http://mrzine.monthlyreview.org/2015/images/av_levels.jpgA number measures the Swiss-chees-i-ness of Obamacare plans: the actuarial value (AV). It is defined as the percentage of costs paid by the insurer, averaged over the entire population enrolled in the particular contract. AV is a statistical concept. On average, the so-called insured pay the remaining percentage, plus their premiums. The Affordable Care Act specifies what shall be the actuarial value of a bronze plan, a silver plan, etc. (see chart below). People who enroll in either of the Kaiser silver plans, for example, will on average bear 30 percent of their health care costs in addition to paying their premiums. The actual percentage will vary widely from one individual to the next; that is the nature of a statistical measure. Most people who purchase an individual health policy, if only to satisfy the mandate imposed by the Affordable Care Act, choose a silver or bronze plan. Their actuarial values impose much more financial burden on enrollees than traditional Medicare. In 2014 the AV of Medicare, excluding the Part D drug program, left on average 16 percent of costs to the enrolled senior citizen. The AV of Medicare was higher in the past, but it has drifted down for years. Still, an Obamacare silver plan leaves on average almost twice as much, 30 percent, for you to pay out of pocket, and a bronze plan at a 40 percent out-of-pocket expense is a mockery of being insured. A real guarantee of a single standard of health care for all, improved Medicare for All, often called single payer, would cover essentially all the cost of health care at an AV of perhaps 98 percent. . . . What can we conclude about the struggle for guaranteed, comprehensive health care in the era of the Affordable Care Act? Five principles are clear. 1. Do not support Obamacare; demand improved Medicare for All. We cannot get to our goal by going down the wrong road. With the proviso that we defend the expansion of Medicaid and a few crumbs from the ACA, we must oppose it rather than pretend that it lays out a path to real health security for all. 2. Fight rising costs and rollbacks of coverage; demand improved Medicare for All. Attacks on the ACA from the right are part of the drive to dismantle Social Security, land a final blow to trade unions, and drive working people into overt slavery. The answer is not the Democratic Party response of always negotiating for a smaller step in the same direction. We cannot evade the polarization of struggle in the U.S. Obamacare is a failure, and we want improved Medicare for All. 3. Make the fight for Medicare for All part of the general class struggle. This principle goes beyond organizational advice to link up struggles among different sections of people struggling over health care, the lack of jobs, employer betrayal of pension commitments, and so on. There is a tendency in the single payer movement to portray a universal health plan as a "win-win" in the interest of both working people and capitalists. Single payer is offered as a rational solution that would provide good care while reducing employers' cost. The strange thing is that capitalists, despite an occasional murmur by a corporate executive, do not buy this line. They know their class interest. The struggle for health security is part of the general class struggle. We demand the prosperity and equality that this country has the workers, the wealth, and the know-how to achieve. Period. 4. Campaign for the national plan, HR 676; stay out of state swamps. Vermont learned that the state-by-state strategy is doomed against the resistance of health insurers and other interests newly enriched by the Affordable Care Act. The centerpiece of struggle should be a direct fight to replace the ACA by HR 676, the "Expanded & Improved Medicare for All Act" sponsored by John Conyers and four dozen other congresspersons, which has been in Congress in stable form for many years. 5. Tell it: Guaranteed, equal care for all is now part of socialism, not capitalism. The project of our era is to go from capitalism to full material equality for all of us -- in living standards, in human work, and in health care. We cannot establish a secure, prosperous life under modern capitalism in its latest phase. It is deluded reformism to evade this fact. Our struggles to defeat cuts and push forward in health care, employment, education, housing, and retirement security become stronger with this recognition.

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