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	Workers Vanguard No. 1111	5 May 2017

Expropriate the Health Care Industry!

For Quality Medical Care for All!

MAY 1—Donald Trump has so far failed to make good on his campaign promise to “repeal and replace” the Obama administration’s Affordable Care Act (ACA) due to opposition within his own party, but his administration is determined to do so. Since 2010, destroying the ACA (popularly dubbed Obamacare) has been a rallying cry for the Republicans and sundry religious and racist reactionaries. We oppose the Republican assault on the ACA; if it succeeds, millions more will be denied medical care, and increasing numbers of people will suffer and die.

Republicans described the ACA as some kind of insidious attempt by Obama to introduce “socialism.” Far from it! Obama’s ACA was crafted to maintain the profit motive in health care. Indeed, it has been a bonanza for the profit-gouging owners of the private hospitals, pharmaceutical and medical supply companies, as well as the parasitic health insurers. From the beginning, we denounced Obama’s ACA as a rip-off of working people in the phony guise of providing health care to all (undocumented immigrants were always excluded). A central purpose of the ACA was to cut costs for the capitalists by undermining employer-paid health plans, including decent ones won by the unions, which are to be hit with a so-called Cadillac tax.

Some 20 million people have obtained health insurance under the ACA. But, under the individual mandate forcing people to purchase insurance, many are paying high premiums, co-pays and deductibles for inadequate coverage. And 29 million still remain uninsured. More than half of the people who gained insurance did so because of the expansion of Medicaid, which now covers one in five Americans. The proposed repeal of the ACA would, according to the Congressional Budget Office, result in 14 million Americans losing their insurance next year, growing to 24 million by 2026. Even the meager gains provided by the ACA are anathema to Trump and his cronies, who are committed to eviscerating any program that might help working people and the poor.

Republicans have run into trouble with a section of their own constituencies, who fear losing their existing health coverage. Moves to allow insurance companies to go back to denying coverage for pre-existing conditions are particularly feared. Moderate Republicans balked at Trump’s bill after receiving tongue-lashings over the proposed cuts from angry voters at town hall meetings across the country. On the other side, the far-right House Freedom Caucus thought Trump’s first bill didn’t go far enough in leaving the poor to die in agony according to the logic of the “free market.” Trump has now won over the Freedom Caucus with an even more vicious version of the bill.

Under capitalism, the bourgeoisie seeks to spend on health care, education and other social benefits for workers the bare minimum to maintain a sufficient mass of labor power to be profitably exploited. The debate over health care “reform” reflects divisions within the U.S. ruling class over just how low that minimum should be. Both Democrats and Republicans share a fundamental commitment to enriching the health care industry profiteers: Obamacare was modeled on a program instituted by Republican Mitt Romney when he was governor of Massachusetts.

Access to quality health care should be an elementary right for everyone from birth to death. The whole health care industry—from the hospitals to the pharmaceutical companies—should be expropriated. The provision of personnel, medical facilities, equipment and medicines entails a cost to society. That cost should be borne not by individuals out of pocket but by the government. Medical care should be free of charge at the point of delivery. It will take fierce class struggle by workers to win even a modicum of the quality care everyone needs. Fully satisfying basic human necessities—including good education, decent housing and stable, well-paid jobs—will inevitably run up against the capitalist drive for profit. This points to the need to overturn the capitalist order through socialist revolution.

Health Care, U.S.A.: Racist, Sexist and Anti-Worker

The tiny, super-wealthy minority at the top of capitalist society gets the very latest and best in medical treatment, while health care for the vast majority in the U.S. is rationed according to race, sex and class. Cries against “big government” have long been coded language for calls to ax social programs portrayed as a “redistribution” of income from hard-working folks to “undeserving” black people and other minorities. In this vein, the Republicans have been taking specific aim at Medicaid. It is no coincidence that most of the states in the former Confederacy were among those whose governments revolted against the ACA’s expansion of Medicaid.

To qualify for Medicaid, people’s income must be at starvation level; the median income for the parents in a family of three to qualify is less than $28,000. In racist, capitalist America black people and Latinos are disproportionately consigned to joblessness and poverty. As paltry as Medicaid is, it represents the only lifeline for millions. Altogether, Medicaid covers some 70 million people, more than half of them children, including millions of white people. Two-thirds of Americans have received care under Medicaid or know someone who has. Many Trump voters are now realizing that workers and the poor across the board, including themselves, will be hit hard by attacks on Medicaid.

Attacks on abortion rights are being used as a wedge to introduce broader attacks on health care as well. Pandering to the religious zealots, on April 13 Trump signed a bill denying federal funding to any agency that provides abortions, even though federal funding to abortion itself has been outlawed since the 1976 Hyde Amendment. The new measure represents a renewed attack on Planned Parenthood, which provides millions of women with free and low-cost prenatal care, cancer and STD screenings as well as contraception.

Per capita medical costs here are by far the highest among advanced capitalist countries, yet the U.S. ranks lower than most in terms of life expectancy, infant mortality and the percentage of people aged 65 or older with chronic diseases. As detailed in Steven Brill’s powerful exposé, “Bitter Pill: Why Medical Bills Are Killing Us,” (Time, 20 February 2013), big urban and university hospitals that are supposedly “nonprofit” rake in lucrative surpluses by charging exorbitant prices for everything from generic Tylenol to surgeons’ gowns. A study published in Health Affairs (September 2016) calculated that what hospitals charge compared to the actual medical cost ranges from 180 percent for routine inpatient care to 2,850 percent for specialized interventions such as CT scans! Drug prices have also skyrocketed, not least due to a ban on Medicare negotiating prices with the pharmaceutical companies.

Hospitals and clinics routinely turn away those without insurance who cannot pay up front. Even working families who have what they thought was adequate insurance can end up with bills for tens or hundreds of thousands of dollars for a simple outpatient procedure or a broken bone. People dying of cancer and their families are hounded by collection agency scavengers. Medical debt is the number one cause of personal bankruptcy—46 million people are currently struggling to pay off medical debt.

Enormous advances are possible when the profit motive is taken out of health care. Albeit under Stalinist misrule, the Cuban deformed workers state, thanks to its collectivized economy, has developed a health system that outshines in many respects what is generally available in the U.S. Despite a longtime imperialist embargo and limited resources, Cuba has three times as many doctors per person as the U.S., and it also sends doctors to scores of poor countries.

The Fight for Free, Quality Health Care for All

As we noted when Obama’s ACA was rolled out:

“That the U.S. is the only major industrialized country in the world without a national health care program is, in large part, testimony to how successfully America’s rulers have wielded anti-black racism and anti-immigrant nativism to divide and weaken the working class and its struggles. Those divisions have been a major roadblock to the development of elementary class consciousness—that is, the understanding that the multiracial proletariat has distinct class interests that require political expression in its own party.”

—“For Socialized Medicine—Quality Health Care for All!” WV No. 1035, 29 November 2013

The race/caste oppression of black people, the majority of whom are forcibly segregated at the bottom of society, is fundamental to American capitalism, which was founded on black chattel slavery. While black workers are the last hired and the first fired, they are a strategic component of the working class, particularly in the unions.

The potentially powerful, multiracial trade unions would find plenty of allies if they waged some hard-fought class struggle. The working class must take up the fight for free, quality health care, including abortion and contraception and link it to the struggle against black oppression and for immigrant rights. Such a perspective is alien to the pro-capitalist union bureaucrats who, despite some griping, fell into line behind the Democrats and supported the ACA.

Contrary to Democratic Party mythology about FDR’s “New Deal” and LBJ’s “Great Society,” social programs like Social Security, Medicare and Medicaid were only conceded by the capitalists after mass social struggle. Social Security came out of the class battles of the 1930s that forged the industrial trade unions. Union health care plans were wrested from the employers through militant strikes after World War II, like the cradle-to-grave, union-run system won by the United Mine Workers in 1950. Medicare and Medicaid were launched amid the ferment of the civil rights and anti-Vietnam War movements.

The labor tops’ prostration in the face of the bosses’ decades-long war on the working class is an expression of the union bureaucracy’s support to the capitalist system. These capitulations have resulted in a shredding of hard-won gains: health coverage, wages and pensions have been slashed. Instead of class struggle to defend pay and benefits, the union tops call on workers to vote Democrat. We fight to break the proletariat from the Democrats, Republicans and the rest of the capitalist rats who uphold the system of exploitation for profit. The labor sellouts at the top of the unions push the lie that workers and bosses have common interests. The unions need a class-struggle leadership committed to mobilizing workers power against the class enemy.

“Single-Payer” Socialists: Keeping the Profit in Health Care

Many liberals and reformist leftists, echoing Democrat Bernie Sanders, are proponents of a “single-payer” health system, something akin to what exists in Canada. In such a system, the capitalist government would pay private providers for the health care costs of the population while rationing medical care. If implemented, such a reform could represent a rational advance over the current “free market” anarchy, but a single-payer system would do nothing to take the profit motive out of health care.

The reformist International Socialist Organization (ISO) explicitly accepts private medicine for profit. An April 6 article on socialistworker.org (“Putting Single-Payer Back on the Table”) says: “The left should embrace the opportunity to put forward single-payer as a real alternative.” It enthuses over a proposed single-payer scheme in California, under which it admits health care will be “carried out by various public and private providers.” The ISO tailors its demands to whatever is acceptable to the liberal wing of the bourgeois Democrats. The truth is that achieving free, quality medical care for all will require an uncompromising struggle by the multiracial working class to rip the health industry out of the hands of the profit-gorged capitalists.

It is the job of revolutionary Marxists to make the working class conscious of its power and interests in leading all the oppressed to overthrow the imperialist bourgeoisie. What is needed is a multiracial, revolutionary workers party to lead the proletariat to seize state power from the capitalists and end the system of exploitation and oppression that barters human lives for profit.