Healthcare for all protest in front of Supreme Court Courtesy Margaret Flowers

The passage of the Affordable Care Act (ACA) in March, 2010 was hailed as an historic victory for health care reform in the United States. But those of us who advocate for a single payer health system saw through the media hype. The new law is inadequate and actually moved the U.S. health care system farther in the direction of privatization, codifying that position into law. As suffering continues, the struggle for health justice goes on in the United States. Single payer advocates are employing new, creative and, hopefully, more effective methods of organizing.

The health reform process, beginning in 2008, was highly scripted and controlled in order to give the illusion of a debate. The discussion in Congress and in the media took place within a narrow neoliberal framework of propping up the current market-based system rather than looking at the roots of the health crisis and evidence-based policy to address them.

A true health reform debate could have compared the three types of systems that currently exist in the U.S.: a socialized system known as the Veterans Health Administration, a single payer system called Medicare, and the market-based private insurance system. An honest comparison of these systems would have proven what is common knowledge in most industrialized nations: Privatized health care is more expensive and excludes those who cannot afford it. The most cost-effective way to guarantee universal access to health care is through a non-profit publicly financed system known as single payer in the U.S. or “Medicare for all.”

There is no doubt that the ACA creates a situation in which some people who would otherwise be uninsured will have health insurance. However, even at its best, the ACA will not cover everyone, will not end medical bankruptcy, and will not control health care costs. The fundamental flaws of the ACA are that it uses public dollars to prop up the wasteful and corrupt private insurance industry, encourages the purchase of inadequate insurance and continues the privatization of health services.

Current estimates are that 30 million people will remain without health insurance in 2016. The actual number could easily be higher. As economic stagnation in the U.S. continues, families simply won’t be able to afford the cost of health insurance premiums and states either won’t be able to afford or will refuse to expand Medicaid. The effects of being uninsured are well documented. It causes delayed access to health care, worse outcomes, and preventable deaths.

The ACA also perpetuates the growing trend of inadequate insurance. Employer-based plans, which tend to be the best, are disappearing. Many employers are moving their employees to less than full-time hours so they don’t have to provide benefits, while some are switching to stipends that employees can use to purchase health insurance. Still others are dropping benefits altogether and paying a penalty to do so. This will push more people to purchase insurance through the health exchanges where the least expensive plans, which most will opt for, will be skimpy with high out-of-pocket costs and low coverage.

Inadequate health insurance places families at risk of financial ruin if a member has a serious accident or illness. A study from 2009 found that over 60% of personal bankruptcies were due to medical costs and that nearly 80% of those with medical bankruptcy had some form of health insurance. Like the uninsured, people with inadequate insurance delay necessary care due to the prohibitive expense.

Worse, the ACA allows the private for-profit hospital and health insurance corporations to continue gobbling up hospitals, medical practices and diagnostic and treatment centers. In general, privatized health services are more expensive and have worse health outcomes. When the bottom line is profit, it comes at the expense of health.

Sadly, it doesn’t have to be this way. We are already spending far too much on health care in the U.S. — over twice the average per person of other industrialized nations that provide universal lifelong and comprehensive coverage. We could achieve this with a national single payer system. Such a system would slow the growth of health care costs while also guaranteeing that people could get necessary care. At present our health care costs are misleadingly decreasing because people are self-rationing their spending, using fewer health services.

However, the passage of the ACA has thrown a significant wrench in the struggle for single payer. Despite its inadequacies, many people have been misled to believe that the ACA will achieve universal access to care or that it can be tweaked into providing universal access. State legislators and health advocates are focused on implementing the ACA, and along with the public, have adopted a “wait and see” attitude.

Healthcare not Wealthcare

Nonetheless, single payer advocates continue to push forward with new campaigns. More see health care as part of the broader struggle for social, economic and environmental justice. Guaranteeing access to health care alone, without addressing the other issues that influence health such as education, housing, work conditions and the environment, will not improve the health of the population significantly.

There is much to be done to continue to achieve health justice in the U.S. At present, the foundation of this work is to protect our social insurances and public health institutions while educating and building a greater movement for health reform. Some health advocates have broadened their work to address root causes of the dysfunctional government such as money in politics and corporate power. Some are working in their communities to build broader coalitions that connect many issues and go beyond health care to educate about all of our human rights. This work provides new and creative ways of organizing and opportunities that are very exciting.

One such opportunity is a divestment campaign called “Healthcare not Wealthcare” that is aimed at for-profit health insurance corporations. A coalition of single payer advocates are encouraging large institutions to invest their funds in a socially responsible manner and are informing these institutions that private health insurance companies which place profits before people do not meet the criteria for social responsibility. The first success is the Presbyterian Church USA which voted unanimously to start the process of divestment. TIAA-CREF, the retirement fund for teachers and professors, is an upcoming target. More information about the campaign can be found at www.Healthcare-now.org.

The human rights framework is gaining momentum as a way to organize not only for single payer health reform, but to go beyond access to health care and push for changes that address all of the factors that impact health. There are five basic human rights principles: Universality, Equity, Transparency, Accountability and Participation. These principles provide a simple test for understanding whether a policy about health care, education or other rights honors or violates those human rights. This framework also informs people that we have human rights as outlined in the Universal Declaration of Human Rights, which is something that is not often taught but will hopefully empower more people to take a stand.

Vermont adopted a Health Care is a Human Right campaign in 2009 and built a large grassroots base of support. They successfully passed legislation requiring the state to design and vote on a health plan that meets human rights criteria in 2010. A new health law was signed in 2011, and while it is not a single payer system, it is the best state health law at present. The Vermont human rights campaign is now pushing the state to put people’s needs first when determining budget priorities.

Maryland is the second state to formally launch a Health Care is a Human Right campaign. It is gaining momentum quickly even in conservative rural areas of the state. Health injustice touches almost everyone and people seem to be searching for an effective way to end it. The goal of the campaign this year is to hold community dialogues throughout the state where people can tell their stories and know that they are not alone in their suffering. This is a form of transformative organizing that uses story-telling and education to create a deep understanding of the systemic crisis and empowers people, especially those most impacted by the crisis, to seek lasting change. Other states, particularly Oregon and Washington, are also developing Health Care is a Human Right campaigns.

Members of the single payer community are also involved in the Occupy movement, sharing the focus on ending the rule of money and shifting power to people. I became an organizer of the occupation of Freedom Plaza in Washington D.C. primarily because single issue organizing is insufficient to bring about the real systemic change that must occur in order for public policies to begin to address human and planetary needs in effective ways. Members of the Occupy community are providing direct patient care through free health clinics and street medic training and are organizing in their communities through Healthcare for the 99% to stop hospital closures.

A major focus of the occupation of Freedom Plaza in the fall of 2011 was the Super Committee, a group of 12 members of Congress from both parties who were given extraordinary power to make recommendations to address the deficit. President Obama has been moving towards cutting social insurances such as Medicare and Social Security since he appointed the Deficit Commission in 2010. We organized protests and held our own Super Committee hearing on Freedom Plaza. The results of that hearing, “The 99% Deficit Proposal,” can be read on www.OccupyWashingtonDC.org.

The drive to cut social insurances and other social programs continues and will likely heat up this spring. This will be a necessary area to engage in resistance. The fight against neoliberal policies and austerity measures is a global struggle. There are many opportunities to work in solidarity. One such global campaign came out of the Quebec Student Movement. Called Via 22, the campaign calls for regular actions on the 22nd day of each month.

We live in an exciting time. While there are many crises, there are solutions readily available and more people are making connections between struggles. We never know how close we are to significant change. Even when it seems farthest away, it may be just around the corner.