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Socialist Democrat Senator Bernie Sanders is mostly credited with putting the crucial health care coverage at the forefront of American political discourse. I personally thought he was the only candidate among the pool who spoke about the issue vocally and perhaps sincerely. His campaign undoubtedly helped the issue get highlighted more prominently in the political, social and media circles. His argument that every citizen needs to have health care coverage was rational and a necessary step in the fight against inequality. It was a unique attitude toward health care reform. He even tagged health care coverage as a human right, which I personally found quite noble in the selfish world of politics. That was a humanistic touch from the Senator. But what made his argument about health care more appealing from his predecessors was the element of single-payer, universal health care. Candidates and politicians from across the political spectrum have talked about health care, but a single-payer system has never been in their talking point memos. Many emphasize the role of the market and private sector in providing health care to Americans.

Bernie Sanders’ advocacy of health care-for-all gained prominence when Donald Trump became president on the promise of repealing and replacing Affordable Care Act (ACA), aka “Obama Care.” The ACA is not a single-payer system, but a good first step toward that end. The ACA has extended coverage to more Americans and now health insurance companies cannot refuse treatment based on pre-existing conditions. This is indeed encouraging. However, the ACA is in real danger. The first attempt by the Trump administration to repeal and replace the Affordable Care Act failed in March. The bill which is called the American Health Care Act (AHCA), failed due to lack of consensus within the Republican ranks. The moderate members of the party backed out of the bill for fear their constituents would lose basic health services. The backlash from their constituents was palpable and anxious. This level of backlash is nearly unprecedented, rivaling the revolt of American seniors over Republican efforts to privatize Social Security back in 2005. When I was watching the town hall meeting of Senator Mitch McConnell, I could not help but appreciate the bravery of the voters who spoke their minds and challenged the Senator for his support of the bill. Republicans technically had enough votes to get the AHCA passed. It was the fearless protests of the voters in town hall meetings across the country that ultimately made the difference. Regretfully, the failure did not deter the Trump administration and Republicans in Congress from introducing a revised version of the AHCA, and this time it was passed, though narrowly, by the House.

According to the Congressional Budget Office, under the version of the AHCA that was killed in March, 24 million Americans would lose insurance coverage, and the bill would raise premiums for older and poor Americans by more than 750 percent. The bill would cut federal Medicaid spending by $880 billion, and it will give a near-trillion-dollar tax break to wealthy Americans. Under the revised version of AHCA, the coverage for pre-existing conditions can be expensive, and aging can be considered a pre-existing condition. A typical 64-year old would have to pay $14,000 in premiums, whereas under ACA it is $1,700. A 40-year old pays $1,700 under the ACA but under the AHCA, it would be $2,400. The revised plan targets Medicaid by eliminating the tax on the rich to expand health coverage to poorer sections of the society. The revised Bill is absolutely disgusting, and this is where the fight for single-payer system becomes a worthwhile struggle, requiring collective effort on the part of the public. This is the time to take action, while the iron is hot. The alternative proposed by Trump not only discriminates against the sick but makes coverage far more expensive.

Political Will is Needed, Not Resources

As a non-American, I believe that political will and leadership are needed to make single-payer health coverage a reality in the United States. It is not about resources. It never was. America is the richest country on earth, with abundant resources. It has the financial muscle, intellectual capacity, technical know-how, and administrative mandate to enact a health care reform bill that provides health services to all. To justify my point of view and demonstrate that it is about political will and leadership, let’s take the example of Cuba. This tiny country has developed one of the most excellent and efficient health care systems in the world. It guarantees health care access to all layers of society irrespective of race, income and class. On a visit to the country in 2014, World Health Organization Director-General Margaret Chan acknowledged the Cuban health care model: “Cuba is the only country that has a health care system closely linked to research and development. This is the way to go, because human health can only improve through innovation”. She praised the Cuban leadership for its efforts “to place health as an essential pillar of development.” Cuba has been successful in its quest to provide health care to all its citizens despite being under economic embargo by the United States for more than half a century. The embargo has put Cuba under enormous economic pressure, limiting its financial resources and maneuvering, and yet that has not stopped it from prioritizing health care for all.

When we dig a little bit deeper into the Cuban model, the results are mind-blowing. Cubans have a low infant mortality rate of 4.2, which is even lower than the U.S. The system has increased the life expectancy of Cubans, and it is now hovering around 78, which is nearly identical to the U.S. The benefits of the system are not limited to just the Cubans. Third world and other developing countries have benefited enormously from the system. Currently, 30,000 Cuban medical staff are working in 60 developing countries providing quality medical services. Cuba has achieved this amazing result by spending just $813 per person annually, whereas America spends $9,403 per person. These results are disappointing for such a high cost of care.

The Argument for Single-Payer System

The Cuban system of healthcare is a good example of single-payer. In this system, healthcare delivery is operated as a public, not-for-profit service. So, everyone receives needed medical services under one universal plan. The system is based on need, not the ability to pay. It allows the nation to have single data base, which is based on a single set of laws, regulations and prices, with a uniform standard for patients’ privacy. There is no need to wait for specialists, and care is not based on insurance or financial ability. Sometimes the wait for specialists lasts as long as six months. But the most significant benefit of the system is saving up money. The United States spends billions of dollars on medical administrative costs. Single-payer avoids large for-profit health administrative costs, resulting in a huge reduction in administrative costs. The saved money can be spent on healthcare, research, innovation and disease prevention. On the other hand, both the ACA and AHCA will be characterized by high premium costs. Under single-payer, premiums no longer exist. There are no expensive co-payments and deductibles, and patients have free choice of doctor and hospital. The free choice of doctors allows patients uninterrupted care, even if they switch their jobs and experience financial troubles. This is the distinct beauty of single-payer. Overall, universal health care replaces the profit-oriented system and covers all aspects of medical services such as dental, prescription drug, and vision. Employers have a minimum role in the system. These benefits must be intriguing for any nation or government considering a transition to single-payer. Why is the United States shying away from it?

The United States is the only industrialized nation in the world that does not guarantee health care to its citizens. Currently, there are close to 29 million Americans who do not have health coverage. Recent studies suggested that, particularly before ACA, some 45,000 Americans died each year because they cannot get to doctors. Millions more are underinsured, as they cannot afford the high copayments and deductibles charged by private health insurance companies. This is not surprising, considering that the U.S. health care sector is a profit-making industry that thrives at the expense of the people. These companies are the problem. They have prevented the realization of a single-payer system because they stand to lose from it. Back in 2009, under then President Obama, there was much euphoria for a major health care reform that could lead to equitable coverage to ensure health care for most Americans. The hope, however, was shattered when health insurance and pharmaceutical companies, working with Republicans and seeking to pressure Democrats, succeeded in blunting health care reform so as to avoid universal health care. Despite the hopes of millions for universal health care, these dreams were shattered via the passage of the Affordable Care Act, which expanded private health insurance, rather than eliminating it.

Drug and insurance companies have undeniable influence in Washington corridors of power. They have skillful and highly paid lobbyists who work with and pressure legislators to blunt progressive change. They have tremendous amount of financial resources that can fund the election campaigns of so many lawmakers. In fact, there are already many Representatives and Senators in Congress who have been elected with the help of campaign donations from drug and insurance companies. They have adept PR firms with old and dirty tricks that can confuse the public about a single-payer system by producing ads framing universal health care as a danger to the quality of care in America. They are one of the major sources of revenue for American corporate media, as they advertise their drugs and services in the media. So, the nexus is perfect to deny Americans health care as a right, rather than a privilege.

The Way Forward

Bernie Sanders’ campaign and the ACA are a good start to pave the way for a single-payer system, although the fate of ACA now depends on the Senate. The aim has always been to give coverage to more Americans and improve the quality of the service. That is what the ACA has partly done. But it is not enough. The American health care system is broken. It is a market-driven care that aims at making profits, giving coverage to those who can afford it and making drug and insurance companies more powerful to undermine progressive policies and democratic principles. This is unacceptable. “Trump care” threatens to further aggravate the problems of securing affordable care in the U.S. This broken system can only be fixed by single-payer.

The movement that has been created by Sanders has produced results. Now, health care is on the national agenda. The fact that both parties are talking about it and trying to out-maneuver each other on health care, shows that it is an important legislative issue with wide political consequences. To be effective, people who support Bernie’s campaign and want to fight for single-payer must make their voices heard. They need to become politically active, communicate with their representatives, pressure them for single-payer, take to the streets in a non-violent manner, sign petitions, share information, expand platforms, support progressive candidates for elected offices, fight drug and insurance companies, and finally vote for candidates who promise to support single-payer health coverage.

I consider mass demonstrations as the perfect tool to bring pressure on Congress for the realization of a single-payer system. Marches have been effective in the past. The bigger the march, the bigger its influence. When is a better time than now to take to the streets and make your voice heard? With an elite billionaire class consolidating its grip on power like never before, and as ordinary Americans are in danger of losing their health coverage, the pressure for progressive change on health care will only continue to grow.

*(A crowd gathered on the Capitol grounds to voice their opposition to the American Health Care Act. Image credit: Congresswoman Marcy Kaptur/ flickr).