Committee on Health Care,
League of Revolutionaries for a New America
The Democratic Party, after turning its back on majority sentiment on the Iraq war, is focusing on the nation’s health care crisis in the 2008 Presidential election. It’s a high-wire act. How can the Party appear to promote universal health care while reducing what little government responsibility still exists, and protect the needs of capital in health care reform?
The pressure is on. Once a battle over policy, the lack of health care is igniting a class struggle for survival. More and more, people understand that health care needs to be a guaranteed human right and that securing universal health care with a single-payer system – one which replaces multiple private insurance company payers – will advance this fight.
For a class increasingly made up of part-time, contingency, undocumented and low-wage workers with limited or no benefits, as well as unemployed, disabled and retired workers whose rights to employment-based health care have been destroyed, ensuring a conscious fight for class unity is a critical responsibility of revolutionaries. Furthermore, re-framing what is truly politically possible allows us to break through a politics of compromise, where compromise is no longer possible.
The historical role of health care under capitalism, to produce and reproduce a work force capable of commodity production, is changing. Since the late 1800s, health provision in the U.S. has been part of an industrial social contract, a privately negotiated relationship between workers and capitalists. Over the years, those with well-paying jobs had premium employer-based benefits, the elderly and disabled got Medicare, the poor got Medicaid, others got charity care at public hospitals, and some of us received no care at all.
Today, fewer workers are needed for production in a society where the tools of production are computers, robots and electronics. Where labor is needed, workers are forced to compete in a global labor market. To increase the rate of exploitation, workers are stripped of benefits like health care and pensions and wages are pushed to the minimum. Workers’ health care is increasingly expendable, and increasingly exists only as a commodity to satisfy capital’ s frantic need to expand and speculate in the pursuit of maximum profits.
What we have accepted as unrelated components of health care provision are now beginning to be seen for what they are – as parts of one system. In a period when a large section of the working class either held industrial jobs or jobs in spin-off industries and government service, a tiered system of distribution seemed to work for most of us. We are witnessing the destruction of this system, laying the basis for the awareness with common working class interests as a politically practical goal.
Health care agreements in the recent United Auto Worker (UAW) contracts are a prime example of a union-management restructuring that signals the beginning of the end of employer-based health care provision. General Motors/UAW negotiations create VEBA (Voluntary Employee Beneficiary Associations) which allow automakers to unload their retiree health care obligation on to workers and their union. When a Communication Workers of America agreement did the same thing a few years ago, retiree out-of-pocket health care costs increased from $43 a month to $690 a month. Such agreements put an end to corporate responsibility, while guaranteeing that workers’ money and savings continue to move through insurers to banks and the stock market.
At the other end of the health care spectrum, public health care is being systematically destroyed. The extraction of profit from public health insurance hastens closures such as the King-Drew Hospital in Los Angeles. Charity Hospital in Louisiana, damaged but reparable after the Katrina disaster, has been permanently closed, while plans to subsidize the local purchase of private insurance continue. Atlanta’s 113-year-old Grady Hospital will be shuttered or forced into a corporate governance plan authored by the Georgia Chamber of Commerce. Nationally, tax money used to support Medicaid is being channeled through private managed care corporations that make profit by restricting access to care. In the past, public health was an important part of the social safety net. Now looting of public institutions for capital is so important that even total destruction of the system seems warranted. Working people who have relied on these institutions, for jobs and for care, are increasingly out of luck.
Workers who used to experience different interests in health reform now have increasingly common interests. Some of these may be new generations of autoworkers who, because of other provisions in the new agreements, will labor under new, poorly-paid conditions. With high health premiums, and no pensions or retiree health care, the ruling class has made formerly high wage jobs into Wal-Mart jobs. Uninsured workers in large corporations rose from 7 percent in 1987 to over 11 percent in 2001. Those of us with job-based health insurance have seen our premiums increase almost 60 percent in six years, reflected in the number of uninsured, which has exploded to over 47 million people.
The reality is that we are moving into a period when the fight over health care provision, like the distribution of other basic needs, is moving out of the arena of bourgeois policy negotiations, and into the arena of a political fight based on class interests.
Politicians tell us to be pragmatic, to get what we can or build on what already exists. But the health care system is being destroyed – there is nothing to build on. In fact, instead of meeting societal needs, both sides of the aisle promote proposals for one or another form of individual mandates to buy private insurance. This is a dead end political strategy, forcing individuals to buy private insurance while leaving a multi-tiered system of corporate health care intact and doing nothing to curb the corporate appetite for profits.
Consumer Driven Health Plans or Health Savings Accounts (HSAs), promoted more often by Republicans, also based on individual responsibility, give speculative capital direct access to workers health savings. Banks, insurance companies, credit unions, and money management firms are salivating at the prospect of making billions of dollars in the form of fees, investments and charges for debit cards each time a patient sees a doctor, gets a procedure or goes to the hospital.
For over twenty years, national health insurance has been the moral demand of a relatively small section of health policy activists. It is now the demand of millions of people, and leaders in this fight for reform are learning step by step that a broad social movement, not simply an alliance for legislative reform, is needed to win a fight for health care reform. By attempting to legislate some form of increased individual responsibility, both Democratic and Republican proposals are intended to stave off a political threat to bourgeois leadership.
As revolutionaries in the movement for health care, we play a key role in the fight. In a world economy dominated by speculative capital, achieving universal health care means a head on challenge to the system of profit and private ownership of the necessaries of life. The introduction of new ideas that flow from an understanding not only of the current stage of the battle, but from a strategic understanding of the march of history, is the critical ingredient for creating a new politics of the possible.
Corporate profits and privatization have become sacred cows, and government run medicine the bogeyman. U.S. workers were told, ”What is good for GM is good for you”. In truth, corporations run the country through their control of the government. Although most Americans see Medicare as an entitlement, fear of socialized medicine has kept our interests in government’s responsibility for health care off the table. New realities have put it back on.
Some also believe that unity of the trade unions or the Democratic Party, rather than the working class as a whole, will achieve reform. In 1994, a California ballot measure for single payer health care failed largely because many voters, despite all facts to the contrary, were persuaded that immigrant workers, particularly those without legal documents, were responsible for the high cost of health care. Labor unity is essential, but that unity must be based on fighting in the interest of the entire working class.
Based in a history of slavery, genocide and the theft of native and Mexican lands, the capitalists’ manipulation of inequality is our Achilles heel as a working class. This legacy has been expressed through a multi-tiered system of health care. Today most of us have worse or no health care than in 1994. Those of us who could rely on high quality insurance can no longer do so. Calls to exclude any of us from health care in this country, including undocumented immigrant workers, will doom the class struggle to achieve health care as a right for all.
The delivery of universal health care at one single high standard of care is incompatible with the realities of world capitalism today. At the same time, the very technology, knowledge and global relations that have rendered health care a scarcity for so many, actually sets the basis for such delivery. As workers come to understand that reality, challenging the profits of all corporations will lead many to question the private ownership of the public necessaries of life. Revolutionaries not only have a responsibility to make this process conscious, but it is also the only practical politics for this time.
A movement demanding universal, single payer health care will increasingly come up against the needs of global capital. Revolutionaries participate in all forms of this struggle, within and outside the legislative arena, exposing lies and leading with new ideas about what is truly politically necessary and possible. As the possibility of health care for all is grasped, much more than national health care will be on the table.
Members of the LRNA Committee on Health Care are active throughout the country in the movement for health care. Email rally@lrna.org for more information.
Jan.2008.Vol18.Ed1
This article originated in Rally, Comrades!
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