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The Supreme Court and the Affordable Care Act

Health Care is a Right, Not a Mandate

by MARK VORPAHL

Any day the Supreme Court is expected to rule on the constitutionality of Obama’s Affordable Care Act (ACA). Most at risk is this act’s “individual mandate” which requires everyone to buy health insurance from a private insurer or face a steep fine. If the “individual mandate” is ruled unconstitutional, it is possible that the Supreme Court justices will throw out the ACA in its entirety. Even if they agree to keep the ACA intact while rejecting the individual mandate, this will put the entire bill in jeopardy since it is this provision that makes the ACA economically feasible.

With all the distortions of the ACA from both its opponents and supporters, as well as the hype anticipating the Supreme Court’s ruling, the health care reform movement’s eyes have wandered far from the prize. That prize is securing full health care coverage as a right for all, regardless of income.

From the perspective of what is most humane and productive for society as a whole, universal health care must be viewed as such a right. However, in the United States health care is first and foremost a commodity sold in order to make the most profit for a handful of large corporate owners, despite the inefficient and inhumane outcome. If universal health care is to be won as a right, it will require a movement that will inevitably pit the social needs of the 99% against the greedy interests of the wealthy corporate elite.

Can the ACA move us closer to universal health care? Does it favor the political interests of workers as opposed to the 1%? Physicians for a National Health Program put out a statement in March of last year addressing this question. Its title is “Pro-single-payer doctors: Health bill leaves 23 million uninsured – A false promise of reform.” In it they succinctly state the facts about the ACA:

“*About 23 million people will remain uninsured nine years out. That figure translates into an estimated 23,000 unnecessary deaths annually and an incalculable toll of suffering.

“*Millions of middle-income people will be pressured to buy commercial health insurance policies costing up to 9.5 percent of their income but covering an average of only 70 percent of their medical expenses, potentially leaving them vulnerable to financial ruin if they become seriously ill. Many will find such policies too expensive to afford or, if they do buy them, too expensive to use because of the high co-pays and deductibles.

“*Insurance firms will be handed at least $447 billion in taxpayer money to subsidize the purchase of their shoddy products. This money will enhance their financial and political power, and with it their ability to block future reform.

“*The bill will drain about $40 billion from Medicare payments to safety-net hospitals, threatening the care of the tens of millions who will remain uninsured.

“*People with employer-based coverage will be locked into their plan’s limited network of providers, face ever-rising costs and erosion of their health benefits. Many, even most, will eventually face steep taxes on their benefits as the cost of insurance grows.

“*Health care costs will continue to skyrocket, as the experience with the Massachusetts plan (after which this bill is patterned) amply demonstrates.

“*The much-vaunted insurance regulations – e.g. ending denials on the basis of pre-existing conditions – are riddled with loopholes, thanks to the central role that insurers played in crafting the legislation. Older people can be charged up to three times more than their younger counterparts, and large companies with a predominantly female workforce can be charged higher gender-based rates at least until 2017.

“*Women’s reproductive rights will be further eroded, thanks to the burdensome segregation of insurance funds for abortion and for all other medical services.” (1)

The article goes on to state “…the Congress and Obama administration have saddled Americans with an expensive package of onerous individual mandates, new taxes on workers’ health plans, countless sweetheart deals with the insurers and Big Pharma, [large pharmaceutical corporations] and a perpetuation of the fragmented, dysfunctional, and unsustainable system that is taking such a heavy toll on our health and economy today.”

The ACA is not even the smallest step forward towards winning universal affordable health care as a right. What else could be expected from a bill that was, in part, written by for profit medical and insurance companies? At best the ACA is a distraction that has derailed the focus of many labor and grass root’s community organizations from building a campaign that addresses their memberships’ needs and involves them in the fight.

This isn’t because an alternative to the ACA is so hard to find. Expanding Medicare to cover the entire population would make health care universal and affordable for everyone, thus securing it as a basic right. In addition to this, there are other important reasons why we should build a campaign that would focus on Medicare for all rather than support the ACA.

A 2009 study by the California Nurses Association concluded that Medicare for all would be a jobs creator and, consequently, a source for economic stimulus.

“Overall, expanding and upgrading Medicare to cover all Americans (single-payer) would create 2.6 million new jobs at an average salary of $38, 262 per year, [paralleling almost exactly the total job loss in 2008], infuse $317 billion in new business and public revenues, and inject another $100 billion in wages into the U.S. economy.” (2)

Medicare for all would also save hundreds of billions in administrative costs. Only 2 percent of Medicare dollars are spent on this, whereas private insurance spends as much as 16.7 percent. These savings alone would be enough to assure universal coverage without raising overall health care spending. (3)

Obama’s ACA is widely unpopular with only 24 percent supporting it in its entirety, according to a June 7th New York Times – CBS poll. In contrast public support for some type of universal expansion of Medicare has consistently received majority support in numerous polls from multiple sources. (4)

Finally, there is the issue of the constitutionality of expanding Medicare coverage to all as opposed to the ACA. Clearly, this issue is open to debate when it comes to Obama’s scheme. In contrast, the constitutional taxing power of Congress that enabled it to create Medicare and Social Security, would also allow it to establish a universal health care coverage system. All that would be needed would be to strike out the phrase “over 65″ from the original Medicare law and establish a tax that would raise the revenue. Considering the enormous concentration of wealth and low tax rate of top 1 percent, it would not be difficult at all to establish such a revenue stream without raising the tax rate for workers a single cent.

Given all this, the question unavoidably arises, “If Medicare for all is a jobs creator, money saver, popular and constitutional, why have we been stuck with the ACA?”

The big medical and pharmaceutical corporations are major political players with a lot of cash to throw around. This cash buys the loyalty of both the Republican and Democratic Parties. If this influence is to be challenged, it will take the power of sustained independent mass collective action to do it.

Even in its weakened state the Labor Movement has the ability to lead this course. For years the majority of unions have been on record for supporting a Single Payer, or Medicare for all system. However, President Obama prohibited any discussion of this while designing ACA, effectively locking out labor.

Rather than dedicating their efforts and resources towards building an independent movement demanding that health care become a basic right, the majority of labor’s leaders opted to appeal to the Democrats by abandoning this call in practice. They held out hope that if they whittled their demand down to a public option within the ACA, they could use this as a transitional step towards establishing Medicare for all. Not surprisingly, they didn’t even get that. Now many are still backing the ACA though it bears as much resemblance to Medicare for all as a roadblock to a freeway. Top labor officials seem prepared to do anything to get that seat at the table with the Democrats, regardless of this strategy’s meager and diminishing returns.

It’s as though these labor leaders bargained with an employer demanding a healthy raise for their members and then, without putting up a fight, settled for a wage cut while declaring victory for maintaining a union/employer “partnership” that lacked any benefits for the membership.

Regardless of the fate of the ACA at the hands of the Supreme Court, the task of the day remains the need to build a mass movement that will support Medicare for all. The corporate politicians will tell us this isn’t possible while they create the most impossible “health care reforms” to please their wealthy backers. They will continue this line until labor and grassroots groups build enough unity to not simply sit at their table, but potentially take it over.

Mark Vorpahl is an union steward, social justice activist, and writer for Workers’ Action – www.workerscompass.org. He can be reached at Portland@workerscompass.org.

Footnotes

(1) http://www.pnhp.org/news/2010/march/pro-single-payer-doctors-health-bill-leaves-23-million-uninsured

(2) http://www.californiaprogressreport.com/site/medicare-all-would-create-26-million-jobs

(3) BRIEF ON BEHALF OF SINGLE PAYER ACTION, IT’S OUR ECONOMY, AND FIFTY MEDICAL DOCTORS WHO SUPPORT SINGLE PAYER AS AMICI CURIAE IN SUPPORT OF RESPONDENTS (MINIMUM COVERAGE PROVISION) http://www.singlepayeraction.org/blog/wp-content/uploads/2012/02/brief.pdf

(4) Medicare for all – chart of Americans’ support: http://www.medicareforall.org/pages/Chart_of_Americans_Support