With the Affordable Care Act Hanging by a Thread, It's Time for Single-Payer

Co-written by Jonathan Stone

While the Affordable Care Act is being deliberated in the Supreme Court -- with no decision expected until the end of June -- progressives and all other rational human beings should ramp up their efforts to build the movement for single-payer and work to ignite the Occupy movement on this issue. The Occupiers are expected to become more visible at the beginning of July, and they could and should become a single-payer force. They could even join the loud chorus coming from the GOP to overturn the ACA and its mandate. Finally, something on which the left and right can at long last agree -- for very different reasons, of course.

The right wants to privatize health care, while the left wants a real national health plan as exemplified by a single-payer model. To date, we have still not seen a coherent health care proposal emerge from the right, while the left has been less than visible in voicing their distaste for the ACA. Too many Dems and so-called progressives in and out of Congress -- including unions -- have flaked out and publicly supported the ACA, while privately loathing it. It is the nature of politics to accept and vote for half measures and Band-Aid solutions to accomplish "something rather than nothing." Standing one's ground on principle is a foreign concept. Where are those 590 local union organizations, including 140 Central Labor Councils and Labor Federations and 40 State AFL/CIO's on this issue? All of them support single-payer and Rep. John Conyers' H.R. 676 bill, The United States National Health Care Act. The unions keep signing on in support of this bill, but have they taken their numbers to congressional leaders or the White House? Are they rallying in the streets? Obviously not.

A huge opportunity was lost when President Obama took office almost four years ago and all three houses were controlled by the Dems. Yet the silence from the unions even then was deafening. With nothing drawing them to single-payer, the Obama administration kept it off the table in its ill-timed health care debate. Our president said in those early days that if he was "starting from scratch," he would go to single-payer. Where was the will to do the right thing? Instead, the insurance industry was allowed to write the legislation, using Mitt Romney's Massachusetts health care plan as a template, which he created with the aid of the Heritage Foundation. As a result, they gave us a system that increases health insurers' control over people's health care decisions and will deliver some 31 million new customers into a system that is rotten at its core and does not essentially change how health care is delivered or paid for. The money continues to flow to the insurers, while delivering less in services each year and shifting more costs to the insured. People are downsizing their use of health care due the unmerciful costs, which remain un-contained. It is not hard to imagine the long-term effects of delayed or ignored health care. We see it every day in hospitals across the country.

Even corporations that have provided health insurance to workers for decades are scrambling to get out of the insurance game, so fewer and fewer have insurance on the job, which has kept untold numbers locked in jobs for decades they would prefer to leave. I'm sure they would bolt in a heartbeat if a comprehensive health care plan such as single-payer were helping not only to give them freedom of choice in the job market, but also bolstering the economy. The core of the ACA is to offer subsidies or Medicaid, which is costly and unsustainable. Corporations have every incentive to end on-the-job insurance and let employees fend for themselves, a truly GOP philosophy. We are the only industrialized nation that hinges health care to the job. It makes no sense now, but it did make sense during World War II, when labor was scarce and a great enticement was needed to bring those remaining at home into the factories. Health care coverage was the hook.

Now we wait for this activist Supreme Court to render its decision and put its stamp on health care policy for years to come. It will either let the ACA survive in bits and pieces, or find it unconstitutional as a whole and throw it out. While the right has yet to unveil an alternative plan, neither does the Obama administration have a "Plan B," as it is certain it will prevail and the bill will be found constitutional -- a foolish stance with the Roberts court in control.

If the GOP and so-called conservatives are sincere about cutting costs, fraud and waste in health care, they should embrace single-payer. After all, it would cut $400 billion yearly from health care costs, money that could certainly cover all Americans and be used for other national needs, other than further military buildups. Imagine the efficiency of rolling Medicare and Medicaid into one system of Improved and Expanded Medicare For All, all while operating at greatly reduced cost. The structure is already in place, with the current administrative cost of Medicare at a modest 3 to 4 percent. Better health care and lower costs -- what a revolutionary concept. Not to mention that single-payer would put an end to those 50 percent of bankruptcies that occur due to illness and medical bills. A healthier, more solvent middle class would emerge.

If the ACA is thrown out, President Obama should breathe a sigh of relief and finally push for single-payer. He would be vindicated and have a real opening, and the American people would support him and his bold new stance. Our president would be in his final term and free to finally deliver on that "change" he promised so long ago.

Right now, single-payer advocates are working in several states to institute single-payer programs. Even New York Assembly Chair of Health Dick Gottfried recently introduced his resurrected single-payer bill, which he first put forth in the early 1990s. Ever the politician, he feels there is a growing movement and support for such a bill right now and wants to get in on the action. Indeed, the single-payer movement as a whole must grow and become much more cohesive and effective if it is to play a role in reshaping the health care debate if the ACA is found unconstitutional. We all know that the first group to be thrown under the bus in any "compromise" legislation drafted to replace the ACA would be those folks with pre-existing conditions. Even within the ACA itself are cuts that will allow our government to essentially turn its back on the most vulnerable among us, like the little item of cutting $4.9 trillion from Medicare part A and B between 2014 and 2033.

There has to be -- and is -- a better way, and every effort must be made to continue to build the Single Payer movement, regardless of the outcome in the Supreme Court, for it is the only rational solution to our many national economic woes. Now, the single-payer movement must ramp up its efforts and become much bolder in its demand for a truly comprehensive national health plan. The American people have waited long enough.