There has been a heart felt yearning for a just system of health care for most of the 20th century. The 21st century holds a vision for a health care delivery system where everyone has access to equal, quality, comprehensive health care services based on need and not on ability to pay, citizenship status or other barriers erected to protect the interests of private health care corporations and insurance companies.
From preventive care, healing and education to sophisticated surgery and beneficial medications, we have the capacity. The knowledge, technology and resources now available can only be secured through a guarantee that the new class of dispossessed, the retired and vulnerable workers are never again abandoned, marginalized or sacrificed in pursuit of a false promise of health care for all!
Restricted by the interests of industrial capitalism the publicly funded social insurance programs of Social Security, Medicare and Medicaid, though militantly fought for by labor and social movements, have been structured primarily to serve the needs of capitalism and only in very temporary and limited ways the needs of our class. Paid for out of workers’ paychecks, these insurances were guaranteed by the State as part of the contract between labor and capital.
Signaling the fracturing of this contract, the “fiscal cliff” agreements postponed many budget decisions until March 1, and locked in elements of the Bush tax cuts. More austerity measures are anticipated, robbing the working class of any publicly funded and administered insurance while setting the basis for further privatization.
Even as the movement fights to protect what’s left of our hard fought reforms, it is time our class moves beyond the outmoded social insurance framework, not because the working class is losing its fight against corporate control, but because it has to go further in order to win. The replacement of human labor by robotics and technology is transforming society and washing away the limited and temporary victories secured in 1935 and 1965. Victory today means distribution of necessities like retirement security and health care, based on the needs of a new class of workers that has no ties to capital.
The underlying cause of the crisis is the transformation of production based on industrial labor to an increasingly labor-less electronics base. Capitalism’s goal of maximum profit has not changed, but the way the ruling class amasses its wealth is changing. The corporate State loots public programs as ever more workers are thrown into poverty by loss of jobs.
Political History of Social Insurance
Social Security and Medicare were financed as part of the cost of production of the worker and directly deducted from wages as a payroll tax. The Social Security Act of 1935 was the result of a massive struggle of millions who marched and demanded relief as the working class resisted the crushing weight of industrial capitalism’s crisis of overproduction, the Great Depression. Brutal force, accompanied by red-baiting and its cousin, “race-baiting,” was used to physically and ideologically attack the demands for an egalitarian social insurance. Social Security initial-ly excluded domestic and farm labor, largely populated by African Americans and Latino workers. These exclusions underscored the power of states’ rights and its dominant ideology of white supremacy that has been used to handcuff working class unity.
The power of Southern political hegemony and the demand for states’ rights are seen in Medicaid’s structure and funding. Some 30 years after the passage of Social Security, Medicaid was a compromise with the Southern states. Medicaid implementation began in 1966, but it wasn’t until 1970 that Southern states accepted the 2:1 federal match for Medicaid funds. Meant as an adjunct support for an unemployed but potential labor force, Medicaid requires a combination of federal and state funding. It was inadequate and unequal from the start with Southern states limiting funding to the bare minimum. Medicaid funding was also used to pay for unethical and radical social policy, such as the dangerous and discredited use of Norplant, primarily foisted on young women of color as a not-so-disguised form of population control.
Medicare and Medicaid came on the heels of the powerful Civil Rights movement as an amendment to the Social Security Act but with very different policy frames. Medicare was designed mainly for those aged who had contributed through payroll taxes during their working years. The disabled were added later. Medicare was to be a precursor for government national health insurance for all, not just those over 65. Because of the divide enforced by the states’ rights policy articulated in Medicaid, and the powerful attack dogs of a ruling class coalition of Dixiecrats, the American Medical Association, and business trade unionism, attempts to expand Medicare
to all were defeated.
The next 20 years fueled the growth of a predominantly private health care delivery system funded by trade union negotiated commercial insurance deals and the social insurances of Medicaid and Medicare. Medicaid is increasingly becoming the essential form of health insurance for greater numbers of unemployed and underemployed workers and is under the most intense attack. Its value to the capitalists is the many ways it can be corporatized.
Today we are confronted with the compromised position of defending an increasingly weakened Medicare and a largely corporatized Medicaid. Securing a safety net for some calls for a strategy to win health care for all; this requires a class united in its own interest, stripped of false ideological divisions that cripple unity.
Affordable Care Act: Boon to Private Insurance
The Affordable Care Act (ACA) is not universal health care, nor a step towards that end. It is private health insurance in the age of electronic production. Supposedly aimed at addressing a severe lack of health care coverage, it was forged from a bipartisan agreement to target future “deficit spending” on health care while maintaining the health care industry for capital investment.
ACA still leaves at least 26 million uninsured, including roughly 11 million immigrants. The undocumented, just like the farm laborer and domestic workers before them, are an integral part of our working class, and they are excluded (except in emergency) from private or public insurance by ACA, setting the healthcare floor at zero and threatening the health security of the whole working class. Most other Americans will join the chronically underinsured with increasing out-of-pocket costs and no relief from medical debt-related personal bankruptcies, which will inevitably increase.
While social insurance of the industrial age is under attack for being public, the ACA is a blatant prop for corporate health care. The ACA mandated that every uninsured person buy private health insurance. The lowest priced insurance will only cover about 60% of billed health care costs and still cost about $5000 a year for an individual. The ACA is another excuse for corporations to drop employment-based health insurance.
Further, there are provisions to publicly subsidize private insurance purchases for some based on income. These market places for private insurance purchases are to be established by state or federally arranged insurance exchanges, “dealerships” for buying private health insurance. In effect, the State will take our money to bolster the private insurance industry. It is integral to a major restructuring of health care, boosting the financial and political power of private insurance. Government is used to guarantee that insurance companies have fully morphed into giant tools for investment capital.
The Supreme Court ruling on ACA undermining state requirements for Medicaid expansion sets a legal precedent for limiting the federal government’s ability to alter other federally financed programs administered at the state level. To date, almost every Southern state has declined to expand Medicaid. The erosion of the United Auto Workers’ union Voluntary Employee Benefit Association (VEBA) agreements is a harbinger of what is to come even for organized labor.
The Fight We Face
The crisis of America’s social insurances is a political crisis, a class struggle over the resources of society. Ruling class ideology, never in the interests of the working class, no longer has any material base in a society that increasingly produces goods and services without human labor. The so-called “deserving” worker is fast becoming “undeserving” as more and more human labor is replaced by electronic production.
The fiscal cliff propaganda and resulting bipartisan actions were aimed at terrorizing us into accepting a “shared sacrifice” based in a ridiculous notion of scarcity in this land of abundance. Our class is being forced to buy private health insurance and defend an increasingly weakened public corporatized health insurance system that excludes the undocumented, is unequal and inadequate to meet recipients’ needs. This is no “grand bargain.”
We can no longer accept a definition of social necessity determined by private ownership of our collective public wealth. The Democratic and Republican parties are offering a bipartisan solution that decimates Social Security, Medicare, and Medicaid in exchange for a paltry income tax increase on the “rich,” leaving investment capital without any requirement of social responsibility.
The Occupy movement, “Strike the Debt” activities, and struggles from New Orleans to Wisconsin, Chicago, and Michigan have put a serious dent in notions of a class neutral society. They can become strong levers for conscious class unity. As revolutionaries, we proceed from the reality that transformation to a free cooperative, publicly owned and administered health system will be fought out in the battle to capture and nationalize our fractured resources. We are at the dawn of a new society. Whether it will be based on the common ownership of the vast resources, products, and technologies of the 21st century and shared for the public good, or whether it will be hoarded, distorted and collapsed into the wealth of a few is up to a class that cannot live with a system based on private ownership of the social wealth. We have a world to win!
March/April 2013. Vol23.Ed2
This article originated in Rally, Comrades!
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