Is Obamacare a step toward single-payer?

Published in Socialist Worker.

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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THE CENTERPIECE of the ACA--the "individual mandate" that requires the uninsured to purchase private health insurance policies or face a penalty on their taxes--was first proposed in 1989 by the Heritage Foundation, a prominent conservative think tank. In the 1990s, the Heritage plan was promoted by Republicans, led by former House Speaker Newt Gingrich, as an alternative to the Clinton administration's plans for health care reform.

In contrast to the Clinton proposal--which, while far short of a single-payer system, was considerably more progressive than the ACA--Gingrich and the Heritage crowd proposed a mandate that placed the burden of obtaining coverage on individuals, rather than the government.

Like Clinton's proposal (which never made it to a vote in Congress), Obama's ACA also requires large employers to offer health insurance to employees--the so-called business mandate--although the penalty for businesses is smaller than the cost of coverage and has been delayed for at least a year.

The Heritage Foundation model was later implemented--in Massachusetts, under then-Gov. Mitt Romney, the eventual 2012 Republican Party presidential candidate. Nothing more clearly exposes the hypocrisy and crass opportunism of the Republicans, who from 2009 on have been denouncing health care "reform" from Obama that most closely resembles a model championed by one of its own only a few years before.

The ACA isn't a case of Democrats and Republicans "meeting in the middle" to find common ground between universal health care and the free market. Rather, it is a case of the political spectrum itself shifting to the right--to the point where Democrats occupy space formerly held by Republicans, and the Republicans denounce their former proposals as "socialism."

With the individual mandate at its core, the ACA is, first and foremost, about making sure health insurance remains "based on the private marketplace," as Obama described his law at the Wall Street Journal CEO Summit in November.

But the private marketplace--and the attendant prioritization of profits over care--is the root of the problems with the U.S. health care system. Money comes first in a free-market system, so those without the money to afford a given commodity go without. So it is with health care--and the 30 million people who will continue to go without coverage under the ACA, as well as millions more who will forgo needed care because they can't afford to spend thousands of dollars every year on copays and deductibles.

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IT WAS clear from the start that defending the health industry would be the priority of Barack Obama's health care law. Consider who played a leading role in drafting the legislation.

As chair of the Senate Finance Committee, Max Baucus ended up with responsibility for writing the law--he happened to be one of the leading recipients of donations from the health insurance and pharmaceutical industries.

Baucus brought in Liz Fowler, a vice president for the for-profit insurance giant WellPoint before she left to join Baucus' team. It was Fowler who, according to Baucus, wrote "the 87-page document which became the basis, the foundation, the blueprint from which almost all health care measures in all bills on both sides of the aisle came."

At the end of 2012, Fowler returned from whence she came: She left her post at the Department of Health and Human Services to take a job lobbying for Johnson & Johnson, the pharmaceutical and medical device manufacturing corporation--a perfect illustration of the revolving door between Corporate America and the Washington that ensures government policy meets the needs of the bottom line.

Baucus deliberately excluded voices for single-payer from Senate hearings on the legislation--instead, he had doctors and nurses who supported a radical alternative arrested. Not only did the Democrats exclude single-payer from the discussion, they conceded on even the half-measure of a "public option" among the choices available for the uninsured looking for coverage at the government "exchanges."

But none of that mattered anyway--despite all of the Democrats' industry-friendly concessions, the Republicans continued to oppose the ACA until the end.

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FAR FROM a step in the direction of single-payer, the ACA has made achieving universal coverage much more difficult.

The ACA entrenches the role of private health insurance--"multiple payers" instead of a "single payer"--by mandating the uninsured to purchase coverage or face a penalty. While the law requires private plans to meet minimum standards, coverage sold on the "exchanges" set up under the ACA are grouped into different tiers, and employer-based plans will continue to vary widely in quality.

Hence, health care inequality will persist--and many will go without care, whether they remain uninsured or can't access care because of high co-pays and deductibles.

Had the ACA included the "public option"--alternative coverage administered by the government available from the "exchanges"--it might have been possible to believe that the ACA would have transitioned into single-payer over time, as the public plan outcompeted private plans because of lower administrative costs and other factors.

Single-payer supporters were skeptical of this all along, but it's a moot point now. While claiming publicly to be pushing for a public option, the Obama administration made a deal with industry lobbyists, assuring them the public option wouldn't make it into the final bill. Sure enough, the public option was dropped.

The ACA makes the insurance industry stronger than ever before by handing it more customers and $1 trillion in subsidies over the course of 10 years. Greater revenues will translate into increased political power, which can be used to resist further regulations--and, obviously, any moves toward a single-payer system that would eliminate the private insurers altogether.

The ACA also includes around $500 billion in cuts to Medicare over ten years. This was initially supposed to include cuts to Medicare Advantage--where the government pays private insurance companies to administer Medicare benefits. However, the Obama administration reversed these cuts to private insurers in April 2013, sending insurance company stocks soaring.

Among the Medicare cuts that weren't reversed are a 14 percent reduction in payments to home care health agencies over the next three years, tens of billions in cuts to skilled nursing and hospice services, and some $260 billion in cuts to hospital reimbursements.

On top of all this, Obama offered to raise the Medicare eligibility age from 65 to 67 as part of his effort to secure a "grand bargain" with Republicans to carry out unprecedented austerity.

Even without the eligibility change, these cuts place the elderly and the disabled--those who are eligible for Medicare--at a disadvantage relative to patients with private health insurance, since doctors and hospitals make more money providing the same care for the latter. This, combined with a relative shortage of primary care physicians and the actions of Medicare Advantage plans such as UnitedHealthcare, which recently cut 10-15 percent of doctors in their plan, could reduce access to care for those with Medicare.

Medicaid pays even less to doctors and hospitals than Medicare does, so health care providers serving disproportionately low-income, elderly and disabled populations could face layoffs and even closure.

And all this has been made even worse by state governments dominated by Republicans that rejected the expansion of Medicaid included in the ACA under the U.S. Supreme Court decision in 2012.

If any part of the U.S. health care system could serve as a "bridge" to a single-payer system, it's Medicare. If Medicare's eligibility age limiting the program to seniors were eliminated, allowing everyone to be automatically enrolled in Medicare, this would be a tangible and completely realistic step toward truly universal coverage. Instead of expanding Medicare, however, the ACA cuts it.

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THERE IS one more question that those who believe the ACA will lead toward single-payer need to answer--the impact on a developing sentiment in favor of a pubic health care system like what exists in Canada.

Health care was a major issue in the 2008 election. Opinion polls before the election showed overwhelming majorities supporting a serious overhaul of the health care system. Nearly two-thirds supported the government guaranteeing health insurance for all, even if that meant paying higher taxes.

Michael Moore's film Sicko, released in the summer of 2007, exposed the devastating effect of for-profit health care on the lives of ordinary people. There was a growth in grassroots activism around the country, with doctors, medical students, nurses and other health care workers joining together with patients to demand universal health care for all. By the spring of 2009, with the health reform debate ramping up in Washington,a national day of action brought out single-payer supporters in all 50 states, including over 3,500 people in Seattle.

The shift in public opinion was undeniable. A New York Times/CBS News poll in June 2009 found that 72 percent of people supported "the government's offering everyone a government-administered health insurance plan like Medicare that would compete with private health insurance plans"--essentially, the public option.

The passage of the ACA, with the public option stripped out, took the wind out of the sails of a growing movement and ultimately reversed the trends in popular opinion. Large sections of existing and potential support for single-payer--in particular, among organized labor--were mobilized to support legislation that was antithetical to single-payer. The combination of unanswered Republican attacks on "socialistic" Obamacare and growing disillusion with what the Obama administration actually came up with has corroded support for any government role in health care.

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NOW THAT the law is finally kicking in, it is important that supporters of genuinely universal health care not allow the Republican right to be the only voice criticizing the ACA.

The failures of the ACA are becoming apparent to more and more people--those forced to buy insurance plans with thousands of dollars in co-pays and deductibles and skimpy networks, the 30 million who will remain uninsured, union workers facing cuts to their health benefits as ACA taxes on "Cadillac plans" loom.

The left must be able to recognize the positive measures in the ACA--ending insurance company discrimination against people with pre-existing conditions, the expansion of Medicaid, the requirement that insurance companies spend at least 80 percent of premiums on care and so one--while opposing the core of the legislation that forces millions of people to purchase defective policies from private insurers, thus locking in one of the central causes of the health care crisis.

There is no reason why the left should not demand a rollback of the ACA's reactionary components, like penalties for the uninsured and the tax on good health plans disproportionately held by union workers.

It is up to supporters of true health care reform to put forward an independent alternative--to demand truly universal coverage and access to care. If health care in the U.S. is ever to be made more equal, the movement for single-payer must regain the momentum lost since the passage of the ACA--and fight for health care to be the human right it must be.

Racism, capitalism and contradictions

Published at Socialist Worker.

IN AN interview at Northstar ("Is there a precariat?"), Charlie Post makes the following point:

Workers under capitalism have a dual existence: both as collective producers struggling against capital for control of the workplace, for hours and wages, but also workers compete as each other. They're sellers of labor-power, which gives rise to what the early 20th century Marxists used to call "sectional interests"; divisions along the lines of race, citizenship, nationality, gender, sexuality, etc.

These dual existences depend on one another. Under capitalism, in order to be a collective producer able to struggle, the worker must sell their labor power successfully. On the other hand, collective struggle is often about winning key demands that increase the value of labor power or improve the conditions of its sale. However, there are also contradictions within each of these.

Racism, which must be combatted if white and Black workers are to unite in struggle--and unity among collective producers is essential for victory in struggle--can also work to the benefit of white workers as sellers of labor power in competition with workers of color. Of course, there are countervailing dynamics as well, since the fact that Black workers are paid less drives down wages for white workers, too, but being white clearly has its advantages--if only relative, but isn't relative the key when it comes to individual competition?--as a seller of labor power.

Similarly, white workers gain relative advantage on the job--they're more likely to get promotions, less likely to be fired, etc. I believe that white workers have more to gain by opposing racism and engaging in collective struggle with their Black coworkers (and other people of color), but better treatment on the job is a countervailing force there, too, which encourages white workers to accept racism and even embrace it.

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WHITE WORKERS both benefit from racism, as whites who receive relative advantages or "privileges" if you will, and are harmed by it, as collective producers for whom racism is an impediment to the unity needed to win gains through struggle. The idea that we must argue that white workers do not benefit from racism in order for interracial working-class unity to be possible, and the idea that such unity is impossible because white workers benefit from racism, are both mechanical and one-sided.

Which tendencies prevail, which are dominant, depends on a number of factors. In periods of heightened class struggle, the identity of collective producers in struggle can overshadow the identity of sellers of labor power. This is where there is the greatest opportunity to combat racism, and even see things like unemployed workers rally to support strikers en masse (as in Toledo, Ohio in 1934) instead of taking their jobs.

In periods of defeat, workers are more likely to take on the identity of an individual seller of labor power, as collective struggle ceases to be seen as a realistic option. This is compounded by the pressures of day-to-day survival. Racism takes root more easily.

Of course, consciousness is always mixed, but in different ways and to different degrees: there are racist workers in times of mass interracial struggle, and there are anti-racist workers in times of defeat. There are workers who in practice unite across the lines of race while holding racist ideas, and there are those who hold anti-racist ideas yet do little or nothing to combat it.

Standing over all of this is the long-term, historic mission of the working class, which is to liberate itself. This requires doing away with all oppression and exploitation. But except in revolutionary times, this mission is only recognized by a minority of the working class.

It is up to us to promote the tendencies noted above that move us in the direction of unity in struggle and combat those that move us in the direction of embracing oppression and division.

What caused the Obamacare fiasco?

Published at Socialist Worker 

THE INTRODUCTION of the new health insurance system established by Barack Obama's Affordable Care Act (ACA) has been a technical--and political--disaster.

But the problems aren't confined to crashing websites, and they won't be solved by Obama's promises that the enrollment process will be fixed before the end-of-year deadline for the uninsured to sign up for health plans on the ACA's "insurance exchanges."

Even if the glitches are ironed out, millions of people will face a choice that's no choice at all: Spend thousands of dollars each year on health insurance plans that, because of high deductibles and co-pays, will be even more expensive to use if they do get sick--or pay a fine with their taxes while they remain uninsured.

The fiasco of the Obamacare rollout is a direct consequence of a byzantine law that was bent and twisted to fit the needs of the health care industry, at the expense of tens of millions of people who will find themselves paying even more for even less health care than now.

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AFTER WEEKS of reports that HealthCare.gov, the federal insurance marketplace where the uninsured are supposed to sign up for coverage was plagued by problems, Health and Human Services Secretary Kathleen Sebelius announced last week that fewer than 27,000 people had signed up on the federal exchange in the month of October. An additional 80,000 enrolled via the state exchanges.

As NBC News reported, "The White House had hoped half a million people would have signed up in the first month [HealthCare.gov] was active. The Congressional Budget Office had projected that 7 million people would sign up for private health insurance on the exchange and that another 9 million would get Medicaid coverage" by the end of the open enrollment period on March 31, 2014.

Adding in the 400,000 who signed up for Medicaid in October, the total number of uninsured covered in the first month of the Obamacare rollout is just 3 percent of the total predicted to gain coverage by the end of the enrollment period, and about 1 percent of the nearly 50 million people without health insurance in the U.S.

Meanwhile, millions of people--over 5 million so far, by some estimates--have received cancellation letters from their current insurers announcing that their health plans will no longer be effective as of January 1, because they don't meet the requirements of the ACA. The paltry enrollment numbers prove that only a fraction of those whose policies are going to be cancelled have been able to sign up for new plans via the exchange--meaning they face a gap in health coverage if the exchange system doesn't start working more effectively.

According to ACA supporters, many of those whose plans are being canceled will qualify for subsidies and therefore will pay less, if and when they can sign up on the exchanges.But as the investigative journalists at ProPublica showed, others face higher premiums for coverage that is inferior to their current plans.

The cancellation letters were a further embarrassment to Obama, who sold his health care proposal with the repeated promise that "if you like your insurance, you can keep it. Period." According to reports, the administration expected these cancellations--yet Obama continued to claim otherwise.

As a consequence, Obama's popularity has sank to the lowest point of his time in office--he has a 39 percent approval rating, compared to 54 percent who disapprove of the job he is doing. The same Quinnipiac poll showed a further decline in support for the ACA: "[O]nly 19 percent [say] they believe the quality of their health care will improve in the next year. Forty-three percent say it will get worse."

Facing pressure from Republicans and a revolt inside his own party, Obama held a press conference last week, in which he apologized for the HealthCare.gov problems and announced that the administration would allow insurance companies to continue to offer plans to current customers through 2014, even if they don't minimum standards under the ACA.

This announcement held down defections of House Democrats in support of a Republican-sponsored bill allowing insurers to continue to sell non-compliant plans--but nearly 40 Democrats voted in favor of the bill the day after Obama's press conference.

Obama's concession, however, doesn't guarantee that insurers won't rescind the cancellations. According to the Atlantic, Obama's measure allows, but doesn't require, companies to continue to offer existing plans. It does require insurers "to tell their customers 1) what the new plans cover that their old plans don't, and 2) that these new plans might actually be cheaper for them. In other words, the administration is trying to get the insurance companies to tell people what they would find on HealthCare.gov if it worked."

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ACCORDING TO Sebelius, HealthCare.gov should be working well by the end of this month--at which point one-third of the time available for people to sign up will have elapsed. But it's unclear whether the technical issues will be resolved by then. An analysis sponsored by CNN found that the site is "getting better, but it looks like there's still a lot to do," said Media Temple President Russ Reeder.

So far, the administration has spent $175 million on federal contracts to develop HealthCare.gov. Incredibly, the companies contracted to create the HealthCare.gov marketplace testified before Congress that "end-to-end testing was conducted only in the final weeks before the site went live, and no senior executive at the Center for Medicare and Medicaid Services was designated as the point person for integrating the various components of the system."

Still, as incompetent as it has made them look, it may be better for Obama if the problems with the ACA rollout are chalked up to technical issues. That's better than admitting the deeper problems with the health care law itself.

The Obama administration and congressional Democrats began developing health care legislation determined to bring the medical-pharmaceutical-insurance complex "to the table"--and then made one concession after another to keep them there. The ACA contains some long-awaited regulations on the insurance industry, such as a ban on using "pre-existing conditions" to deny coverage and requirements that plans cover preventative health care.

But the law leaves the main problems of the current system intact because it preserves the place of private profit in a corrupted and wasteful system--instead of making quality, universal care the priority.

Thus, the technical issues are directly connected to the complexity of the system created by the ACA. Different types, levels and costs of coverage are available, and they vary depending on income and what state the customer lives in.

Residents of 36 states must rely on the federal HealthCare.gov site, while the rest have state-level exchanges. Once enrolled, people can choose between different levels of coverage--from Bronze plans, with the lowest premiums, but highest out-of-pocket costs, through Silver and Gold, to Platinum plans, with the highest premiums, but lowest costs if and when policy holders use their insurance. Not only that, but many exchanges include multiple insurance companies, selling multiple versions of plans at each of the four coverage levels.

This creates the illusion of choice, with a bewildering multiplicity of options--but all within a relatively narrow framework that shifts the burden of health care costs more and more onto individuals.

In the future, the "Cadillac tax" on expensive health insurance plans offered through employers will place downward pressure on the quality of existing coverage, particularly for union workers who have bargained for the best coverage over the years. The tax will create incentives for employers to shift more costs onto workers.

For right now, though, another complicating factor is the subsidies for purchasing coverage, which the government offers to individuals earning between 100 percent and 400 percent of the federal poverty line, with amounts varying again by state. These subsidies, which the Congressional Budget Office estimates will total over $1 trillion in the next 10 years, will help make plans on the insurance exchange more affordable--but the money will go straight into the pockets of private insurance companies, which is probably while the stock prices for these companies are up.

Last year's U.S. Supreme Court decision on the ACA allows states to opt out of one important aspect of the law--an expansion of the government-run Medicaid health care program to cover individuals and families just over the poverty line. Fully one-half of U.S. states, led by Republicans, are refusing to accept additional Medicaid funds for the expanded coverage. This will leave even more people--those with fewer means to start with--to negotiate the complicated exchange process.

Managing all of the different options requires the online marketplace to interface with the computer systems of multiple health insurance companies, as well as several government agencies. The system must validate users' information by cross-referencing data entered on the site with records at government agencies, determine the eligibility for Medicaid and/or subsidies, and transmit that information to insurance companies to ensure that enrollment is completed successfully.

Some insurance companies, ever on the lookout for a way to make even more money, have allegedly attempted to take advantage of the confusion caused by the ACA to trick customers into paying more for plans when they might qualify for better, cheaper plans in the federal exchange. According to CNN, the state of Kentucky has fined leading insurer Humana for sending illegal letters saying that "customers had to choose one of two options within 30 days: Either legally extend their current policy through next year or choose a new, more expensive policy that complies with Obamacare. The letter never mentioned buying insurance through the new exchange."

Still, the $60,000 fine won't make a dent in Humana's profits, which totaled some $1.4 billion in 2012. Humana has been sanctioned in other states as well, but without penalties that make it costlier to break the law than comply with it, it should be expected that insurers will continue to make the logical business decision to maximize profits by skirting the law.

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Compare the complexity, confusion and opportunities for insurance company scamming under the ACA to a single-payer system, such as Canada's, where everyone in each province qualifies for government-provided health insurance. Instead of multiple tiers of insurance plans with varying levels of costs, coverage is the same for residents within each province--though those who aren't citizens or legal residents are unjustly excluded.

While universal coverage is available for medical care, the system is not pure "single-payer"--a majority of Canadians buy supplemental insurance for dental, vision, pharmaceuticals and other elements of coverage.

Still, the relative simplicity of this system means that not only is the proportion of the uninsured reduced far lower than the best estimates under the ACA, but there are immense savings on administrative costs. More of health care workers' time can be spent caring for patients instead of dealing with the paperwork associated with determining insurance status and billing multiple insurers.

According to a survey published in Health Affairs two years ago:

[T]he administrative costs of and time spent interacting with multiple payers in the United States far exceeded time spent and costs in Canada with its single-payer system. Physician practices in the United States spent $82,975 per physician per year while Canadian practices spent $22,205 (financials were adjusted for purchasing power). Nursing staff at physician practices in the United States spent 20.6 hours per physician interacting with health plans while their Canadian counterparts spent 2.5. Clerical staff in the United States spent 53.1 hours compared to Canadian clerical staff's 15.9.

A pure single-payer system would save even more time and money. Medicare, which is essentially federal single-payer health insurance system for seniors and the disabled, spends less than 1 percent on administrative costs compared to the major health insurer Aetna, which spends 29 percent, as Time magazine explained in a report earlier this year.

The U.S. continues to spend more than any other country in the world on health care, yet lacks universal health coverage and has poorer outcomes than most advanced industrialized nations.

Despite all its problems, the ACA will, in fact, reduce the numbers of uninsured in the U.S. But it doesn't address the many other aspects of the system that lead to these higher health care costs and poorer outcomes. Instead, Obamacare preserves the role of for-profit insurance companies whose existence is the source of many of these problems.

Fixing the bugs in the ACA won't fix the need for a movement for truly universal health care.

Paying the price for the ACA

Published at Socialist Worker.

The introduction of the "insurance exchanges" set up by the Affordable Care Act (ACA)--the "virtual stores" where the uninsured are supposed to be able to comparison shop for health care coverage--are showing everything that's wrong with Barack Obama's health care law.

The exchange websites have been plagued by problems that won't be fixed for weeks--as a consequence of the byzantine complexity of a 2,000-page law where the priority is preserving the role of the private insurance industry. When the uninsured are able to consider their options, they're finding that the "choice" is no choice at all--sign up for still-expensive health plans that contain all kinds of provisions like co-pays and deductibles that make them even more expensive, or stay uninsured and pay a fine on their taxes.

Part of the rationale for the ACA is that the exchanges would bring younger people, who tend to be healthier, into the system, where their premiums would allow the insurance companies to provide less expensive coverage for older people who need more health care. But there's a flaw in the argument: Instead of healthier people subsidizing health care who have a greater need for it, they're also subsidizing the bottom lines of the health insurance companies.

Gary Lapon asked three young adults about their experiences with the health care system and with the ACA: Spring is a 34-year-old freelance makeup artist living on Staten Island in New York City. She is pregnant; she and her husband are expecting their first child in February 2014.Brian is 27 years old and lives in Washington, D.C., where he works full time at a bicycle shop.Melissa is 32 years old and lives in Oakland, Calif. She currently works in retail in San Francisco.

Brian: Not really. When I have gotten sick, I just try my best to make it go away--ha ha.
I was in a bicycle accident last year and sustained a concussion, even with my helmet on. I didn't go to the hospital; I just talked to my sister, who is a doctor, on the phone for some advice. People tell me that if I'm in another accident and it's bad, I'll wish I had paid for the insurance then. But I seriously can't afford to spend another $100 every month. And even if I could, the cost of the co-pays would keep me from going anyway. Why should I pay for something I can't afford to use?
I was in a bicycle accident last year and sustained a concussion, even with my helmet on. I didn't go to the hospital; I just talked to my sister, who is a doctor, on the phone for some advice. People tell me that if I'm in another accident and it's bad, I'll wish I had paid for the insurance then. But I seriously can't afford to spend another $100 every month. And even if I could, the cost of the co-pays would keep me from going anyway. Why should I pay for something I can't afford to use?

HOW WOULD you describe your current health care situation. Are you insured and do you have access to care? What is that like?

Spring: I'm "self-employed," so I have to pay for individual health care. Because my husband and I were planning to get pregnant, we got the only plan we could afford that has maternity coverage, which is over $300 a month.

About two months after finding out we were pregnant, I got a notice that the health care plan that I have will be discontinued as of January 1, 2014. That's just over a month before I'm due to give birth. Their excuse was that they no longer will cover "sole proprietors"--meaning small business owners with no employees, which I am. We tried to find a new plan to replace this one that included prenatal/maternity coverage, but the cheapest plan started at over $1,000 a month, which is way out of our price range.

Brian: I currently don't have health insurance and haven't for almost two years. My employer is small and doesn't offer health insurance. I'm fairly healthy, although my lifestyle of bicycling everywhere puts me in a vulnerable position.

I was hit by a car in late February of this year and broke my heel. Fortunately for me, it was the driver's fault, and his insurance company paid for my treatment after six months of legal disputes, though I had to incur that debt during those six months. It cost me hundreds of dollars for 10 minutes of care every week. For six months, I was on crutches. Normally I ride my bike everywhere, so a 30 minutes commute via bicycle became a 60 minutes bus ride.

I got calls from the hospital almost every week, with new and confusing bills I had to pay and put on my credit card, which gained interest. Every time I went in for a regular checkup, it was $200 to $300 each time, when I really only had about 5 to 10 minutes with the doctor--from what I hear, that was a good deal. All my bills came to about $10,000 total! I had to really tighten my belt on everything that I did during those six months. It gave me an insight into the industry--even most receptionists had no idea how much out of pocket an appointment would be.

Melissa: I'm uninsured. I got my bachelor's degree two years ago and planned to teach ESL, but ESL programs have taken a huge hit since public schools have faced severe budget cuts, and now I'm left with $36,000 in student loans and meager job prospects, much like others in my graduating class.

The thing is, I was 30 when I graduated, so I'm not eligible to be covered by my parents' insurance like many in my cohort--the Affordable Care Act enables people to remain on their parents' health insurance until they reach age 26--assuming their parents have insurance anyway.

I work in a small retail shop in San Francisco, but since I can't afford to live there, I can't get HealthySF, the city insurance for low- to medium-income people. I've gone back to a community college in Oakland to get training in machining, in the hopes that I can get a job with insurance soon.

HAVE YOU ever gone without care due to a lack of health insurance?

Melissa: Fortunately, I live in an area of the country with some decent clinics. I can go to the Berkeley Free Clinic for some very basic care, but not much beyond that.

I have a genetic condition that, while usually mild, can potentially have serious health complications. The seriousness can be mitigated if the complications are caught early, but that requires me to have an EKG more frequently as I get older. The last time I was due was last year. My grandmother died at 56 from this disorder, and my uncle almost died at 48. That's when everyone in my family got tested, and I found out I had it.

I also wear glasses, which the ACA doesn't cover either. Same for dental. It also has very restricted mental health coverage. It's like they don't care if I'm blind, crazy, and my teeth fall out, as long as the rest of me is fit for work.

Spring: Until this year, I went without health care coverage for as long as I've been a freelancer, which is about eight years. I've never been able to afford coverage for myself, and previously had coverage through employers or Medicaid. Once I became self-employed, I no longer qualified for Medicaid, although my income was low.

WHAT DO you think of our options under the Affordable Care Act?

Melissa: I feel pretty confident compared to most, but I'm no expert. The one thing I do know is that I can't afford insurance through it and I'm going to get fined because of it. And I think that's the case for a lot of people.

Spring: The ACA is very confusing, especially when it comes to what types of coverage an individual qualifies for, and how to go about actually getting coverage. I know that I can't be denied because of a pre-existing condition, and that the income level that qualifies for Medicaid has been raised, and I now qualify for Medicaid. The fact that I have to have coverage or face a penalty is ridiculous, and financially penalizes the poor and those who can't afford it.

Brian: I don't feel totally confident that I know my options. However, I'm sure I will become more well-versed as I go through the process a little more.

I do understand it as a handout to insurance companies. All of the sudden, working people will have to shell out a fair amount of money for private insurance, which have some of the highest profits of all companies. There are good things in the bill, like you can't be denied insurance for pre-existing condition, but that won't matter if you can't afford insurance.

HAVE YOU signed up for insurance via the insurance exchanges? If not, do you plan to?

Brian: I've applied for DCHealthLink.com for assistance. I have yet to hear back, but according to estimates, if I don't get assistance, I'll have to pay $200 per month for the most basic plan. This would be a huge chunk of my monthly income, including my rent and other bills. I've thought about just paying the penalty, because that's $95 a year--for now, I know it will be going up in the coming years.

I definitely will be in a worse financial position than I was before. It will be much harder to nearly impossible to be able to save money for either purchasing a place to live and having a family in the future.

It's hard to say how all this will impact my decision-making. I'm sure I will have to pick and choose the food I get and times that I go out to do things. I really want insurance, and it's really hard to be in a position to have to choose how much I value my health.

Spring: I signed up for insurance via the New York exchange website. It proved to be confusing and very time-consuming, and it used terms that I've never heard before. It also had many technical glitches that made it difficult to complete the application or go back in and update information.

I'm forced to use this option because my current insurance is being canceled as of January 1, 2014, and there are literally no comparable plans available. This is directly connected to ACA, as insurance providers are discontinuing their low-rate plans and waiting until January 1 to roll out new ones. To add me to my husband's employer-provided insurance would be $1,000 a month--way outside our budget.

The best part of ACA is that I now qualify for Medicaid. The worst part is that I won't hear back on my application until as late as mid-December, leaving only a couple weeks before I am cut off from my current provider. With a baby due in February, it is very stressful to have to depend on the government to provide insurance on time, and it leaves me potentially without coverage right before our baby is due.

If anything goes wrong with the application, and it ends up that I am not eligible for Medicaid, I will literally have to find new insurance in two weeks, which is impossible.

Melissa: I've decided I'm going to remain uninsured and pay the penalty. I'm pretty sure I'll have a job with benefits before the end of next year, so it'll probably be a one-time thing for me. But I'd still rather spend the penalty money on something that would actually help me--new running shoes or even a donation to the Berkeley Free Clinic.

I feel like I'm being robbed. My options are to pay for something I can't use or pay a fine for not buying something? That sounds like a scam.

Welcome to new and unimproved health care

Published at Socialist Worker.

THE CENTERPIECE of Barack Obama's health care law--the state and federal Health Insurance Marketplaces, commonly known as insurance exchanges--came online on October 1.

The long-awaited opening of the "virtual stores" for the uninsured to obtain coverage was overshadowed by the government shutdown that began at the same time. The health care law was a factor in the shutdown--House Republicans refused to set aside their attempts to delay or defund the Affordable Care Act (ACA), causing a stalemate over passing legislation to keep the federal government operating.

When the media reported on the new exchanges at all, it was to document continuing problems with the websites where customers are supposed to enroll. Technical experts say the glitches will be worked out in plenty of time for people to start getting coverage on January 1. But the computer troubles were an unpromising start for a system that has been criticized, by the right and the left, as unnecessarily complicated.

As a result, though, no one is looking at the substance of this central element in the new health care law.

When the media get around to that (if they do) and when the uninsured make it through the online enrollment process, they'll find a system for providing insurance that's nothing like what its right-wing critics claim about it--but that's also not at all the great leap forward its supporters say it is.

From before it became law, the Republicans falsely claimed the ACA was a "socialist" (if only!) takeover of the health care system, aimed at putting the government in charge of decisions about your medical care. New enrollees using the exchanges will be relieved--but probably not surprised--to find that they don't have to go before an online "death panel" to determine if they will be euthanized.

But those who sign up online hoping they will find that "the health care system is being fixed, step by step," as Barack Obama promised, will be disappointed.

The exchanges--like other parts of the ACA, including the individual "mandate" requiring people without insurance to purchase a plan through the exchanges or pay a penalty with their annual taxes--are designed to preserve the role of the private insurance industry, not to guarantee access to affordable, quality health care for everyone. The signs of this underlying priority will be visible at every step of the way.

Much more will emerge over time about the ACA and how it will impact the lives of the millions of people now subject to it. Some of those experiences will be positive--because there are positive aspects to the law.

But at its core, the ACA is a market-based reform that maintains the central role for private corporations in the provision of health care. It will deliver millions of new customers and more than $1 trillion in subsidies to private insurers over the next decade. As for those customers, those who do find insurance through the exchanges will be paying hefty prices for coverage with all kinds of holes and limits. And when all is said and done, the ACA is expected to leave some 30 million people without insurance.

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THE EXCHANGES are essentially online shopping centers for health insurance plans. Several states, including New York and California, are running their own exchanges, while many others are relying on the federal exchange.

Users can log on, enter their information, and choose between health insurance options at different prices for different levels of coverage. They can also determine their eligibility for Medicaid, the government-run health care program for the poor--and for subsidies to use toward the purchase of insurance from private companies.

Plans come in four tiers, going from bronze, with lower premiums and higher out-of-pocket costs; to silver; to gold; to platinum, which has the highest premiums and lowest out-of-pocket costs.

However, not all states offer much of a choice. In New Hampshire, for example, Anthem Blue Cross Blue Shield is the only insurer participating in the state exchange, though it will offer 11 different plans.

The ACA originally included an expansion of the Medicaid program to everyone earning less than 138 percent of the official poverty line--state governments would be forced to implement the expansion, or lose all Medicaid funding. However, the U.S. Supreme Court ruled that it was unconstitutional to threaten states with losing all their funding if they refused to implement the expansion. Half of the states have essentially opted out of this important aspect of the ACA.

Nevertheless, the Congressional Budget Office predicts Medicaid enrollment will increase by 7 million next year alone, despite the Republican obstructionism. This is arguably the most positive outcome of the ACA--the expansion of premium-free health care with nominal co-pays to millions of poor people.

But Medicaid expansion is also good for business--private companies that run Medicaid managed care plans expect a big surge in revenue as a result. According to USA Today, "For industry titans such as UnitedHealthcare and WellPoint, as well as smaller, Medicaid-focused plans such as Molina, the Medicaid expansion is expected to bring significant enrollment and revenue growth" in the range of hundreds of billions of dollars in coming years.

There are other components of the ACA that are positive reforms--a requirement that health insurance include a minimum level of coverage with free preventive care, and prohibitions on insurers denying coverage due to pre-existing conditions, for example. Young people may remain on their parents' health insurance until age 26, and insurers cannot charge higher premiums for women--who on average access more health care--than for men.

And for the roughly 10 percent of the currently insured who buy health insurance on the private market, they'll find that the cost is less and coverage is better under the ACA.

But weighing against these positives is the mandate--the requirement that individuals who don't have insurance buy coverage from a private insurer or face a tax penalty.

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THE ARGUMENT for the mandate is that it will offset increased costs to insurance companies while also reducing premiums for those who need a lot of health care, such as older adults and those with chronic diseases--by bringing healthy, young adults into the system. It's a zero-sum game where the big winner is the insurance industry--the ACA reduces costs for older and sicker people by increasing them for younger and healthier people.

The mandate to buy insurance is to be enforced via penalties on those who remain uninsured. In 2014, the penalty will be $95 per adult and half that for a child, capped at $285 per family, or 1 percent of income after the tax-filing threshold, whichever is greater. This penalty will increase each year, reaching $695 per person and a family cap of $2,085, or 2.5 percent of income, by 2016.

So an uninsured individual making $30,000 a year would pay an annual penalty of $300 in 2014, rising to $750 by 2016, while an uninsured couple making $60,000 would pay $400 in 2014 and $1,390 in 2016.

The penalties attached to the ACA are clearly regressive. According to Health Affairs, nearly 60 percent of the approximately 30 million people who will remain uninsured under the ACA--and therefore subject to a penalty--are low-income. More than 16 percent of the uninsured will be Black, though African Americans are less than 13 percent of the population.

Faced with these penalties, the CBO estimates that some 9 million people will purchase health insurance on the exchange next year. This is expected to reach 26 million by 2018--enough to cut the percentage of the population without insurance in half, according to the estimates touted by the Obama administration as proof of the ACA's concrete advances.

What Obama and other supporters of the law don't say is that the newly insured will also be new customers for the private insurance industry, buying plans with premium payments that will flow into the bank accounts of private companies. And that's not all. The insurance industry stands to gain enormous sums directly from the government, in the form of a subsidies system created by the ACA.

In order to help the uninsured pay for plans on the exchanges, the federal government is offering subsidies to those earning between 100 percent and 400 percent of the federal poverty level--this year, that's $11,490 to $45,960 a year for individuals and $23,550 to $94,200 for a family of four.

According to the CBO's estimates, four out of five enrollees will qualify for a subsidy--those who qualify will receive an average of $5,290 in 2014. Obviously, this will make insurance relatively more affordable--although many individuals will still pay hundreds of dollars per month for premiums, and everyone will be stuck with out-of-pocket deductibles that can rise into the thousands of dollars before insurance kicks in.

The subsidies will be paid directly to the private health insurance companies selling their plans on the exchanges. The CBO estimates that subsidies will surpass $1 trillion in the first 10 years after the exchanges kick in.

All this revolves around the mandate for individuals to buy insurance or face a penalty. But corporations get to play by different rules.

Under intense pressure from lobbyists, the Obama administration decided to delay the so-called "employer mandate" for at least a year. This mandate would require companies with 50 or more full-time workers to offer affordable health insurance to their employees, or get hit with a penalty themselves. As SocialistWorker.org reported this summer:

The administration had estimated that the federal government would receive about $10 billion in penalties from companies that didn't abide by the employer mandate. Then there's the money that at least some companies would have spent to conform, but won't have to now--which is money in the bank, at least for another year.

If there were any doubts left about the business-friendly character of the ACA, you only have to look at the big gains in stock prices for health insurance companies after the ACA passed--in anticipation of increased profits from an influx of customers and subsidies.According to Barrons, "The Morgan Stanley Health Care Payor Index has jumped 73 percent during the past two years, with Aetna (AET) up 64 percent and UnitedHealth Group up 45 percent. At $41.59, shares of HCA Holdings (HCA), the nation's largest hospital operator, have more than doubled over that same span."

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THE ACA is incredibly complicated, and the Republican lies, misdirection and hyperbole, willingly echoed in the right-wing media, have made it all even more confusing. To make matters worse, the ACA impacts people in similar situations differently based on where they live.

Let's take, as an example, a family of three earning $12,000 per year. Because their income places them well below the federal poverty level, in states that have accepted the ACA Medicaid expansion, they would qualify for Medicaid and have access to health care at little or no cost.

However, if they live in a Republican state that rejected the expansion, such as Alabama, they will not qualify for Medicaid. In Alabama, a family of three must have income under $4,500 to qualify for Medicaid. But because they earn less than 100 percent of the federal poverty level, a family earning $12,000 a year is too poor to qualify for subsidies on the exchange. They will be exempt from paying a penalty, but will almost certainly remain uninsured.

The Republican opposition to Medicaid expansion is particularly cruel given that the states refusing to implement it, including most of the former Confederacy, are home to disproportionate numbers of the poor and nonwhite uninsured. According to the New York Times:

The 26 states that have rejected the Medicaid expansion are home to about half of the country's population, but about 68 percent of poor, uninsured Blacks and single mothers. About 60 percent of the country's uninsured working poor are in those states. Among those excluded are about 435,000 cashiers, 341,000 cooks and 253,000 nurses' aides.

According to the Times, as a result of state-level Republican obstructionism, the ACA "will leave out two-thirds of the poor Blacks and single mothers, and more than half of the low-wage workers who do not have insurance."

That the Republicans would throw these people under the bus to score political points is yet more evidence of the party's racism, free-market fanaticism and cynical disregard for those at the bottom of society.

But it's important to understand as well that Republican state officials are able to weasel through these loopholes because of fundamental problems with the way the ACA was written.

The ACA does not ensure universal access to health insurance and affordable health care. Some 30 million people will remain uninsured years after its implementation, and health care will remain a commodity, not a right, with private companies having a sickening amount of power over whether people get the medical treatment they need or not.

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THIS IS best illustrated by looking at what insurance plans will be like for those with incomes between 100 and 400 percent of the federal poverty level--people who will therefore qualify for a subsidy when they buy health insurance on the exchanges.

A single adult living in Los Angeles, California making $30,000 per year would qualify for a subsidy of $276. They would still end up spending $210 a month for a Silver plan--one of the middle-tier levels of coverage.

That silver plan comes with an annual deductible of $2,000, which means paying that amount out of pocket for many services--including surgery, ER visits, giving birth and mental health services--before insurance kicks in. If they require a lot of care, total out-of-pocket expenses could reach the capped maximum of $6,400.

Add the subsidized premium payment to out-of-pocket expenses, and a person making $30,000 a year could end up spending as much as $8,920 in one year. That's a worst-case scenario--but the minimum, if they access enough medical care to cover the deductible and full coverage kicks in, would be $4,512.

That's the middle-tier plan. Alternatively, a lower-tier Bronze plan costs less--$151 a month, after the subsidy--but it has a much higher annual deductible of $5,000, which applies to almost all non-preventive care. Out-of-pocket costs are still capped at $6,400, but if the insured happens to get sick and need their insurance, they could end up paying much more with a Bronze plan than with a Silver plan.

So a Silver plan is most likely a better deal for all but the healthiest people. But $210 a month is a lot of money for someone earning just $30,000 in an expensive city like Los Angeles.

Those earning less than 250 percent of the federal poverty level may qualify for additional "cost-sharing assistance" from the government to help pay these burdensome out-of-pocket costs.

For example, a family of four earning $35,325 a year--which is 150 percent of the federal poverty level--would pay a maximum of $118 per month for health insurance, and would have to buy a Silver plan to qualify for cost-sharing assistance. Instead of covering 70 percent of their costs, like a normal Silver plan, government assistance would drop the deductible from $2,000 to $250, and drop the out-of-pocket limit from $5,500 to $2,000.

But even with premium subsidies and cost-sharing assistance, that low-income family of four could pay as much as $3,400 a year on insurance and out-of-pocket costs--nearly 10 percent of their income. That's obviously a hardship for families barely making ends meet.

The obvious effect of high out-of-pocket costs will be to cause many people to avoid seeking care in order to save money--and take the risk of their condition worsening down the line. A recent survey by HealthPocket found that over 40 percent of people would go to the doctor less if they had a co-payment of more than $50 for each visit. Co-payments for non-preventive visits to a doctor under California's Bronze plan are $60 after the first three in a given year.

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WHAT DOES all this mean for real people?

Randi Jones Hensley, who lives in Texas, is still deciding whether to sign up--or bite the bullet and take the tax penalty. As she said:

For my spouse and me, the Affordable Care Act is far from "affordable." We're already operating on a pretty tight budget, with rent, bills, outrageous student loan payments, etc. So adding an expense of a few hundred dollars to our already stretched monthly budget is going to leave us with nothing.

We've been without health insurance for several years, and of course, we would love to have access to health care, but it's hard to imagine paying so much extra money a month when it's really unclear what the coverage will be like and how much co-pays are going to cost us. And with so much of our money going to insurance every month, how are we supposed to put anything aside for the future?

For Hensley and millions like her, the ACA is not a sustainable solution to the health care crisis in the U.S.--which spends far more on health care than any other nation, despite the lack of coverage and access.

While the Republicans rant about the ACA being a government takeover of health care, that's far from the truth. Principally drafted by a former insurance company executive, the law creates a marginally improved regulatory framework for insurance, but maintains the central role of private, for-profit health insurance.

In fact, the framework of the ACA, focused around the exchanges, is based on the health care law championed by 2012 Republican presidential candidate Mitt Romney when he was governor of Massachusetts. Romneycare's mandate to purchase health insurancewas itself based on a plan devised by the right-wing Heritage Foundation--which had been promoted by Newt Gingrich in 1993 in opposition to the Clinton administration's failed attempt at health care reform.

Nevertheless, Republicans have made opposition to the ACA a major focus of their propaganda in recent years, despite the fact that it is a fundamentally business-friendly reform. No doubt one central reason is that Republicans fear the ACA could become perceived as a popular success, like Social Security or Medicare--and earn their Democratic rivals prestige and popularity over the long term.

So the Republican attitude has been total rejection. But the fact that the maniacs of the GOP are determined to deny the poorest of the poor Medicaid coverage and to wreck whatever positive effects might come from the ACA shouldn't blind us to the much bigger problem with the law--that it puts the interests of the health care industry before people who need health care.

Health care is a basic human need, and the only way to ensure this need is met is to make it a basic human right, accessed through a single-payer system in which the government assures that everyone has access to health care.

The ACA will do nothing of the sort. Instead, it will make the health care industry ever richer, while people's needs go unmet.

Poor prospects in a "middle class" society

Published at Socialist Worker, Truthout, and the Indypendent.

ONE OF the biggest myths about the United States is that it's a mostly "middle class" society, with poverty confined to a minority of the population.

The reality is exactly the opposite: The vast majority of people in the United States will experience poverty and economic insecurity for a significant portion of their lives.

A recent Associated Press feature article--relying on data from an exhaustive survey to be published next year by Oxford University Press--has put this in stark terms: Around four out of every five people in the U.S. will endure unemployment, receive food stamps and other forms of government aid, and/or have an income below 150 percent of the official poverty line for at least one year of their lives before age 60.

That startling statistic shows the truth about a society where there are a lot more have-nots or have-littles than have-enoughs. But there are so many other myths and misconceptions about poverty in America. For example, the AP and Oxford statistics show that while people of color suffer economic difficulties at disproportionately high rates, large numbers of whites fall into the same category. Similarly, more whites benefit from social programs such as welfare and food stamps than any other group.

These facts contradict the racist stereotypes about who is poor or at risk of falling into poverty. And they underline the reality that the vast majority of Americans of all races are in the same boat--they scramble to get by, at best--while only a small minority of people live comfortably throughout their lives, and a tiny few are obscenely rich.

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THE OFFICIAL government statistics measuring poverty often obscure more than they reveal.

According to the U.S. Census Bureau, in 2011, there were 46.2 million people living below the federal poverty level--15 percent of the 308 million people living in the United States.

If this statistic were an accurate reflection of the number of people living in poverty, it would still represent a crisis. However, actual levels of economic and social deprivation and insecurity are much higher than the official figures show--because they are based on outdated measures that greatly underestimate the true level of impoverishment in the richest country in the world.

For example, in 2013, an individual living in the continental U.S. must make less than $11,490 a year to be counted as officially poor. For a family of four, the poverty level is $23,550.

Those are paltry sums, as anyone reading this article knows. Even the figure used in the AP and Oxford research of 150 percent of the federal government's poverty level--$17,235 for an individual and $35,325 for a family of four--is painfully low. In many parts of the country, making ends meet on twice the federal poverty threshold is difficult if not impossible.

That's what the Economic Policy Institute (EPI) found when its researchers developed their "Family Budget Calculator," which, unlike the federal measures, takes into account specific regional differences in the prices of necessities. The EPI looks at the costs of a variety of goods and services--housing, food, health care, child care, transportation and other basic needs – to determine what a family in a given area would need to earn "in order to attain a secure yet modest living standard."

Regional variations can be extreme. For example, average rent in New York City is now over $3,000, compared to just under $600 in Oklahoma City. But according to EPI, its calculator shows that families everywhere "need more than twice the amount of the federal poverty line to get by."

Nationally, four in 10 people live at or below 200 percent of the federal poverty level. Thus, the number of people in the U.S. who would be classified as poor based on this more accurate standard is more than two-and-a-half times greater than the official figure.

The survey data reported by AP reveal even more widespread experiences with poverty--79 percent of everyone in the U.S. will spend at least one year of their lives facing "periodic joblessness, reliance on government aid such as food stamps or income below 150 percent of the poverty line."

The researchers who calculated that statistics believe things will only get worse if current trends continue--by 2030, they expect that percentage to reach 85 percent.

So economic insecurity isn't the exception, but the rule. Another recent survey found that:

Fewer than one in four Americans have enough money in their savings account to cover at least six months of expenses, enough to help cushion the blow of a job loss, medical emergency or some other unexpected event, according to the survey of 1,000 adults. Meanwhile, 50 percent of those surveyed have less than a three-month cushion and 27 percent had no savings at all.

The consequences of all this plays out in numerous ways in people's day-to-day lives.

For example, bouts of unemployment can have serious, lasting impacts on those affected, even for those who find another job. Unemployment is associated with mental health issues such as depression and anxiety, as well as chronic diseases such as diabetes and high blood pressure.

For children, "poverty experienced at any stage of the child's development is associated with reduced cognitive outcomes," according to researchers at the University of Queensland in Australia.

Increasingly, a period of unemployment can trigger a longer term, if not permanent, drop in living standards. According to the National Employment Law Project, during the Great Recession, 60 percent of lost jobs were at the middle level of wages, paying between $13.84 and $21.13 an hour, but only 22 percent of new jobs in the recover fell into this category. By contrast, low-wage jobs accounted for 58 percent of all new jobs created in the recovery.

Many of these new jobs are in retail and fast food, where workers are often forced to work multiple jobs and still fail to make ends meet. As Terrance Wise, a worker at Pizza Hut and Burger King in Kansas City, who went on strike this month to demand $15 per hour, told Democracy Now!:

I have three lovely daughters and an equally lovable fiancée. And I'm working two jobs at about 50, 60 hours a week, so I'm leaving in the morning...and my daughters were still sleeping. When I get off tonight, they will probably be asleep again. So it's consecutive days where I don't get to see my daughters... That's one element that's really the hardest...

It's just an everyday hustle. I use public transportation every day, so I have to leave early to get to work. So I'm gone 15, 17 hours a day. It's just really hard--a struggle every day.

The flip side of that struggle--and of the fact that vast majority of people in the country live in poverty now, have lived in poverty in the past, or will in the future--is that a relatively small minority has amassed such fantastic wealth that they will never have to worry about going without, even if they never earn another cent.

The 400 richest Americans, with a total net worth of $1.7 trillion as of last year, were worth an average of $4.2 billion each, enough to support over 89,000 families of four at 200 percent of the poverty level for an entire year.

It is no coincidence that overall corporate profits, measured as a share of the gross domestic product, are at record highs while overall wages are at record lows as a percentage of the GDP. The threat of economic insecurity is an important part of discouraging workers' struggles and increasing profits at the expense of the living standards of the vast majority. The personal experience of going without--and the constant reminder from seeing family, friends and others in the community deal with stretches of poverty and unemployment--sends the message that workers who step out of line can face the same fate.

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THE RESEARCH covered in the AP feature shows growth in the rates of white poverty, something often overlooked in mainstream media accounts. According to AP:

By race, nonwhites still have a higher risk of being economically insecure, at 90 percent. But compared with the official poverty rate, some of the biggest jumps under the newer measure are among whites, with more than 76 percent enduring periods of joblessness, life on welfare or near-poverty.

According to the Census Bureau, there were more than 19 million non-Latino whites living below the poverty line in 2011, compared to 11 million African Americans and 13 million Latinos.

The U.S. Department of Agriculture reports that 36.9 percent of food stamp recipients are non-Latino whites, while 22.8 percent are Black and 9.6 percent are Latino(the race of recipients was unknown in 18.4 percent of cases, according to the USDA). Blacks, whites and Latinos each accounted for roughly the same percentage--between 30 and 32 percent--of recipients of the main welfare program, Temporary Assistance for Needy Families.

Despite these facts, poverty in the U.S. is often racialized by political leaders--more often and more brazenly by Republicans, but by Democrats, too. The common stereotype about these government programs is that they benefit an "undeserving" (read: Black) minority, not workers of all races.

Ronald Reagan, for example, explicitly made race a part of his caricature of Cadillac-driving (Black) "welfare queens" and "young bucks" who were taking advantage of hard-working (white) "taxpayers." During the 2012 Republican primaries, Newt Gingrich recycled the same racist filth when he called Obama the "food stamp president."

But Democrats have latched on to the same stereotypes when they were the ones wielding the budget act. It was a Democrat, Bill Clinton, who promised to "end welfare as we have come to know it"--and carried through his campaign pledge when he signed the "Personal Responsibility and Work Opportunity Act." Likewise, Hillary Clinton, in her losing bid for the 2008 Democratic presidential nomination, was playing the same racist game when she claimed she was better positioned than Barack Obama to win the support of "hard-working Americans, white Americans."

The facts, however, undermine these commonly used stereotypes. As the AP pointed out, "For the first time since 1975, the number of white single-mother households living in poverty with children surpassed or equaled Black ones in the past decade, spurred by job losses and faster rates of out-of-wedlock births among whites."

The fact that widespread poverty and insecurity crosses racial lines on the one hand, but that racist stereotypes are used to justify attacks on social programs that benefit the majority on the other, means that struggles for economic and racial justice must be intertwined in order for either one to be successful. Those who seek to defend and extend unemployment insurance, welfare, food stamps and other benefits that help working people must challenge the racism used to undermine them--while those who seek racial justice must also struggle for economic justice.

On this 50th anniversary of the 1963 March on Washington, it is important to remember that the civil rights demonstrators were demanding jobs and freedom. The calls for racial and economic justice were linked, as they were again in the Poor Peoples' Campaign that Martin Luther King Jr. would help launch a few years later. Speaking of the campaign, King called it "a new co-operation, understanding, and a determination by poor people of all colors and backgrounds to assert and win their right to a decent life and respect for their culture and dignity."

That struggle for the right to a decent life is still with us today.