When Representative Joe Wilson shouted “you lie” in Congress in September 2009, referring to whether or not undocumented workers will get healthcare under the Affordable Care Act (ACA), the politics of the current period of healthcare reform were set. It continued with Sarah Palin’s June 2012 tweet, “Obama lies, Freedom Dies,” and ex-militia Mike Vanderboegh’s threat of “civil war” after the recent Supreme Court decision on the “Individual Mandate,” referring to whether or not the mandate was a tax. Responding to this politics of attack, the Democratic Party has been successful in posing the fight for ACA as the fight for universal health care itself. Both sides obscure what’s really going on and what’s really at stake.
Both main parties insist that the majority of society must accept economic scarcity while guaranteeing the interests of global investment capital. The fight between the capitalists over how to sustain their class interests, over who will gain the most power and wealth in this process while keeping class peace, obscures working-class interests.
This reality is the context for the 2012 election cycle and beyond. Healthcare is increasingly central to everything from the struggle against the loss of trade union benefits, cuts to Medicaid and Medicare, to fights against hospital closures. U.S workers are joining an international class battle against a global austerity agenda, against government cuts in social programs for the sake of so-called fiscal responsibility. This agenda attempts to solve the crisis of capitalism, rooted in the application of labor-replacing technology to every aspect of production in the economy.
The way forward relies on revolutionaries who can develop the consciousness and ignite the potential power of the new class of workers. These workers cannot ignore the reality that job loss is fundamentally the result of increasingly laborless production. Healthcare can no longer be tied to jobs, provided as part of a social contract between labor and capital. The battle over health care reform is the fight to hold government responsible for providing basic necessities, and against the reorganization of society in the interests of Wall Street and corporate America. Revolutionaries have to guarantee the coalescence of a broad social consciousness around programmatic demands that healthcare and other basic necessities be provided to all of society on the basis of being human, regardless of job status, citizen status or the ability to pay.
A New Legality of Exclusion
The politics of austerity necessitates a restructuring of government based in a new legality of exclusion, while guaranteeing scapegoating and division among working people. The recent Supreme Court decisions on the “individual mandate” for healthcare and on Arizona’s “alien registration” law illustrate how the fight over the role of government in establishing this legality of exclusion in America is shaping up.
The individual mandate and the basic restructuring of healthcare reflect the bipartisanship at the heart of current health reform. The ACA is modeled after Mitt Romney’s Massachusetts state healthcare plan established in 2006. The mandate itself was originally proposed by the Heritage Foundation in 1989 as a counterpoint to both Medicare For All and the employer mandate, and appeared legislatively in 1993 as the GOP alternative to Clinton’s health reform bill.
The limited and short-term benefits of ACA will help pockets of the population. This leaves the millions who need equal, quality and affordable healthcare hoping they will gain something. Unfortunately, the reform relies on the same corporations that created “pre-existing conditions” and other problems in control while creating exclusion on an even broader basis. Despite the hopes of many progressive advocates who defend the Act, it is essentially the private insurance industry’s solution to capital’s inability to sustain the existing system of health insurance.
The individual mandate is regressive, requiring the near poor to pay a much higher percentage of their income for their coverage than the affluent. As costs continue to rise many times faster than wages, employer provided healthcare will continue to go the way of defined benefit pensions and the “Cadillac healthcare plans” that were the result of over a century of trade union battles.
States’ Rights and Medicaid
The same Supreme Court decision that upheld the individual mandate struck down the provision that would penalize states for refusing to expand Medicaid, the key guarantee in the plan for expanded coverage. Medicaid is the main way poor and disabled people have gotten healthcare in this country. This was already problematic. Having coverage doesn’t guarantee you get seen by a doctor because it reimburses doctors and hospitals less than care actually costs. Already fewer are willing to accept Medicaid.
Furthermore, states have been struggling to sustain the Medicaid programs as they are. Under the current economic system loss of jobs has forced more into poverty. But these problems are compounded with the ruling that states can decide if they even want to implement federally-supported expansion of the program. Some states have already announced they do not have enough doctors and other health care workers to carry out the expansion. The same 26 states that sued over the Medicaid expansion in the first place, arguing it was unconstitutional coercion, contain 55 percent of the nation’s uninsured, a total of 27.6 million uninsured people. Some states are al-ready talking about cutting Medicaid services in the coming year to help close a gap between Medicaid costs and appropriations. Other states are already asking the federal government if they can impose annual limits on hospital stays on Medicaid patients, no matter how sick the patient is. A hospital official warned, “I worry that the Medicaid card will be like Confederate money. You won’t have anywhere to use it, and it won’t be worth anything.”
This is not a side issue. Because of the economic crisis and the rising cost of health insurance, Medicaid is projected to serve about 22% of the population this year. Medicaid expansion is the way ACA is planning to cover an estimated 16 million people over the next seven years. By legalizing a state’s right not to implement this aspect of the ACA, the coverage promised by the new reform is itself at stake. Healthcare “reform” then is a conduit for social restructuring in the interests of global capital through our country’s particular historical support of states’ rights. Furthermore, by ruling the mandate a “tax” the Supreme Court decision establishes the basis for future judicial challenges to the social insurance model, as well as establishing the basis for undoing the entire legislation.
Immigrant Rights Set Standard of Care
The exclusion of all workers without citizenship documentation sets a legal limit on who has the right to stay well and to live in this country, particularly in light of the direction reflected in the other recent Supreme Court decisions to maintain the “show me your papers” provision of Arizona’s new anti-immigrant law. ACA clearly and specifically excludes undocumented immigrants from healthcare coverage. These exclusions give the attack by the right on “Obamacare” greater significance. The attack on healthcare is part of an attack on wages and the standard of living for the working class as a whole. Companies can go anywhere and their tendency is to go where wages are cheaper. Labor has the opposite tendency. They go where the wages and standards are higher. The denial of healthcare to undocumented workers represents an attack on the legal status of the entire new class who are increasingly forced to move within and across borders to survive in this global capitalist economy.
Immigrants’ rights to benefits have divided and hobbled the healthcare movement in the US for decades. In New Deal legislation, as the social contract for the industrial working class was consolidated in the U.S., farmworkers, domestic workers and others were excluded from benefits, wages and collective bargaining rights. The restructuring being implemented through “reform” is upping the ante. The standard of living of the U.S. working-class, until recently relatively privileged, is being driven down. This lays the basis for scapegoating among the workforce, ignoring the reality that job loss is fundamentally the result of this era of increased laborless production.
The fact is that the standard of care for the undocumented is becoming the norm. This relies on a moral acceptance that more and more of us won’t have rights corporations or government is bound to respect. The acceptance of propaganda that isolates the dispossessed and unemployed as criminals — and the legalizing of this criminalization — creates the social base for fascism in this country. This is the social and political cost of exclusion in healthcare or any other basic human need.
It’s not that ACA isn’t “good enough.” It is not an incremental step toward Medicare For All. It does not solve the problem we are faced with. We need access to healthcare. ACA provides access to private healthcare businesses for some, while excluding millions.
Equal Quality Healthcare for All
Revolutionaries rely on the objective interests of a new class of working people.
Those suffering for lack of access to healthcare but legally excluded are at the heart of this class. They cannot afford to “boycott” ACA. Those fighting for Medicaid expansion in their states have the potential to become part of the movement calling for government to guarantee the needs of everyone. A programmatic politics based in these class interests is the only force that can hold government responsible for equal, quality healthcare for all.
Revolutionaries have to guarantee that the fight for Medicare For All continues, while building on the growing consciousness that accessible quality health care for all can be secured only if our health care system is restructured, not in the interest of big corporate hospitals, big Pharma or private insurers, but in the public’s interest and under our public control. To secure that, government must act to nationalize health care resources in our interest. Provision of healthcare shows the social interdependence of humankind. Such interdependence requires a social system that supports health decisions based on science, ecological sustainability and human morality. This is incompatible with the dictates of capitalism.
Health care is corporatized. It needs to be nationalized. The future is up to us.
September/October 2012.Vol22.Ed5
This article originated in Rally, Comrades!
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