treatment into the pockets of the insurers.

But since neither the Senate nor the House bill has any provision to bring skyrocketing insurance costs under control, those subsidies will impose a huge and growing burden on the federal budget. And since the White House has insisted that any reform not add to the federal deficit, Congressional debate has come to resemble an argument about who to throw overboard in an overcrowded lifeboat.

Case in point: the Senate bill would raise money by imposing a 40% excise tax on insurance policies worth more than $8000 a year for individual coverage or $20,000 a year for families. The Communication Workers of America estimates that, if premiums keep rising at their current rate, the tax will cover one-third of all insurance plans within ten years.

What about the public option, which was supposed to ‘keep private insurers honest’ by setting up a government-run plan to compete with them? It has been so watered down that it is expected to cover only a small fraction of the population and poses no real threat to insurance company profits. It will do nothing to control runaway costs that are driving the health care crisis. Its value at this point is largely symbolic: if it’s not in the final legislation, it will be seen as a defeat for President Obama, organized labor and other progressive groups that have invested enormous political capital in it.

Organized labor in particular has painted itself into a corner on this issue. In a historic vote at its national convention in September, the AFL-CIO unanimously endorsed single payer as the best possible solution to the health care crisis and pledged to fight for it. On Capitol Hill, however, union lobbyists have pursued a strategy that says, in effect, “any bill is better than none” because a defeat for President Obama on health care could doom labor’s chances of getting the Employee Free Choice Act passed.

Granted, strengthening labor laws so it is easier for workers to organize and win union protection is important. But health care is literally a matter of life and death: A recent Harvard study estimates that 45,000 people in this country die needlessly every year because they can’t get access to healthcare. If there ever was an issue where unions should be fighting for the interests of the entire working class, this is it. No other interest group in Washington can come close to matching the enormous power of the insurance industry.

What now? The Mobilization for Health Care for All, which spearheaded the nationwide civil disobedience campaign in the fall, is calling for a new round of protests on December 10, International Human Rights Day, to drive home that health care is a human right and not a product to be bought and sold on the market. Activists will be demanding removal of the toxic anti-abortion language and the excise tax from the federal legislation and calling for a provision that will allow states to set up their own single payer plans in the absence of a national one.

Meanwhile Senator Bernie Sanders of Vermont has vowed to bring his own single payer bill, SB 703, to the Senate floor no matter what, so an effort will be made to turn out the largest possible vote for it.

When the dust settles and Congress finally acts, however, we’re likely to be left with a ‘reform’ that heightens the contradictions in the U.S. health care system. People will be required by law to buy insurance whose cost eats up an ever greater slice of their income. Many will be forced to purchase cut-rate plans that fail to provide protection when they most need it. Billions of dollars will continue to be wasted as doctors and hospitals wrangle with insurance adjustors over disputed claims.

Insurance companies, now enjoying the advantage of a guaranteed market for the damaged goods they’re peddling, can be expected to be even more rapacious and irresponsible as they ration care in the service of the bottom line.

But then, no one will be able to claim that 40 million uninsured are responsible for the health care mess.

In the coming months, we have to build and sustain a mass movement that’s strong enough to expose the socially destructive nature of the health insurance industry, isolate it politically and assure that our elected representatives have far more to lose than to gain by doing its bidding.

Yes, we can.

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Peter Shapiro was arrested for criminal trespass in a demonstration at the Portland, Oregon office of Blue Cross/Blue Shield on Oct. 15. He co-chairs the Health Care Committee of Portland Jobs with Justice.

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