Is Obamacare a Step Toward Single-Payer?

NO, NO and no: That’s been the Republican Party position on health care reform since the Obama administration’s first months in office. No matter how many pro-industry concessions were made in drafting what came to be called the Affordable Care Act (ACA), Republicans never wavered in their all-out opposition.

But increasingly since its disastrous rollout last fall, the ACA has had critics from the left, too–people who oppose a “reform” that falls far short of universal coverage while threatening harsh financial penalties on those who can afford them least unless they purchase the defective products of the private insurance industry.

Groups that criticized the ACA all along, such as Physicians for a National Health Program and National Nurses United, continue to stand for a “single-payer” program–where the government cuts out the insurers and guarantees health care for all under a system similar to the current Medicare program for the elderly, but much better funded and available to the whole population.

Then there are those among liberals and the left who disagree with both sides. They continue to defend the ACA–on the grounds that it is a step toward universal health care.

An editorial in the Nation magazine last month, for example, acknowledged that the ACA came about because Barack Obama and Democratic leaders in Congress “believed [single-payer] was politically unachievable, so they cobbled together a hybrid of public regulation and private insurance that has come back to haunt them.”

Nevertheless, wrote the Nation’s editors, the left should defend this “hybrid”: “Progressives must step in not only as ardent advocates for better implementation of the ACA–a relatively easy task–but also for structural repairs to the law that will make it a better bridge to the truly universal, truly humane and truly functional health care system that America needs…Indeed, winning [the fight for the ACA's effective implementation] will make future reforms all the more possible.”

The Nation is wrong. The ACA isn’t a bridge to universal health care. It is a cul-de-sac, structured above all else to maintain the central role of the health care industry in general, and private insurance companies in particular.

Achieving universal health coverage and access to care will require dismantling the core of the ACA and replacing it with something else entirely. Making a defense of the ACA in the way the Nation does–as a step in the direction of a single-payer system–cedes ground to the right and is counterproductive to the goal of winning health care as a human right.

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