Truthout - February 18, 2021

As the American Rescue Plan (ARP) winds its way through Congress, some progressives are hailing its health provisions as the greatest expansion of the Affordable Care Act (ACA) in 10 years, while conservatives are claiming that it is a slippery slope to a national Medicare for All system. Democrats have decided to forego seeking Republican support for President Biden’s $1.9 trillion promise of relief to those suffering from the COVID-19 pandemic and recession by using the budget reconciliation process. This has Republicans worried the legislation will be used to advance the progressive agenda to expand government health care programs.

However, at the end of the day, while the bill may be used to strengthen some provisions in the ACA, it will not move the United States’s health care system any closer to the popular national improved Medicare for All system that we need. It is more likely to enrich private health insurers and delay broader health care reform.

To understand why, it is important to note that the ACA, passed in 2010, was crafted to prevent national improved Medicare for All, not to create a path toward it. Following the financial crash of 2008, nearly 50 million people in the United States did not have health insurance, primarily because the premiums were unaffordable. Something had to be done, and public support for a single-payer health care system, which would replace private health insurance with a universal Medicare-like system, was growing.

The medical-industrial complex — consisting of the private health insurance, pharmaceutical, hospital, and other related corporations — viewed single-payer as a threat to the industry’s bottom line and worked overtime to stop it. Health industry corporations and trade groups donated heavily to campaigns for federal office in 2008 and invested billions in lobbyists to shape the ACA in their favor. The Center for Public Integrity reports that a total of $3.47 billion was spent to double the number of health care lobbyists in Washington, D.C., in 2009. There were eight lobbyists per member of Congress. Millions were also spent on public relations campaigns to portray Medicare for All negatively and to convince people that what they really wanted was a choice of health insurance.

Progressive organizations also played a role in preventing national Medicare for All. Tens of millions of dollars were donated to establish a front group called Healthcare for America Now (HCAN), which was intentionally given a name similar to the national grassroots Medicare for All group, Healthcare Now. HCAN convinced advocates for universal health care that a single-payer system was not achievable, and that a more practical demand would be a public health insurance plan called a “public option.” It worked, and progressives became the loudest defenders of a bill that former Cigna executive Wendell Potter renamed the “Private Insurance Profit Protection and Enhancement Act” — even though it didn’t include a public option. ...
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