Universal health care or universal nightmare? Two types of insurance, two meanings of universal, two options for health care reform

I offer a framework to examine the Patient Protection and Affordable Care Act (P-PACA), the new federal health care law in the United States. I build upon the concept of insurance and distinguish between two types that lead to two meanings of universal coverage, each with radically different implications for the goal of providing guaranteed access to medical care to the population. I argue that because the type of insurance underlying P-PACA is that of casualty or commercial insurance, where insurance is treated as a market commodity, the new law will lead to ‘resolving’ the problem of the mounting number of uninsured while, paradoxically, increasing the number of individuals without access to medical care. I also discuss how alternative proposals to reform the US health care system, such as the Extended and Improved Medicare for All Act (HR676), drafted upon the cooperative principle of social insurance, are shunned in legislative and other public debates as ‘politically unfeasible’, when not rendered invisible by an intense propaganda campaign led by a loose collaboration between the business sector, political elites in the two main, ‘opposing’ parties, and the corporate media.  I conclude by suggesting that no less than a massive popular uprising demanding social justice in health care matters will resolve the conundrum of the most powerful nation in the planet allowing an increasing number of individuals to fail to receive even minimally decent medical care, as a result of which they suffer from unnecessary disability and early death.