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The burning question that should be on the minds of activists in the United States is whether universal healthcare is possible under the current social order of US capitalism. History says no for the simple fact that the notion of universal coverage has struggled to gain traction in the center of capitalist development. Recent history is even bleaker, with monopoly health insurance corporations and pharmaceutical giants dictating care in the United States for enormous profit. However, the struggle for single-payer, universal healthcare has never been more necessary than now. Democrats are rejoicing the recent setback for the Trump Administration's healthcare policy, which would have largely dismantled the Affordable Care Act (ACA) popularly known as Obamacare.

The defeat of the GOP healthcare bill is nothing to mourn. Its passage would have greatly scaled back coverage and Medicaid services for millions of Americans. However, the preservation of the ACA is nothing to celebrate either. There is a debate raging in Washington over the direction of healthcare precisely because of the crisis that afflicts millions of people nationwide. Obamacare's provisions did not alleviate healthcare costs and in many ways further entrenched the corporate health insurance and pharmaceutical industry's grip over US healthcare.

The GOP has been attempting to dismantle the Affordable Care Act since its passage despite the fact that the bill was birthed from the Republican-aligned Heritage Foundation. Former President Barack Obama did everything possible to ensure single-payer healthcare was off the table in 2009. Health insurance and pharmaceutical lobbyists negotiated the law without any input from single- payer advocates. Since the passage of the Affordable Care Act, profits for the insurance corporations have surged. But it is the impact of the bill on working class families that has left its future uncertain.

The Affordable Care Act has been a gift to the profits of healthcare monopolies and a burden for working families already struggling to meet the cost of living. Rather than a single-payer system regulated by federal oversight and funded by a progressive tax structure, Obamacare provides health insurance companies with billions of dollars worth of taxpayer subsidies to administer mandated health insurance. States provide various "exchanges" on the so-called federal marketplace that are little more than private health insurance plans in public window-dressing. These plans are broken up into four tiers: bronze, silver, gold, and platinum. Bronze is the cheapest monthly premium payment but possesses a steep deductible before coverage that only pays for sixty percent of total cost kicks in. The costlier silver, gold, and platinum plans cover a higher percentage of services but are simply unaffordable to the vast majority of the population. Tax-credits only serve a minority of those enrolled. Under Obamacare, more people have insurance but struggle with the cost.

This has left the ACA vulnerable from a political perspective. The US population is split over whether to defend it from attack. That is not to say that Medicaid expansion and provisions to eliminate restrictions to care based on pre-existing conditions have not provided any benefit. However, such benefits come with a greater cost. Employers are opting out of health insurance plans because incentives now exist to push workers onto the exchanges rather than provide insurance internally. Drug corporations and their insurance partners are running away with record profits while medical debt continues to plague working people at astounding rates. The ACA's private health insurance model not only leaves nearly thirty million without coverage, but also ensures that those who are covered are nothing more than a guaranteed market for the insurance monopolies.

The Republican Party has attempted to regain legitimacy in the eyes of the US population by viciously attacking Obamacare. Trump promised to repeal and replace Obamacare throughout the election cycle. However, what was to replace the Affordable Care Act was not clear except for a few vague references to "universal" coverage. For millions of voters, this was enough. Yet Trump and the GOP's recent proposal for repeal was wildly unpopular, as many of its stipulations actually attacked the Affordable Care Act from the right. The bill quickly lost steam in Washington, leaving questions about the future of healthcare in the United States.

Democrats breathed a sigh of relief when the Republican Party's failure guaranteed the preservation of the Affordable Care Act for the foreseeable future. However, what the event actually demonstrated was the large distance between the aspirations of the masses and Washington's broader interests. Both corporate parties are indebted to the pharmaceutical and insurance lobbies, with notable Democratic Party and Republican Party politicians such as Corey Booker and Mitch McConnell finding their ties to the drug monopolies exposed to the public. While so-called representatives in Washington continue to fight for the interests of the healthcare capitalists, a Gallup poll in 2016 revealed that sixty percent of the voting population actually prefers single-payer coverage over the current US healthcare model.

Single-payer, universal coverage is the only solution to the healthcare crisis in the United States where tens of thousands of people die each year for treatable diseases. Single-payer coverage is the prevailing model in much of the Western world and progressive nations in the so-called underdeveloped world. It has brought far better health outcomes in places such as the UK, Canada, and Cuba than what currently exists in the US. Single-payer leaves no one out and eliminates wasteful administrative costs. It is the only model of healthcare coverage that prevents the profits of care-cutting health insurance corporations and drug-dealing pharmaceutical firms from privileging bottom-lines above all else. Such a radical reform in the US can only take shape, however, if a movement demanding single-payer healthcare becomes strong enough to challenge the very social relations that make corporate-controlled healthcare possible in the first place.