labor / US Politics

Health Care For All!


 

The Question to be  Decided: Shall Health Care Be Regarded as a Basic Human Right or as a For-Profit  Multi-Billion Dollar Business?

The Affordable Care  Act (ACA), having been upheld by the Supreme Court, contains a number of very  positive features. But there are yawning gaps in its coverage of enormous  proportions. When fully implemented, it will still leave 27 million uninsured,  and that number could be much larger with the Court’s having made expanded  Medicaid coverage optional for the states. This is undoubtedly the worst aspect of its  decision. It puts at risk the main tool to expand insurance coverage to  the very poor, mostly people of color. Moreover, untold numbers of the uninsured  will inevitably decline to purchase insurance, despite the  mandate.

Looking to the future,  health care costs will continue to rise, more people will be underinsured, and  those who cannot afford private insurance — or who simply refuse to buy it —  will not only be deprived of health care coverage, they will have to pay a stiff  fine.

At the heart of the problem is the fact  that the insurance companies will remain at the core of the health care system.  As long as this is the case and these companies are able to plunder hundreds of  billions in profits from the system,  the ACA will be severely crippled in carrying out its stated goal of  providing health care coverage for all.

Background

Health care in theUnited  Statesmakes up 17.9% of the economy,  incorporating some of the most profitable enterprises, as well as vital  facilities and services which barely cling to life. While working people suffer  and die waiting for care or through mishaps in the system, the most preposterous  charges and claims reverberate in a torrent of election-year  nonsense.

Underneath all the  extreme rhetoric and exaggerated claims lies a free-for-all fight by competing  corporate interests. Benefits to ordinary people are coincidental. The Supreme  Court’s decision of June 28, 2012 on the ACA cemented health care profiteering,  left union workers in an even more precarious position, and further undermined  prospects of the very poor’s obtaining basic health care. Within hours of the verdict,  the stock market reflected the true story.

Stocks of for-profit  hospital chains shot up. With the confirmation of the individual mandate  projected to guarantee a steady stream of paying customers, the value of  Hospital Corporation ofAmericastocks rose 15%, while Tenet  gained 10%. The commercial health insurance corporations, buoyed by the  retention of the individual mandate, can now focus on whittling away the  concessions they made in 2009. Pharmaceutical and medical device manufacturers  held their own, already planning for the added expenses  they would be incurring to help close the  donut hole of Medicare Part D and insurance coverage  expansion.

Drawing a Balance  Sheet on the ACA

It was hoped that the  ACA would dramatically expand Medicaid for most low-income folks, but the  Supreme Court’s decision undermined that. The ACA pledged increased funding for  community health centers – culturally competent care close to home – but this  has been weakened by threats to  Medicaid expansion and a variety of attacks on immigrants, with or without  papers.

On the plus side,  children can stay on their parents’ insurance plans until age 26.  Some of the most outrageous insurance  company practices are finally outlawed, like denying care for pre-existing  conditions and annual and lifetime caps on benefits. Gender inequality is  proscribed. The donut hole will be closed.

On the down side,  there will be no real limits on what insurance companies, hospitals and drug  companies charge. Those who do not have health insurance coverage one way or  another will be forced to buy the insurance industry’s shoddy products or pay an  additional penalty and remain without coverage. As inMassachusetts, where the  ACA’s prototype was enacted in 2006, the new norm is unaffordable  underinsurance.

Health care costs will  continue to rise swiftly, strengthening employers’ resolve to shift costs onto  workers through pushing high-deductible, low coverage plans, or by dropping  health insurance altogether. Strikes and lockouts over health benefits could become more frequent and of longer duration. Workers in  unions with joint union-management Taft-Hartley health and welfare plans will be  confronted with more employers demanding renegotiation of terms by the end of  2013. And in 2018, the excise tax on so-called Cadillac health insurance plans  will kick in, adding further burdens to those with stagnating  wages.

Which Way for the  Labor Movement?

Resolution  34 of the September 2009 AFL-CIO  convention inPittsburgh proclaimed the goal of a national  social health insurance: a   single payer program. This  resolution was the result of seventy pro-single-payer resolutions submitted in  the pre-convention period, more resolutions on one issue than ever before in the  history of the AFL-CIO. The steady growth of labor’s commitment to fundamental  health care change grew from the work of the All-Unions Committee for Single  Payer Health Care — HR 676.

By the time the  national debate over health care took off early in 2009, nearly six hundred  labor organizations in forty-nine states had already endorsed HR.676.  Thirty-nine state labor federations, one hundred thirty-five central labor  councils and twenty-two national and international unions stood up to be  counted.

To deepen and mobilize  this sentiment, the Labor Campaign for Single Payer was organized in St. Louisin January of  2009. This coalition set as its first priority the adoption of Medicare for All  as a strategic goal for organized labor. That goal having largely  been met with the passage of Resolution 34, the struggle now is to move from  resolutions to action and to link the fight for a just healthcare system with  labor’s overarching goal of driving back the threat of austerity and winning  security for the working class and the entire population. This will require building labor/community  coalitions across the country capable of mobilizing  gigantic numbers in the streets  demanding no cuts to the safety net and Medicare for  All!

Following the 2010  enactment of the ACA, and in the wake of the 2010 elections, the pendulum has  swung to the states. The Vermont Workers Center, an affiliate of Jobs with Justice, and many  unions in Vermont provide the solid backbone of  the movement for health care as a human right in the   Green Mountain State. Built on several years of solid  grassroots work, the single-payer movement inVermonttook advantage of federal funds  allotted to the states under the ACA to fashion health insurance exchanges to  entrench their goal of emerging in 2017 with a true single-payer system.  Powerful forces are now pouring resources into the state to block this advance  for health care justice or to subvert this movement into something palatable to  the corporations and politics as usual.

Some unions  representing those who work in health care, especially National Nurses United, are deeply involved in refashioning  their industry, rejecting corporate  partnerships and fighting for the highest possible standards of care. This  militancy is reflected in strikes and other actions to block the erosion of  access to care and threats to advances already won.

How Did Things Get  This Way in the U.S.?

U.S.health care remains  dominated by profiteers, and they exercise extraordinary influence in both the  Republican and Democratic parties. This explains whyU.S.taxpayers  spend more on health care per capita than taxpayers in any other developed  country, yet we still have fifty million uninsured people, only half of whom are  promised eventual coverage by the ACA. The bottom line is this: Profit rules,  with the working class, one way or another, paying through the nose as a result of  enactment of the ACA.

The Bush-appointed  chief justice John Roberts cast the deciding vote to maintain the overall  structure of the ACA. But a challenge to that structure  came from 26 state governments, many of  whose governors threaten to reject the expansion of Medicaid — which would make it  available to those making up to 133% of the federal  poverty line — even though the federal government would pay 100% of the  cost for the first three years and at least 90% for the succeeding years. Their main rationale: “We need the money for education.”  But instead of pitting educational needs against health care needs, the states  need to demand additional funding for both, which can easily be paid for by  slashing the astronomical Pentagon budget.

How many of the 26  states that brought the suit against ACA to the Supreme Court will end up  refusing to implement Medicaid expansion? InMassachusetts, politicians call Medicaid the  “budget buster.” We need to step up the fight for all states to sign on to the  expansion, even as we intensify the struggle for a single-payer,  Medicare-for-All system. Everybody in, nobody out!

The individual  mandate, thought up by the ultra-conservative Heritage Foundation in the 1980s,  is the most regressive way to attempt to get to universal health insurance  coverage. Whether constitutional or not, it is an integral part of the “shared  responsibility– shared sacrifice” mantra of the neoliberals. It was used to  block single-payer inMassachusettsand on the national scene. It’s  argued that the individual mandate is necessary to rope in all those who don’t  buy health insurance on their own and so place a burden on everyone else. In  reality, most people who don’t have health insurance are that way because they  can’t afford it.

As bad as the  situation for health care in the U.S. is today — and will be even under the ACA — it will be predictably far worse if  Democrats and Republicans join in a “grand bargain” to impose substantial cuts  in Social Security, Medicare, Medicaid and other vital safety net programs.  It is widely expected that an attempt  will be made to ram through such a “bargain” along the lines of Bowles/Simpson  during the Congressional lame duck session in December. What’s needed is for the  labor movement and our community allies to join together to do everything in our  power to prevent this from happening.

This entire experience  underscores the need for reforming the health care system in a most fundamental  way. Let’s not forget that the Tories and Liberals did not usher in the  universal health care system in Canada or Great  Britain. It was the  labor movement that led the fight to win these historic breakthroughs.  Independent political action by labor in theU.S.  organized in trade unions and in the community must lead the fight for a just health care system if it  is to become a reality in our country. Mass action on  the ground and labor campaigns wherever possible can spearhead this drive. Labor will also need to build its own  party with its own demands, including Medicare for All!

Our goals and slogans going forward  should include:

  •  Resist attacks on  Medicare, Medicaid, Social Security and all other social  benefits!
  • Demand that Medicaid  expansion be agreed to in all the states!
  • Organize all health  care workers into fighting unions!
  • Mobilize for  single-payer locally and nationally!
  • SupportVermont’s grassroots  efforts for single payer!
  • Affiliate unions with  Labor Campaign for Single Payer!
  • Challenge all  candidates on real health care reform!
  • Run independent labor  candidates!
  • Prepare for a rebirth  of the Labor Party!

Issued  by the Emergency Labor Network (ELN)

For  more information write emergencylabor@aol.com or P.O. Box 21004, Cleveland, OH44121 or call 216-736-4715 or visit our website at www.laborfightback.org. Donations gratefully accepted. Please make checks payable to ELN and  mail to above P.O. Box.

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