That health care plan

Only one thing is really clear about the Obama health care plan, which was just upheld by a majority on the Supreme Court that included conservative Chief Justice John Roberts: If it is going to be any better than what we already have, we’ll have to continue to fight for at least a single-payer system that covers everyone in this sick society.

And single-payer, while popular with progressives, still falls far short of socialized medicine in socialist countries like Cuba, where major government resources are committed to promoting the health of the population and no one has to worry about how to pay for care.

Criticism and support of the Obama plan come from both left and right. What was just upheld by the court was the mandate that everyone get health insurance or pay a penalty tax. This made the insurance companies and other health-related industries happy, of course, because it means they’ll be sure to make more money.

Left critics of the plan say that many among the tens of millions of uninsured don’t have coverage because they just can’t afford it. They will wind up having to pay the fine, which they surely can’t afford either in these days of high unemployment and low wages.

Supporters of the plan say this provision was essential — that without it the whole plan would have died, allowing insurance companies to continue rejecting people for “pre-existing conditions.” They also say that people who can’t afford the premiums will get assistance. However, this ruling allows states to “opt out” of expanding Medicaid to more poor people, which the original law had mandated, even though the federal government would pay for most of it. Right-wing governors in Florida and South Carolina have already said they will not expand Medicaid.

Some liberals say passage of this plan gets a foot in the door for single-payer. Others counter that it provides a precedent for states to defy progressive federal regulation on issues like workers’ rights, the environment, women’s and lesbian/gay/bisexual/transgender/queer rights, and other issues.

We have no special expertise on how this will shake out. But this we know: What the court had to say is not the deciding factor. What is decisive is the relative strength of the two main classes in society. Britain started its national health plan after World War II when the British ruling class was weak, and the workers were strong and militant. It was a concession to the workers meant to deflect their demands for real socialism, that is, for expropriating the capitalists’ property and setting up a workers’ state. The same thing was true in France, another capitalist country where a national health system was put in place even earlier.

Just because the ever-so-slightly more liberal (on social issues) Democrats are in the White House is no reason to sit back and think things will get better. This is a time of cruel assaults on workers’ rights, growing poverty, especially in communities of color, and vicious cutbacks in all public spending except for the military and the prisons.

It is a monumental crime that in the richest country (for the rich), people spend more for health care and get worse results than in other developed countries. It’s another reason to fight for not only a real health-care-for-all plan, but a complete overturn of the anachronistic system of capitalism, which milks us dry from the cradle to the grave.