Fight for single payer government health insurance must go on

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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