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What Next for Single-Payer Advocates?

Supreme Court Ruling Means Health Care Remains a Commodity

by MARK DUDZIC

Yesterday’s Supreme Court decision that substantially upholds the Affordable Care Act (ACA) was widely praised by the national labor movement. “Working people won a resounding victory,” proclaimed SEIU President Mary Kay Henry as she thanked President Obama and the members of Congress who supported the ACA.

Likewise, AFL-CIO President Rich Trumka declared himself “pleased and relieved.” However, he also stated that, “We have no illusion that the destination has been reached, and we are more committed than ever to the hard work necessary to achieve our dream of quality health care for all.” One “indisputably constitutional solution,” Trumka suggested, would be to “allow Americans of all ages to buy into an improved Medicare program.”

The National Nurses United (NNU) took a longer-term perspective. Co-President Jean Ross pledged that NNU would step up its campaign for a reform that would be based on “a universal program based on patient need, not on profits or ability to pay. That’s Medicare for all.”

“Medicare is far more effective than the broken private system in controlling costs and the waste that goes to insurance paperwork and profits,” adds NNU Co-President Karen Higgins. “[I]t is universally popular, even among those who bitterly opposed the Obama law. Let’s open it up to everyone.”

Most single-payer advocacy organizations used the occasion of the Supreme Court decision to focus on the inadequacies of the ACA. Healthcare-NOW! points out that there will still be 26 million uninsured and that the ACA, “Embeds private, for-profit insurance in the system’s core, allowing them to continue to profit and game the system at our health’s expense.”

“Contrary to the claims of those who say we are ‘unrealistic,’ a single-payer system is within practical reach,” says a statement signed by eight leaders of the Physicians for a National Health Program. “The most rapid way to achieve universal coverage would be to improve upon the existing Medicare program and expand it to cover people of all ages.”

In Vermont, the Vermont Workers Center (VWC) sees the decision as a “vindication of Vermont’s own path toward a human-rights-based universal healthcare system.” Declaring that “Vermont can lead the way,” the VWC contrasts the ACA’s mandate to “buy health insurance as a commercial product” with Green Mountain Care’s treatment of healthcare as a “public good to all, financed through tax-based contributions.”

Vermont Senator Bernie Sanders–the only U.S. Senator who is a current sponsor of single-payer legislation—echoed these sentiments. While expressing support for the Supreme Court decision and the ACA, he asserted that, “the real solution to America’s health care crisis is a Medicare-for-all, single-payer system. Until then, we will remain the only major nation that does not provide health care for every man, woman and child as a right of citizenship.”

“I am proud that Vermont is making steady progress toward implementing a single-payer system,” he added. “I hope our state will be a model to show the rest of the nation how to provide better care at less cost to more people.”

Where Do We Go From Here?

The most immediate consequence of the Supreme Court decision will undoubtedly be political. Pundits are already calling it a momentum changer in the presidential campaign. Indeed, Republicans, with their call to “repeal and replace,” appeared disoriented and mean-spirited. For President Obama it was a triumphal day as he decreed vindication for his vision that, “In America, no illness or accident will lead to a family’s financial ruin.”

The jury is still out, however, on what effect this decision will have on the actual healthcare that Americans will receive under the ACA as well as its effects on the long-term prospects of the fight to make healthcare a right for everyone in America. Certainly, a more sober assessment of the healthcare realities faced by most working Americans and their families would show that we are a long way from President Obama’s aspirational vision.

Many have also expressed concern that the structure of Supreme Court decision may set the stage for future judicial challenges to the social insurance model. The Court refused to anchor the ACA’s individual mandate in the Constitution’s “commerce clause.” This is the clause that has been used to justify nearly every piece of social legislation—from the right to join unions to the food stamp program–since the New Deal. While having no material effect on the implementation of the ACA (the Court ruled that the mandate could be enforced under the constitutional power to tax), this new interpretation, coupled with the Court’s apparent assertion that the federal government cannot force states to comply with all of the provisions of state-administered programs such as Medicaid, could indicate that the Court would be willing to countenance a broader attack on social programs. The Labor Campaign for Single Payer has repeatedly affirmed that, to win, our fight must be part of our broader fight to defend and expand the social insurance model.

Coming at the end of a Supreme Court session that was especially cruel to the labor movement, it is perhaps to be expected that there would be some celebration at what was widely seen as a defeat of labor’s worst enemies. But this must not detract us from the urgency to prepare for a renewed assault on employer-provided healthcare benefits. At a recent strategy meeting of the LCSP Steering Committee and Advisory Board, we heard from union leaders from around the country who are seeing the writing on the wall. Public employee benefits are under the gun in nearly every jurisdiction. Union Benefit Funds, often the gold standard in employer-funded healthcare, are facing threats to their very survival as ACA regulations impose new mandates while new state insurance exchanges potentially draw off their youngest and healthiest participants. And the 2018 “Cadillac Tax” is beginning to look more and more like a “Chevy Tax” as continued healthcare inflation will trigger this penalty on the hard won benefits of millions more union members than originally predicted.

What Happens Next?

The Affordable Care Act is now indisputably the law of the land. This will create new conditions and new challenges. Many millions will undoubtedly benefit from increased access to healthcare and regulation of the private insurance industry. Many millions more will find out that the right to buy health insurance is not the same thing as the right to healthcare. States will be required to set up healthcare exchanges by 2014 and state-level innovation—including state single-payer reforms—will be barred until at least 2017 (although President Obama did re-affirm his support for efforts to move that date up to 2014).

Certain things won’t change, however. Healthcare will still be treated as a commodity and a profit center rather than as a human right. Millions will continue to be denied access to basic healthcare. Costs will continue to rise two, three, even four times faster than our wages while quality deteriorates. Employer provided healthcare will continue to go the way of defined benefit pensions and healthcare fights will continue to be the biggest cause of strikes, lockouts and union busting.

The labor movement has no choice but to fight on for healthcare justice. And we in the Labor Campaign for Single Payer vow to re-dedicate ourselves to this fight to remove healthcare from the bargaining table and make it a right for everyone in America. We believe that it is labor’s historic responsibility to lead this effort and we will not rest until it fulfills this mission.

Mark Dudzic is National Coordinator of Labor for Single Payer.