As insurance enrollments of previously uninsured U.S. working people rise under the Affordable Care Act (ACA), Republicans and Democrats continue to spar over healthcare policy. Labor groups and forces associated with social progress advocate truly universal, affordable healthcare by removing market obstacles to access, including insurance-company and pharmaceutical-industry super-profits.
Is the idea of healthcare as a human right, often associated with a “single payer” or “national healthcare” system, emerging as an issue in the near future? Or is the ACA, often called “Obamacare,” a step away from that? How can we move effectively toward decent healthcare as a human right in the U.S.?
This article will review a range of perspectives, from those of liberals and moderate socialists to radical-minded socialist groups. This may help put in perspective one of the current issues in the news, which is the decision by nineteen Republican-led states to reject the expansion of Medicaid support for poor people, provided for and funded by the ACA.
Thus, while millions of persons previously lacking access to healthcare are gaining access — about 40 percent previously uninsured Kentucky residents are now covered — millions more are still denied access by the spite of right-wing governors and legislators. A million Texans and 300,000 Mississipians are among these.
Liberal columnists such as Paul Krugman and Katrina van den Heuvel, editor of the Nation, are campaigning on this issue. Vanden Heuvel wrote in the Washington Post, “It’s time for Democrats to run on health-care reform, not away from it.” Thus for some, the issue of healthcare as posed as a partisan issue in which one party is in the right and the other in the wrong.
The labor-union officialdom leading the AFL-CIO has this perspective as well. The AFL-CIO’s web site states, “The Affordable Care Act is a historic milestone” toward guaranteed high-quality health care for all. It points to the danger of repealing the ACA or its key provisions, while also advocating extending access to health care by providing “Medicare for all.”
The views of Democratic Socialists of America (DSA) are often consistent with those of the AFL-CIO leadership. DSA’s emphasis is to ask its supporters to contact their Congress members to sponsor single-payer legislation. The DSA web site contains a history of the effort for national health insurance by Gerald Friedman of the University of Massachusetts, Amherst. It points out that the ACA discussion has reflected a move to the right by both Democrats and Republicans. The legislation that Republicans and Fox News today are calling “socialist” matches proposals by Republican Newt Gingrich and the right-wing Heritage Foundation in the 1990s. To obtain Democratic votes for the ACA, the Obama administration “has entrenched the insurance and drug companies as arbiters of America’s health care system,” according to Friedman. Nevertheless, he writes, “the ACA commits the United States to providing universal access to healthcare … a great achievement, one to be treasured and nurtured.”
Another opinion source on the left is Portside, often looked to by supporters of the Committees of Correspondence for Democracy and Socialism (CCDS). An article by Rose Ann DeMoro, executive director of the California Nurses Association/National Nurses Organizing Committee (CNA/NNOC). DeMoro advocates the single-payer as an alternative to the ACA. She emphasizes faults in the ACA from the standpoint of health-care service users.The Socialist Party has long advocated, in its Platform, a socialized healthcare system that would replace private health insurance for profit with an efficient way of providing healthcare to all, as needed, funded by a steeply graduated income tax. It sees single-payer as a first step toward a comprehensive system that would include “public ownership and worker and community control of the pharmaceutical industry.” Full reproductive healthcare would be a basic part of such a system.
Stephanie Cholensky, Co-Chair of the SP USA, said in a statement in October, 2013, “The Affordable Care Act enacts long overdue regulations such as preventing insurance companies from denying coverage or charging more because of a person’s sex or because of a pre-existing condition. However, the Act’s benefits to working people fall short under closer scrutiny, as it grants the care they should have had to begin with, but lacks a single-payer option and still leaves an estimated 30 million uninsured. The Affordable Care Act does call for public funding of healthcare, but these public funds end up in the pockets of the wealthy at the end of the day, making it hardly different from other corporate welfare programs.”
Left currents within the labor movement are similarly highly critical of ACA. Mark Dudzic, of the Labor Campaign for Single Payer Healthcare, writes that the ACA having the effect of increasing inequality between union and non-union workers, in part because it was “deliberately designed to continue to treat healthcare as a commodity to be bought and sold in the marketplace and primarily covered through employment-based private insurance plans.” He refers to a section on health care in Steve Early’s book, Save Our Unions, that explains how unions in the U.S. designated healthcare as a contract benefit, not a right, decades ago.
Strong criticism of the ACA can also be found in Labor Notes, a publication by union activists that has existed for several decades. A concern by a March 2013 article by James McGee is that, “Because the Affordable Care Act (ACA) tilts the playing field to disadvantage multiemployer plans, this decades-old gain of the labor movement may be irreparably damaged.”
The Green Party of the U.S. offers a negative view of the ACA, whose benefits a former Green Party candidate said “are thoroughly offset by numerous defects and continued deficiencies that can be readily remedied by legislation that expands Medicare to all Americans.” Green Party 2012 standard bearer Jill Stein has predicted the collapse of the ACA.
Likewise, an article in Socialist Alternative states that ACA is not the answer that working and poor people had hoped for. “Designed to convert the 47 million uninsured Americans into paying customers for the insurance and pharmaceutical corporations, Obamacare adds unnecessary costs and layers of complexity for patients and health care providers. … Insurance does not guarantee affordability. It guarantees profits to the insurance corporations.” Socialist Alternative is a group that ran Kshama Sawant’s victorious campaign for Seattle City Council in fall 2013.
An article by Gary Lapon, published by Socialist Worker, argues, “The ACA isn’t a bridge to universal healthcare. It is a cul-de-sac, structured above all else to maintain the central role of the health care industry.” According to Lapon, “the ACA has made achieving universal coverage much more difficult.” SW is published by International Socialist Organization (ISO).
A review of left views on ACA and the struggle for universal healthcare shows divergent emphasis and analysis. Can labor and socialist activists work together? A first step is to become aware of the differences and to consider them.
How can we move toward healthcare as a right? One socialist argument would be that the Democrats, like the Republicans, are tied by a thousand financial and other connections to the profit-making healthcare industry. Writing to them, lobbying them without money in hand, or addressing public appeals to them may accomplish little.
What will make a difference is more likely to be the mobilization of large numbers of people in the streets. To do that, the unions would have to loosen their ties to the Democrats and take a more independent course as suggested by Labor Notes, the Labor Campaign for Single Payer Healthcare, and others.
Socialists can advance that by consulting together and waging local struggles, with allies, aiming toward nationwide mobilizations. The mobilizations could begin, for example, with defensive efforts like the Moral Mondays in North Carolina or with protests against the exclusion of poor people in some states from Medicaid.