In September, the U.S. government released its annual report on health insurance coverage, showing a continuing decline in private health insurance and the huge number of people who had no health insurance for all of 2008. That same month Democratic senators released their proposal for health insurance 'reform.' However, this proposal could end up as more of a bailout of the for-profit health insurance corporations than a solution to people's health care needs. The best solution for working people, a government run, single-payer health insurance program, was endorsed by the AFL-CIO national convention in September. But this single-payer health insurance plan has been largely excluded from the health care debate by the Obama administration and the corporate media.

In the U.S. Census report on health insurance coverage in 2008 (which also covers income and poverty), the percentage of people with private health insurance dropped again, from 67.5% to 66.7%. This is the eighth year in a row that this percentage has fallen. 20 years ago more than 75% of the population had private health insurance, but more and more businesses have cut their health benefits and individual policies have become too expensive. Last year, more than 15% of the population, or more than 46 million people had no health insurance, private or public, for the entire year.

The health insurance situation is even worse for African Americans, Latinos and other oppressed nationalities. Only 52% of African Americans have private health insurance as compared to 75% of whites. More than 30% of Latinos had no health insurance at all, as compared to less than 11% of whites. This lack of health insurance is one of the factors contributing to poorer health and earlier deaths for oppressed nationalities.

But lack of health insurance is just part of the problem. Health insurance companies can increase their profits in two ways. They can use their size to bargain with doctors and hospitals for reduced rates. They can also not pay for treatment by excluding 'preexisting conditions' or certain treatments or drugs. This has led to a growing problem of 'underinsurance' where more and more people with private health insurance are hit with staggering medical bills, while others cannot get insurance at all because they are sick. Right now most of the people who declare bankruptcy because of their medical bills actually have health insurance!

This decline in private health insurance coverage is also a growing problem for the big health insurance corporations, which are losing their customers. But this could change with the health care 'reform' bill in the Senate, which would force everyone to buy private health insurance or face a government fine. The government would subsidize lower-income households that can’t afford to buy private health insurance, but this would still leave many working families with a choice between health insurance that they can't afford and going without insurance and paying a fine. The Wall Street Journal said that the biggest beneficiaries of health care reform could be the health insurance and drug companies.

Many liberals and Democrats in Congress have been pushing for a 'public option,' or a government-run health insurance company that would compete with private insurance companies. The public option was first proposed as a huge program that would take half the insurance market and use its size to force down costs and offer lower premiums. But the public option plan that is actually in Congress today is a shadow of the original plan, with so many restrictions that it would not be able to be big enough to offer real savings.

The other problem with the current bills in Congress is that they pit working people against each other. In order to get the private insurance companies to accept people who are already sick, it will force others to buy insurance that they can't really afford. To pay for the subsidies for lower-income working people, there will be future cuts in Medicare spending. The health reform bill also opens the door for new taxes on employer health insurance plans and explicitly excludes the undocumented.

What working people really need is a government run, single-payer health care system. There is a model for this: Medicare, which covers people over 65 years of age and spends only 2% of total revenues on administration. In contrast, private health insurance companies that run 'Medicare Advantage' programs spend almost 17% of revenues on administration and profits. Medicare also benefits from its huge size, which allows it to reimburse hospitals and doctors at lower rates. A single-payer health insurance would have the same ability as Medicare to keep costs low.

Our neighbor to the north, Canada, has a government single-payer health care program, also called Medicare. In Canada the government health insurance bargains with drug companies to lower their prices, thus the well-know fact that prescription drugs are cheaper in Canada. But here in the United States, lobbying by the drug companies has led to a ban on the government bargaining for lower drug costs. It is no wonder that we have high health care costs, where 15.8% of our economy is devoted to health care, while in Canada, only 10% is. But Canadians manage to live longer and have a lower death rate for infants, while maintaining a choice of doctors. Thousands of doctors and now the country’s largest trade union federation have endorsed a single-payer insurance plan. The time is now to fight for health care reform for working people, not for profit-making insurance companies. The best way to do this is a single-payer plan.

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