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	Workers Vanguard No. 1170	21 February 2020

No Illusions in Sanders' "Medicare for All"

For Socialized Medicine!

Expropriate the Health Care Industry!

The health care industry in capitalist America is a leech feeding off the illness and ailments of working people and the poor—and not just the 30 million disproportionately black and Latino uninsured, who are bilked for everything they have, if they get treated at all. For many of those with insurance, coverage provides little protection against exorbitant bills and wrenching decisions. In 2017, over 137 million people suffered financial hardship due to medical expenses, with hospitals filing ever-more lawsuits to garnish the wages of the sick and judges jailing thousands for not appearing in court for unpaid bills. Record numbers of people are putting off needed doctor visits, medical procedures and drug purchases. The burden is immense as preventable diseases roar back to life and undertreated chronic conditions abound.

While those with means can buy world-class medical services, the bulk of the U.S. population pays considerably more for health care than people elsewhere in the industrialized world, with much less to show for it. All the while, the insurance parasites, the profit-gouging hospitals and the pharmaceutical giants are making a killing. It’s no wonder that the majority of Americans today favor some kind of government-backed health plan for everyone, a single-payer system popularly dubbed “Medicare for All.”

Bernie Sanders is closely identified with this demand, having made it central to his bid for the Democratic presidential nomination, both in 2016 and again today. Last year, he introduced “Medicare for All” legislation in the Senate that would replace Medicare, Medicaid and private insurance with a single public agency to oversee the financing of health care, while leaving the delivery of care largely in private hands. A similar bill has been presented in the House by Pramila Jayapal.

Sanders and his reformist cheerleaders like Socialist Alternative present “Medicare for All” as one of the major rewards that would follow if he gets elected to high office. The lie is that a Sanders White House would be a benevolent capitalist government, that is, one supposedly defending the interests of “the people” against the robber barons of Wall Street. In reality, nothing of the sort could ever exist. Whether administered by “progressive” Democrats or right-wing Republicans, this government is the executive committee of the capitalist ruling class, the brutal exploiters who amass their profits from the blood and sweat of the workers. Under capitalism, the rulers will always seek to spend on health care the bare minimum to maintain a labor pool fit enough to exploit. They will only concede anything of significance if forced to by class and social struggle.

If ever implemented, a single-payer system that knocks the legs out from under the private insurers would likely represent a gain. But even the most ideal version of the Sanders plan would be no panacea. It is impossible under capitalism to eliminate the rationing of care, which is conditioned by the class, race and sex bias of this incredibly unequal society. The truth of the matter is that “Medicare for All” would not excise the root of the problem plaguing health care in this country, namely the capitalist profit motive.

Take just one facet of that problem: the corporate consolidation of health care delivery. Most people in the U.S. live in places where hospitals, clinics, physician practices and laboratories have been merged into monopolies controlling nearly all aspects of health care locally. These monopolies use their market power to extract higher prices from the privately insured and the uninsured, who are on average charged substantially more than Medicare patients for the same service. A single-payer plan has the potential to undercut this so-called “cost shifting,” but not to buck the pressure from the hospital goliaths (and Big Pharma) driving up base prices.

Medicare is widely perceived as the one public plan available in this country that provides somewhat affordable coverage on a consistent basis and as better than most employer-based plans. At the same time, Medicare—a program aimed at patients 65 years and older—reimburses less than half of the medical charges of those enrolled and excludes coverage of necessities like hearing aids, dental care, eyeglasses and long-term elderly care. To get comprehensive treatment and coverage, Medicare recipients have to fork over additional cash to private insurers. Congress constantly tinkers with funding sources and formulas to limit Medicare’s budget.

Quality, universal medical care free at the point of delivery should be an elementary right. But to achieve that requires socialized medicine—the expropriation without compensation of the capitalist health care corporations who have gotten away with bartering in human lives for far too long. Only the destruction of this entire system of exploitation can throw the doors wide open for the highest level of care for everyone—the employed and unemployed, native-born and immigrant, regardless of status. Socialized medicine would, among other things, include free abortion on demand, supplemented by free 24-hour childcare, to help liberate women from the servitude of the family.

When those who labor rule, a rationally planned, collectivized economy can be established to eradicate the poverty, hunger and homelessness that today condemn countless millions to a life of misery, disease and early death. For all this to be realized, there must be a socialist assault on the capitalist order by the multiracial working class under the leadership of a revolutionary workers party. Such a party can only be forged through breaking the chains that bind the exploited and oppressed to the capitalist Democratic Party, including its “progressive” wing represented by the likes of Sanders.

Democrats—Enemies of Workers, Oppressed

Notwithstanding his pretensions to being a “socialist,” Sanders, like all Democrats, is a capitalist politician whose job is to defend and maintain the profit system. His lengthy track record of support to U.S. imperialist wars and occupations abroad is one testament to his service to the class enemy. Another is his full-throated support for chauvinist trade protectionism. The same commitment to restoring the competitive edge of U.S. enterprise informs Sanders’s pitch for health care reform. In a contribution to Fortune magazine titled “Why Medicare-for-All Is Good for Business” (22 August 2017), he bemoans the “dysfunctional health care system” for “having a very negative impact on our economy and the business community—especially small- and medium-sized companies.”

Sanders is promoting “Medicare for All” to channel the very real anger with the U.S. health care industry into the “anti-Trump resistance” and garner votes for yet another round of Democrat-administered capitalism. The last time a Democratic administration promised some form of health care reform in the guise of helping the average American, the product was the Affordable Care Act (ACA), Barack Obama’s signature health care legislation. While some people got a modicum of relief through the ACA’s expansion of Medicaid, Obamacare was consciously designed to help pad the bottom line of the private insurers and crafted to undermine employer-based insurance (including by proposing a heavy tax on so-called “Cadillac” union plans). Over the past decade, premiums for these plans went up by 54 percent.

While Medicare and Medicaid were genuine reforms, they were deliberately limited to those the insurance companies did not want to cover—i.e., the elderly and disabled (Medicare) and the poor and long-term sick (Medicaid). What made the two programs, established in 1965, different from Obamacare was not altruism on the part of John F. Kennedy or Lyndon B. Johnson. They were by-products of the tumultuous social struggles of the period, especially those that led to the uprooting of legal Jim Crow segregation in the South.

Similarly, it was not through the ballot box or the Capitol lobby that workers won their employer-subsidized health plans, but rather through hard-bitten struggle against the titans of industry beginning in the years following World War II. Over the current decades-long lull in strike action, the bosses have increasingly taken the ax to health and pension benefits. Responsibility for these attacks going down almost wholly without a fight lies with the union misleaders, who view themselves and the unions as partners with the employers in preserving the profitability of American capitalism.

When class battle is engaged, as it was in last year’s 40-day strike by United Auto Workers (UAW) members against General Motors, the union tops instruct the workers to faithfully observe all the bosses’ rules—to fight with one hand tied behind their back. Nonetheless, by collectively withholding their labor, auto workers headed off an attack on health care, although the hated multi-tier wage and benefits system was kept intact, and temporary workers were hung out to dry. The labor officialdom rejects the class-struggle methods that built the unions, instead preaching reliance on false “friend of labor” Democrats. This course has proved a disaster: workers across the country have been forced to endure higher health care costs, stagnant wages and worse working conditions, while their elementary defense organs, the unions, are considerably weakened.

Today, union bureaucrats around the country are lining up to endorse one Democratic presidential candidate or another (or Trump). Sanders has received his fair share of labor support, but has also elicited criticism from those union tops aligned with his “corporate” Democratic rivals, like Joe Biden. This past week, officials of the 60,000-strong, heavily immigrant and female Nevada Culinary Union made waves by publicly opposing “Medicare for All,” counterposing it to the existing Culinary Health Fund. The Culinary Health Fund provides relatively generous benefits because union members fought back in prior decades to defend their benefits against Las Vegas casino owners, notably taking over 900 arrests in a bitter 1984 strike, the largest in the city’s history.

Claiming that “Medicare for All” would “hurt members and their families,” the Culinary Union bureaucrats, as well as others like AFL-CIO head Richard Trumka, despicably echo the right-wing slanders against single-payer health care as some kind of menace to the country and its economy. In doing so, they express the parochial and suicidal view that the task of the unions is to preserve their own status at the expense of others, driving a wedge between their membership and working people who desperately need health care (including the extended family and friends of union members). This poisoning of class unity can only further weaken the unions and turn them into isolated outposts. Such a stance by the labor bureaucracy, which barely lifts a finger to organize the vast numbers of unorganized workers, flows from its position as a layer that has separated itself out from the rest of the working class, acting as labor lieutenants of the bosses in exchange for perks and privileges.

It is understandable that workers with decent union health plans might fear loss of benefits under a government plan. The unions must be ready to fight against any takeaways of their existing hard-won health plans. Defense of these gains, in fact, is part and parcel of the fight for quality health care for everyone. Today, only 10 percent of the workforce in the U.S. is unionized, and only a fraction of unions have adequate health care plans. Among those, entire sections of the membership are excluded or receive inferior coverage—like those relegated to lower workforce tiers, as well as part-time and temporary workers—due to the many workforce divisions acquiesced to by the union misleaders. Furthermore, health care coverage provided by the employer has its disadvantages. Come contract expiration time, management can bring out the knives to shred health benefits or use the plan as a bargaining chip to force other givebacks. When struggle is waged, the risk is that coverage will just be cut off, as GM recently did for a week to striking UAW members.

The labor movement has every interest in fighting for socialized medicine, and would find massive popular support in the oppressed layers of society if it did so. But such a perspective is thoroughly alien to the pro-capitalist union bureaucracy. These sellouts at the top of the unions must be sent packing, to be replaced by leaders who are clear-eyed about the class nature of the Democratic and Republican parties and put all stock in the class struggle and in building an independent political organization of the working class, i.e., a workers party.

Race and Class in American Health Care

Sanders is fond of proclaiming that aside from the U.S., “every other major country on earth” has national health insurance. But this did not come from the generosity of the capitalist rulers in Europe, where the greatest expansion of national coverage occurred in the aftermath of the victory of the Soviet Red Army over Nazi Germany in WWII. At the time, working-class upheaval gripped much of Europe, frequently coupled with aspirations to shatter the capitalist order. National health care programs and other welfare measures were introduced or expanded to appease workers’ militancy and counter the influence of the Soviet Union, where health care was free and available to all as a result of the proletarian October 1917 Revolution.

In short, the intent of the capitalist rulers was to ward off the specter of red revolution. Particularly since the counterrevolutionary destruction of the bureaucratically degenerated Soviet workers state in 1991-92, these gains have been whittled away. Even those national health care programs held up as models by social democrats, like that in Britain, provide inadequate care for the needs of the population.

The American bourgeoisie has long wielded a combination of anti-black racism, anti-immigrant nativism and sexual bigotry to rail against the so-called evils of a national health care program. That no such plan has ever seen the light of day is in large part due to how the bosses have used the race-color caste oppression of black people—a structural feature of American capitalism—to divide and weaken the whole working class and its struggles. The mass of black people are segregated at the bottom of society, disproportionately hit by unemployment, poverty and lack of medical care. Any serious effort to win universal health care must centrally take up the fight for black rights.

The capitalist rulers’ attacks against social programs that are perceived as aiding black people are in fact aimed at the working class as a whole. Initial drafts of the 1935 Social Security Act provided for state-sponsored health insurance, but the Dixiecrats (the Jim Crow Southern Democrats) refused to tolerate any such government “intrusion” into the health care system, fearing it could threaten segregation of the hospitals. To accommodate them, Franklin D. Roosevelt dropped the health insurance section and excluded the mostly black agricultural and domestic workforces from the Social Security Act’s other benefits. Up to this day, Republican rants against “big government” are racist code, shown in the revolt by politicians in the states of the former Confederacy against the ACA’s expansion of Medicaid. The white and black poor are now paying the price.

As for the Social Security Act, it is another prime example of a concession to mass struggle. The purpose of the legislation, like the rest of FDR’s “New Deal” reforms, was to derail the political radicalization of the working class and douse the flames of class struggle. The year prior, three citywide strikes led by communists and socialists—in Minneapolis, San Francisco and Toledo—had been fought and won by mobilizing the mass strength and solidarity of the workers against the forces of the capitalist class enemy. The convulsive class battles that forged the integrated CIO industrial unions would soon follow. But the CIO leaders treacherously redirected the budding appetite of many militants for a workers party back into support for Roosevelt’s Democratic Party. Among these misleaders were social democrats and Stalinists, the latter having shifted rightward to line up behind the liberal FDR.

Labor and National Health Insurance

Today’s social democrats are still hitched to the Democrats, only now Sanders is the object of their affections. One such outfit, the Democratic Socialists of America (DSA), is all about giving the Democratic Party of racism and war a makeover from the inside. It has provided Sanders with many of his “Medicare for All” foot soldiers, and churned out a steady stream of campaign propaganda in publications like Jacobin magazine. Typically, DSA material combines cheerleading for Sanders with calls for “a mass movement exacting pressure at all points of the process”—in other words, a lobby to convince “corporate” Democrats to get behind Sanders’s agenda.

One figure lauded by DSA members for his contributions to such “mass movements” of the past is Walter Reuther, the head of the UAW from 1946 until his death in 1970. It was no accident that this quintessential labor statesman, who collaborated with Democratic presidents on a host of issues, was also the main architect of the UAW bureaucracy, which worked tirelessly to suppress the combativity of auto workers. Reuther’s chief method for holding power over the years was to promote social-democratic schemes like Democrat-sponsored national health insurance as a substitute for mobilizing the working class to struggle in its own name and for its own interests.

Reuther pushed his way to the top of the UAW by riding the massive strike wave that swept the country with the close of WWII. At the time, fully one-third of non-agricultural workers were unionized, and they demanded wage increases to keep up with rising food prices. The ruling class responded with a carrot-and-stick approach. The biggest carrot was an improvement in the material conditions of the working class, made possible by the dominance of American capitalism over its war-devastated imperialist rivals. The stick was state repression and the legal shackling of union power, codified in the slave-labor Taft-Hartley Act of 1947, which prohibits secondary boycotts and other class-struggle tactics.

Another carrot, this one on offer from Democratic president Harry Truman, was a national health insurance plan supported by Reuther. The plan’s announcement was made in November 1945, at a time when UAW leaders were having difficulties restraining the fighting spirit of the ranks. Within two days, 225,000 GM workers poured out of 92 plants in 50 cities. Truman would go on to drop his plan after it provoked the ire of the American Medical Association (AMA), which denounced it as a Communist plot.

Truman prosecuted the Cold War against the Soviet Union and the anti-Communist witchhunt of the unions that went along with it. Reuther played a forward role in this crusade, enforcing the Taft-Hartley loyalty oaths to purge the UAW of the reds who had been central to the class battles that built the union. This move beheaded the UAW, while clearing the path for the Reutherite bureaucracy to fully cohere.

Truman revived the health plan proposal in 1948. It was election year, and union miners were waging a bitter series of strikes for union-controlled health benefits. Predictably, the AMA again mounted a major protest against the Truman plan as “creeping socialism,” and the reform died on the vine, although by then Truman had won a second term. Reuther was a major spokesman for the bill and sat on the White House health care committee.

With the writing on the wall for the Truman plan, and the miners having succeeded in extracting cradle-to-grave health benefits from the mine owners, Reuther and his team first negotiated employer-provided health benefits in the 1950 “Treaty of Detroit.” To achieve labor peace, the automakers granted several such gains in exchange for major concessions, like a five-year no-strike pledge and linking wage raises to productivity. At the time, health and pension plans were cheaper options for the bosses compared to wage raises.

The next decade, Reuther took up the civil rights struggle in order to help chain it to the Democratic Party. At the same time, he maintained his commitment to the racist status quo within the auto industry and the union bureaucracy. At the same time that black workers, who formed a strategic militant core of the UAW, began to rebel against this status quo, everyone working in the Detroit plants was feeling the pinch from a steady decline in real wages. By the late 1960s, one wildcat after another was breaking out in Detroit auto. The Reutherite bureaucracy swung into action to crush this revolt.

Against this backdrop, Reuther kicked off the Committee for National Health Insurance (CNHI), one of his final projects, in 1968. With the cost of health care then ballooning, he spotted an opportunity to recruit management to stand with the labor tops and liberal Democrats on the committee, and met with the GM bosses to that end. As Max Fine, the CNHI executive director, later put it: “Walter Reuther saw, way ahead of his time, that business and industry in America, if it had to bear the burden of health benefits—and foreign manufacturers didn’t—were…going to lose out to foreign companies.” Today, many U.S. corporations seek to improve their position vis-à-vis foreign competitors by shedding the costs associated with employer-paid insurance. This motivation is what has driven the Democratic Party’s various health care schemes over the decades.

Workers need an entirely different kind of “social vision,” one that views matters from the standpoint of class against class. The vehicle to impart such a vision is a revolutionary workers party, which would champion the cause of all the exploited and oppressed in the fight for their emancipation from capitalist wage slavery and all-sided misery. The state of health care in this sick capitalist society cries out for socialist revolution and the founding of a new social order.