Photo – www.nationalnursesunited.org
By the League National Healthcare Committee
Medicare and Medicaid turned 60 last year and health care is back on the national agenda. For those of us who have spent our lives working and fighting for health care as a human right, the anniversary is an invitation to think more deeply about the future. Medicare for All remains indispensable because health care should never depend upon employment, wealth, citizenship status, or private insurance. But universal insurance alone cannot answer who owns health care infrastructure, who controls health care data, who governs artificial intelligence, who plans the health care workforce, who guarantees care in communities abandoned by the market, or who ensures that technological abundance serves human need rather than speculative profit.
The 1965 passage of Medicare and Medicaid took place alongside the Voting Rights and Civil Rights Acts in the United States. Together, these reforms were a direct result of a U.S. Civil Rights Movement, a powerful social movement that temporarily coincided with the interests for maintaining a stable workforce of an expanding global capitalism. That era is over.
For over half a century since these reforms, fighters for basic human rights have understood our task as completing an unfinished project. Medicare should become Medicare for All. Medicaid should be strengthened rather than cut. Employer-based insurance should give way to universal public insurance. Health care is a social right rather than an industry.
Americans have not given up. In June of this year, in an open letter from National Nurses United (NNU) and over three-hundred other organizations called for Congress to finally pass Medicare for All.
Voters from New York to Michigan are electing candidates calling for a universal health care. Congressional members from Sen. Bernie Sanders to Rep. Pramila Jayapal have made Medicare for All their calling card. But achieving it requires a sober assessment about what we are up against today, about who we are and how we build a movement sufficient to the task.
We are one year into implementation of the “Big Beautiful Bill,” (HR-1) that directly targets Medicaid and what’s left of America’s health care delivery system. American communities, particularly in rural areas, face hospital closure. ICE detention centers, and AI data centers get vast investments, while citizens and noncitizens alike are denied health care. Any social contract that once existed in America is long broken.
U.S. Health care reform on the federal level stalled in 2010 with the passage of the Affordable Care Act (ACA), also known as Obamacare. ACA provided a way to expand access to health insurance but kept the insurance companies in control of that access. Since then, the fight for reform has focused on the state and local levels while corporate rule has become increasingly global.
It’s not about saving money. For decades, reformers have led with the reality that “Single Payer” health care is far cheaper than the monster Frankenstein of U.S. health provision. But in the six decades since Medicare’s passage, health care has itself become a principal site for capital accumulation. Hospital systems have merged into vast regional corporations. Private equity firms purchase physician practices, nursing homes, and emergency departments. Pharmaceutical corporations exercise enormous influence over research and treatment. Insurance companies increasingly function less as managers of care than as managers of financial risk.
The application of digital technology to the health care industry illustrates both the promise and the danger of this moment. Artificial intelligence and digital systems can help diagnose disease, reduce paperwork, and expand access to medical knowledge. But when capital’s primary goal is reducing labor costs and maximizing profits, innovation deepens the crisis rather than solves it. The real question is who controls it and whose interests it serves. The politics of class power determines its use.
The global COVID pandemic of 2019-2022 showed the world how fragile our non-system had become. The U.S. public health apparatus, long in tatters from decades of cuts to on-the-ground health promotion and prevention, was able to develop timely vaccines, as well as monitor and provide guidance to the nation. Congress passed emergency bills to avoid pushing more Americans out of housing, food and health care than before the pandemic.
But corporate private property still rules. Even before American deaths got back to “acceptable levels,” the American fascist propaganda did everything it could to attack acceptance of medical and health science, public health and people’s life-sustaining basic needs. Over the last year or so, Secretaryof Health and Human Services (HHS) Robert Francis Kennedy Jr.’s cuts to the Centers for Disease Control (CDC) and the National Institutes of Health (NIH) is bent on destroying what’s left of America’s federal public health system.
But the most potentially profound transformation in health care provision in the United States is human. Health care is a key driver of profitability for capitalism, but it is also the largest job industry in the United States today.
The COVID-19 pandemic exposed the fragility of America’s “essential” health care workforce. Hospitals, for-profits in particular, already understaffed and resourced came out of the crisis looking for a way to cut labor costs further by working with silicon-valley to expand “just-in-time” staffing schemes. Gig work is moving into health care. CareRev, ShiftMed, Trusted Health, Nomad Health, connectRN promise investors big bucks.
AI and other digital technologies, from remote patient monitoring and electronic health records to AI diagnostics are changing the system and replacing workers. The strength and geographic scope of nurses strikes in the past year is a key expression of this process. Early this year, 20,000 nurses at 12 private-sector hospitals in New York City went on strike for forty-one days over staffing cuts and untested AI technologies, the largest and longest nurse strike in NYC history.
While the U.S. can export factories, the reality is that when it comes to service and care jobs, the United States cannot export its health care workforce. For over four decades, the health care industry in the United States has relied on what we have known traditionally as the “empire of care,” importing workers from other countries who often put more of their national resources into advanced scientific, and medical education to export workers to the United States.
This is true in urban and rural care provision. In the American rural South, Trump called for local governments to pay big bucks to get foreign-trained folks to fix shortages of lab technicians. In the California’s San Joaquin Valley, local clinics are already using doctors from India and Pakistan and with the large population of Spanish-speaking folks, Mexican doctors are critical.
Health care has become an industry, yet its ostensive purpose is not simply to create commodified products but to preserve life itself. This contradiction creates terrible challenges but it has also created the conditions for a broad movement for real transformative change.
Health care workers organizing around winning union contracts are also taking political stands. Members are demanding safe staffing, protection of public hospitals, defense of Medicaid, equitable patient care, and preservation of scientific integrity. They are fighting for Billionaires’ Taxes to fund care, and taking union funds out of Israel in opposition to the bombing of hospitals in Gaza. They are joining with community-led organizations calling for community mental health, health care justice and “Care not Cops,” and abolishing ICE.
These motions reflect collective strategies for self-protection. They also reflect the emergence of a social and political consciousness of the contradictions of our society and what’s needed to create a truly cooperative society. Attacks on immigrant caregivers has created conflict between immigrant and non-immigrant workers and communities, but it has also begun to shape a movement towards class unity.
Immigration and Customs Enforcement (ICE) agents in U.S. hospitals has become a central workplace issue for hospital staff and patients. Health care workers are traumatized, afraid to come to work and incensed at having ICE agents in the room when they see patients, against all medical ethics. The recent Supreme Court decision to end Temporary Protected Status (TPS) for Haitian and Syrian home care workers is leaving elderly and disabled American patients feeling angry and abandoned.
The health care workforce is now one of the largest and most diverse sectors of working America. We are asking how technology can strengthen rather than replace caring relationships. We insist that immigrant caregivers are members of our communities, not disposable labor. We measure economic success not simply by financial growth but by whether people can live healthy, meaningful lives. We understand public health as a democratic responsibility.
The fight for Medicare for All has reached a historical turning point. Will health care remain primarily a commodity purchased in the marketplace or become a social commitment organized around human need? Can we envision and build a publicly owned and governed system of care in America?
The answer will depend upon whether we can build a movement whose vision is as large as the transformations now reshaping our world. For those of us who have spent our lives caring for others, that task is profoundly social and political. And it may be one of the defining democratic responsibilities of our generation.
Video on the struggle over Medicare For All: https://vimeo.com/showcase/5783489?video=505812996
Published on August 19, 2026.
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