Just over a week before Inauguration day, in an early morning party-line vote, Senate Republicans voted to take the first steps towards the repeal of the Affordable Care Act. Because the measure was attached to what is termed a “reconciliation” bill, it allows for the Senate to take a vote without the need for a super-majority vote or the threat of a Democratic filibuster. The same week, House Speaker Paul Ryan raised the prospect of a “reform” to Medicare that would change the fundamental nature of that essential safety net for seniors.  

by Steve Xavier

GOP members of the House seem in a state of disarray over the lack of a concrete proposal for a replacement for the ACA, with some vowing to vote against any repeal without a replacement plan in place. Some of the proposals being discussed by rightwing think tanks would shift significant out-of-pocket expenses onto the backs of working class people while giving more breaks to the rich. 

During the 2016 Presidential campaign, the Republican field of candidates all promised to “repeal and replace” the so-called Obamacare health insurance plan. In December, Paul Ryan assured the public that there  ”will be a transition and a bridge so that no one is left out in the cold, so that no one is worse off”  As recently as a couple of weeks before the inauguration (1/3/17), Trump spokesperson Kellyanne Conway promised that there would be a replacement plan, saying, “We don’t want anyone who currently has insurance to not have insurance…” 

Mixed signals about the health care law have led to confusion among the ranks of Republicans and have led to speculation about what will replace the ACA. In his Inaugural speech, the new President failed to include to any mention of health care in his “America First” rhetoric. After a month of the Trump regime, no “alternative” seems to be on the horizon and activists are mobilizing against individual members of Congress to defend the ACA. Members of Congress have faced angry constituents at town halls and many legislators have refused to have public meetings with voters in order to avoid confrontations with protestors. Trump has decried the town hall protests as the work of “professional” protesters. Some commentators have drawn parallels between the protests against members of Congress with the Tea Party protests in the early stages of the Obama administration.  

People in the US often brag that the US healthcare system is the best in the world. This claim may well be true, but the truth is that quality medical care is rationed according to income, with the richest  getting the best care and the rest of us facing a confusing and unnecessarily expensive system. Despite the Affordable Care Act (ACA) reform, which was supposed to address the question of the uninsured, some 29 million people in the US remain without health insurance.

During the Bush years, sentiment was building for a solution to the crisis in health care costs. Advocates for a Single Payer system felt that the incoming Obama administration would enact some form of single payer, but hopes were dashed when the final product of Obama’s efforts emerged from the Washington meat grinder. Obama, formerly a supporter of single payer, received more than $20 million in contributions to his 2008 campaign. 

From Romneycare to Obamacare

The ACA is similar to the plan originally  proposed by Hillary Clinton during the reign of Bill Clinton. It bears a resemblance to the privatized healthcare schemes passed under neo-liberal regimes in Columbia and elsewhere and is very similar to the statewide reform passed under Governor Mitt Romney in Massachusetts.

When Obama was elected, his promise to reform health care and make sure that everyone in the US was covered quickly evolved into something else. The pressure of the private medical insurance companies made sure that there would be no “public option” included in the final product. While the public option was included in the bill that passed the House, by the time the Senate had completed its work, this notion had been stripped from the law. Some progressive aspects of the law survived, like protection for people with pre-existing conditions and the extension of the time an adult child can remain on their parents’ insurance plan.  

The ACA, or Obamacare, as the right wing quickly labeled it, has become an expensive failure. Despite the mythology among its defenders, the ACA is not an improvement for all working families. The reform had the effect of cutting off the movement for Single Payer, while acting as a bailout of private insurers. The reality of neo-liberal health care means that some get decent coverage while others scramble to survive.

The ACA keeps for-profit insurance companies at the center of the medical care system. The ACA system is based on a sliding scale of cost tiers referred to as the metal plans – bronze, silver, gold and platinum — in which the costs are managed through differing plans based on varying premiums and out-of-pocket expenses. For example, the “bronze” plan has lower premiums and higher co-pays while the “gold” plan has higher premiums but offers more coverage options and lower out-of-pocket expenses. Lower income workers are more likely to choose a plan with a lower premium, but their out-of-pocket expenses can be prohibitive if a health crisis occurs. Premiums continue to rise, with a projected 24% increase in 2017 and health care costs continuing to rise across the board. The massive overhead due to administrative costs of private, for-profit, insurance companies continues to contribute to the high cost of health care. 

We should continue to defend the progressive aspects of the ACA. As socialists, our support must be in terms of how we see the health care debate. First, we support health care as a basic human right. Everyone should have the same access to quality health care. Second, we want to remove the profit motive from medical care. The toxic role of private insurers, healthcare corporations, and pharmaceutical manufacturers serves to keep vital treatment from the vast majority.

We should be fighting for a single payer system to replace the current system.   Of course, the progressive aspects of the ACA, like coverage of pre-existing conditions and protections for women’s reproductive health, must be preserved. That said, the preservation of profit-centered healthcare will only continue to undermine any advances made by working people.

Pro-capitalist politicians, both liberal and conservative, will argue that taking the profit out of healthcare would stifle innovation. The staggering number of vaccines, cancer treatments and other medical breakthroughs made by the Cuban healthcare system stands as a sharp repudiation of the assertion that a profit-driven is best for patients and providers. Working under conditions of scarcity, and under siege by US imperialism, the Cubans have managed to build a system of medical care unlike any other. The Cuban people don’t have to worry if they will be able to afford a doctor or vital medicines. The Cuban government has famously sent medical aid, including doctors, to war torn regions and to the care for the victims of natural disasters. Under the Sixth CCP Congress reforms the Cuban health care and educational systems have been undermined.

The only real beneficiaries of a for-profit healthcare system are the rich.

We must fight for an alternative that sees health care as a basic human right. The increasing proletarianization of health professionals creates the potential for an alliance of healthcare workers with a mass movement aimed at winning a system based on human needs. Working conditions of nurses and other personnel, including doctors, have eroded, with longer hours and patient loads in excess of what is considered safe for either the workers or patients. Doctors are much more likely to be employees of corporations than self-employed practitioners. Saddled with debt from student loans and working under increasingly poor conditions, doctors and nurses should be natural allies of a movement for free universal health care. Health care for all will be won through the mass struggles of working people. Depending on politicians of either ruling class party or on an NGO-style method of passive mobilization and lobbying won’t win the fight.

Winning single payer is only a first step. A national health insurance system would still leave private, for-profit,  healthcare corporations in the mix. The goal of socialists should be to bring the entire healthcare system under public ownership — neighborhood clinics, hospitals, and  the pharmaceutical industry — and build a system based on human needs, not profits.


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