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.

#UnitedStates #Healthcare #Capitalism #SupremeCourt #singlePayer #healthCareReform

Passage of President Obama’s health care reform in late March made for great political theater. Here was House Speaker Nancy Pelosi, skillfully maneuvering the bill through Congress after many had given it up for lost. Here was House minority leader and Republican point man John Boehner, reduced to ranting about ‘Armageddon’ and predicting the end of civilization as we know it if the bill passed. Here were Republican legislators egging on the mob of teabaggers who massed outside the Capitol, hurling racist and homophobic slurs at Representatives John Lewis and Barney Frank as they went inside.

I'll admit the scene worked on my emotions. The Republicans' tactics were ugly and cynical and I was happy to see them fail.

Now that the dust has settled, however, a hard look at the legislation that prompted all the fuss suggests that, far from ‘fixing our broken health care system,’ it merely reproduces some of its worst features.

The bill does nothing to lessen the grip of the private insurance industry on our health care system. It won’t bring exploding health care costs under control. It does little to change the shameful disparities in access to treatment in a society that treats medical care as a commodity to be bought and sold, rather than as something all of us need and deserve.

What it will do is require everybody to buy health insurance, with federal subsidies for those who can’t afford the premiums on their own. The price tag of these subsidies is $447 billion over the next ten years. That’s money that could have gone to pay directly for medical treatment but which will, instead, wind up in the pockets of the insurance industry – one more corporate bailout at taxpayers’ expense.

To help pay for it, public hospitals that treat the uninsured will have their federal funding slashed by $36 billion. Eight years down the road, union health plans and other job-based health insurance will be slapped with a 40% ‘excise tax.’ Protests from organized labor succeeded in getting this tax modified somewhat, but not eliminated from the bill.

The bill does expand eligibility for Medicaid, the federal health care program for the poor. And it is supposed to make it harder for insurance companies to deny legitimate claims or refuse to cover ‘high-risk’ patients. Insurance industry lobbyists, who actually helped draft the bill, swallowed these reforms in part because they’ll get 30 million new customers out of the deal, and in part because over the years the industry has proved adept at evading every government attempt at regulation.

Physicians for a National Health Program, which has led the fight for a single payer system comparable to what other developed countries have, likens the bill to morphine for a cancer patient. It lessens the pain for a while, but it doesn’t stop the cancer from spreading. Health care in the U.S. costs twice as much as in most other countries, mainly because the administrative costs of maintaining a private insurance system soak up nearly one in every three dollars we spend on it. And a big chunk of that money goes to buy politicians. The health care industry spent a record $266.8 million last year making sure nothing got into the bill that would seriously threaten its profits.

I’ve heard some interesting arguments over whether we’re better or worse off with this law on the books, but it’s really beside the point. The battle for universal, equal access to care still lies ahead, and it won’t be won until those of us who are victimized by the health care system have more political clout than those who profit from it.

The law’s shortcomings will provide ample organizing opportunities in the fight for true reform. Here are a few:

1. Medicaid. It’s financed with matching state and federal funds, and while the federal government may have the money to pay for expanded eligibility, most states don’t. Oregon, where I live, already has a very liberal program of health care for the poor, but the state is so strapped for cash that it actually has to hold a lottery to determine which eligible people get benefits. And because an underfunded Medicaid program compensates doctors so poorly, many doctors are already reluctant to take Medicaid patients. The new law promises to make it easier for poor people to get care; we should be prepared to hold politicians’ feet to the flames if it doesn’t happen.
2. Rate hikes. Since everyone will now be required to buy insurance or pay a fine, insurers are likely to take advantage of their captive market by jacking premiums up even more. There should be organized, angry protests every time it happens.
3. Underinsurance. Before the law passed, a woman with ‘pre-existing’ breast cancer was apt to be refused coverage. Now she can’t be denied coverage – but she may find that her new policy won’t pay for the extra round of chemotherapy or surgery she needs. Nothing in the law spells out what benefits must be offered for insurance plans to qualify for the government-run ‘health insurance exchanges’ that will be set up in 2014. The requirement that everybody buy insurance will mean a proliferation of cut-rate policies that are of no use when you most need them. When policies like that go on the market, we should read the fine print and expose them for what they are.
4. Inadequate regulation. Supporters of the new law boast that it outlaws ‘rescissions,’ the practice of cancelling a policy as soon as a policyholder files a claim. But rescissions were already illegal! State regulators simply didn’t enforce the law. We need to keep a close eye on them and demand that they do their job.
5. Employer mandates. “If you like the coverage you have, you can keep it,” says Obama. But it’s really your boss’s decision, not yours. The penalties for employers who cancel their coverage are too small to discourage them from cancelling or cutting back on increasingly costly employee benefits. Unions can expect continued brutal fights over health insurance at contract time. Whenever it happens, they shouldn’t hesitate to point out that health benefits shouldn’t even be on the bargaining table – the government should be picking up the tab for everybody, regardless of where they work or how much they make. Only by advocating for health care for all can unions win public sympathy when their own coverage is under attack.
6. Penalizing the uninsured. A lot of people who can’t afford to buy coverage, even with federal subsidies, will get stuck with stiff fines for remaining uninsured. They need to become organized and visible and demand relief.
7. Discrimination. Denying coverage to immigrants is a particularly ugly and pointless feature of the new law. Preventing sick people from going to the doctor doesn’t ‘secure our borders’ or discourage people from coming here, as anti-immigrant propagandists claim. It just means more needless and untreated illness and more pressure on overburdened hospital emergency rooms. Full access to health care is a key component in the battle for immigrant rights.
8. Federal deficits. As costs keep rising, subsidizing insurance premiums will inevitably add to an already huge federal deficit. There will be intense pressure to cut necessary social programs, including Medicare, to pay for it. In defending those programs, we should be prepared to raise the issue of single payer – pointing out that a universal government-funded health care system would save the taxpayers billions and make those cuts unnecessary.

It’s common for politicians like President Obama to say they support single payer ‘on principle’ but don’t consider it ‘realistic.’ The truth is that it’s the only realistic solution. Nothing else will solve our health care crisis. We have to keep the heat on until we get it.

Peter Shapiro co-chairs the Health Care Committee of Portland Jobs with Justice.

#UnitedStates #Healthcare #healthCareReform

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.

#UnitedStates #Editorials #Healthcare #singlePayer #healthCareReform