The large demand for health insurance that overwhelmed the federal as well as many state exchanges comes from the large number of people in the U.S. who have no health insurance. About 15%, or more than 45 million people, had no health insurance for all of last year according the newly released report on Income, Poverty, and Health Insurance in 2012. Oppressed nationalities (African Americans, Asian Americans, Chicanos, Latinos and Native Americans) had even higher rates of going without health insurance, with the rate topping 30% for Chicanos and other Latinos.

The main reason for so many people going without health insurance is that businesses have been cutting health insurance benefits for their workers. In addition, the restructuring of the labor market to replace full-time, permanent jobs with more and more part-time and temporary jobs that intensified during the last recession also means fewer workers have health insurance. While young people have the highest rates of lacking health insurance, the biggest drop over the years have been among workers aged 25 to 64.

While the ACA promises to cover millions of Americans who lack health insurance, mainly through the expansion of Medicaid, which will be available in many, but not all, states to all low-income people. But millions more, including the 11 million undocumented in this country, will still not have health insurance even after the ACA is fully up and running.

The fundamental problem is that it is not profitable to insure everyone, and that for-profit health insurance spends about ten times as much for administration, profits for share-holders, huge salaries for CEOs, than government health insurance does. With the ACA based on forcing individuals to buy health insurance from private insurers through a combination of penalties (individual mandate) and subsidies, it actually expands this expensive and wasteful part of U.S. healthcare.

The example of Massachusetts, which pioneered a very similar plan to the ACA, shows both what this ACA can and can’t do. Massachusetts has the lowest rate of people without health insurance, at about 3%. On the other hand, Massachusetts is the most costly in terms of total health care spending, coming at 36% above the national average.

To both cover all Americans and lower costs, what is really needed is a single federal government health insurance, similar to Medicare, but available to everyone, also known as a single-payer system.

#SanJoséCA #Healthcare #singlePayer #healthCareReform #Obamacare #AffordableCareAct

On June 28 the U.S. Supreme Court upheld most of the 2010 Affordable Care Act or ACA. In particular, the Court upheld the “individual mandate” that requires people with incomes above the poverty line to buy private health insurance. While the Court did not accept the government's argument that the mandate itself was constitutional, a slim majority (5-4) said that the fine for not buying insurance was like a tax and therefore was constitutional.

This ruling upholds the status quo in U.S. health care – a system based on private, for-profit health insurance, hospitals and drug companies. While rejecting the right-wing and Republican arguments against government health care, it upholds the Obama administration’s and the Democrats’ strategy of using government powers to aid big business, from Wall Street to health care corporations. This strategy will not provide universal coverage, nor will it bring down the cost of health care.

The Supreme Court struck down the part of the law that forces state governments to expand the Medicaid programs (health care for low income individuals) with federal help. If this ruling ends up blocking the expansion of Medicaid, some two-thirds of the uninsured, or more than 30 million people, will end up without any health insurance even after this ‘health care reform’ takes place.

Even if the Medicaid expansion were to come about, Medicaid is a second-rate government insurance. Because it pays as little as half what Medicare (government health care for the elderly and disabled) pays, many doctors don’t accept Medicaid patients and some hospitals even have separate clinics for Medicaid patients. People with Medicaid often have to rely on county hospitals and wait months or even more than a year for tests and treatment.

The Affordable Care Act also doesn’t bring down the cost of health care. Even though the U.S. spends the most on health care of any country, and 50% to 100% more than other capitalist countries like Britain, Canada, Germany, or Japan, our outcomes in terms of how long we live and how healthy our babies are worse than these countries. The main reason is that the U.S. is the only capitalist country with for-profit, private health insurance, which can skim off 25% or more of the health care dollar for profits and huge executive salaries and which only wants to cover those who can pay and aren’t sick, leaving millions without any health insurance.

Only a single-payer, government health insurance can eliminate the waste of private, for-profit insurance. The United States already has a form of this, which is Medicare. Medicare’s administrative costs take less than 2% of their premiums while 98% goes to pay for medical care. Medicare already covers the most expensive patients – the elderly and disabled – and it would be relatively simple to expand Medicare to cover the entire population, which would save up to $400 billion a year in health care costs. In Canada, which has single-payer government health insurance, medical drugs can cost as little as half of what they cost here in the U.S., because the Canadian government bargains with the drug companies for lower prices (something that drug companies blocked here in the United States).

The problem with single-payer government health insurance is not practicality, it is politics. The for-profit health insurance companies are part of Wall Street, and for-profit hospitals and drug companies are big business. With Wall Street and big business in control of both the Democratic and Republican parties at the national level, the best way forward at this time may be to fight for single-payer health care at a state level. Fight Back! encourages all of its readers to support efforts to win single-payer health care health insurance in their state.

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