The crisis in health care shows the inability of capitalism to function as a viable economic system. The crisis is conditioned by the development of electronic forces of production. Revolutionary change in the way goods and services are produced, including in health care, necessitates a corresponding revolutionary political solution if we are to get the health care we need.
History
The needs of capital have defined the State’s role in health care in this country. Under the laws of the plantation South, a slave’s health and survival depended entirely on the labor needs of his owner and the brutality of his or her labor. Slaves “sold down the river” had a scientifically calculated life span of seven years. In the 19th century, some slaves received crude health care because the planter understood that “to save his capital was to save his Negroes (slaves).”
To resolve wage-labor productivity problems as the economy transitioned from a manufacturing and rural economic base to an urban industrial one, the State elevated its role in providing health care. The 1909 Rockefeller Sanitary Commission launched the first public health program to increase productivity of Southern mill workers by eliminating lethargy-producing hookworm infections. Increased productivity led to reduced labor costs and increased profitability. That lesson was not limited to the textile barons of the South.
The struggle over the needs of the two class forces, the workers and the capitalists, shaped the period of industrial capitalism in the mid-to-late 20th century. Intense trade union struggles, especially among coal miners and auto workers, tied good health care benefits to the conditions of employment. The so-called Cadillac plans of a generation ago were necessary to maintain the productivity of the worker and insure the extraction of maximum profit by General Motors and Ford. The rope that tied opposing class interests together found political expression in the marriage of the trade unions to the Democratic Party, ensnaring the broad mass of workers far beyond organized labor.
Accommodated by capitalism’s expansion, the powerful civil rights movement of the 1950s and 1960s secured the passage of Medicare and Medicaid. Governmental policy assumed health care responsibility for those no longer working, reducing poverty for the disabled and those over 65. Medicaid was a very thin thread from the start, however, and neither program challenged poverty. Now both are being painfully dismantled and privatized in the face of increasing need.
The Health Care Industry: From Cottage to Commercial
Fueled by funds from union contracts, public health insurance, accelerated scientific advances and the carnage of two world wars, health care was transformed from a cottage industry to a commercial enterprise. The vision of universal Medicare for all was aborted by petit-bourgeois professionals and a compromised trade union movement satisfied with offering negotiated health care benefits as an incentive to unionization. But changes in the productive forces of society (the ways things are produced) began to take hold, forcing changes both in industry and health care.
The 1990s witnessed huge transfers of wealth with the mergers of private insurers and the conversions of “not-for-profit” health insurance companies to for-profit. Commercial private for-profit health insurers were locking in their hegemonic position in the health industry. Privatized public resources and neoliberal governmental policies took hold. Medicaid was turned over to private managers who siphoned off public monies by callously restricting access to care.
An alphabet soup of HMOs, PPOs and HSAs appeared as employment-based private for-profit health insurance options along with soaring premiums and bankrupting deductibles. As robotics and electronics started replacing human labor on the factory floor and supermarket check-out counters, capital’s historic “investment” in health care shifted from increasing labor productivity to speculation. By now the huge health care industry already accounted for more than one-fifth of the U.S .economy.
21st Century Reorganization
The introduction of electronics into the health delivery system is forcing a total reorganization of this huge section of the economy. The birth canal of this reorganization is the Electronic Medical Record (EMR) system.
Stimulated by regulatory and funding legislation from 2009 to the recent Patient Protection and Affordable Care Act (PPACA), EMR’s primary function is to secure profitability in an increasingly valueless system of commodity production. The patient — a heart-beating, deep-breathing, flesh and blood person — becomes a “virtual” commodity.
What are termed Accountable Care Organizations, a product of the PPACA, are absorbing what’s left of independent physician practices. Huge vertical systems of hospitals, clinics, laboratories, pharmacies, and health supply companies, are being linked by EMR and Internet “clouds.” Doctors become workers. Nurses are deskilled. Robotic “care-givers” and pharmacists wait in the wings to replace more health care jobs in a 15 million-person industry. No job is secure. Over 3000 health-care workers including doctors and nurses were recently laid off in Georgia alone.
The crime is that scientific advances are feeding speculative capital rather than being used to yield potential life-saving wonders to humanity. Abundance of resources exists. Scarcity is not the issue. Delivery and distribution have to be brought in synch with need.
Private equity firms are having a feeding frenzy, loaning billions of dollars to hospitals to structure these integrative health industry systems. Vanguard Health System bought Detroit Medical Center for $1.5 billion, backed by two private equity funds, Blackstone and Morgan Stanley. Private equity firms are the loan sharks of speculative capital. The contradiction between the mega-delivery systems being created and the private insurance and equity firms who require a profitable return on their investment will shake the foundations of the health industry and ultimately the whole economic base of the country.
The corporate consolidation and concentration of health care is nothing like the family doctor of a generation ago or even the HMO of ten years ago. We cannot go back. The very concentration of the resources of health delivery begs the solution of public nationalization of those resources to secure the health delivery we need.
Breaking the Ties that Bind
Over 50 million Americans are uninsured. Millions more are underinsured. The rope that tied labor to capital has been snapped by increasingly laborless production. Robots do not need health care.
Last ditch efforts to stave off a total collapse of the health care system can only serve to accelerate it. The PPACA mandate that everyone buy private health insurance has been a useful default for employers to drop health benefits completely, or offer the investment-laced High Deductible Health Savings Accounts — a sure and deceptive road to absolute poverty. Unaffordable insurance that covers nothing, minimally subsidized by public monies to ultimately pay speculative capitalists, demonstrates the folly of a shell game called health care under capitalism today.
The struggle for health care reform in the last twenty years has been characterized by increasing efforts to protect health care benefits and demand single payer national health insurance. Both are being challenged by the transformation in the economic base. The historic policy debates pounding within the confines of legislative halls, union meetings, and Democratic Party gatherings are rushing toward a real political fight. New leadership is emerging that has no option but to go on the offensive. Real lives, not virtual commodities, are at stake.
The Voluntary Employee Beneficiary Association (VEBA) agreements of the UAW and others expose the core of the crisis. The auto industry set up an under-funded VEBA trust fund, ultimately abandoning its health care obligations. Originally projected to last 80 plus years, VEBA’s security is now questionable beyond a decade. Why would it be otherwise? There are more non-producing retired workers than active workers, despite an abundance of products.
A myriad of bipartisan Super Committees call for “sharing the sacrifice” by accepting cuts and further privatization of Medicaid and Medicare, rearranging the old rope that tied labor to capital into a noose strangling the whole working class. Arizona and Southern states go to great lengths to exclude the undocumented from access to health care alongside other human rights. Medical students in debt, militant nurses forced to strike on their own and their patients’ interests, and the health and welfare of the people of New Orleans abandoned in the wake of Katrina all sharply define dispossession. They all make it perfectly clear that governmental power and resources cannot be negotiated, only taken, signaling the potential emergence of new activity and consciousness.
Increasing calls for National Single Payer Health Insurance and the elimination of the private insurance industry reflect the direction towards health care provision for all in this country. The current system of health care was built to support the productivity and reproduction of an industrial working class, and no longer fits a society that replaces labor power with technology. Governmental policies that have paved the way for this unprecedented corporate health industry have to be met with a fight for control over the healthcare system as a whole, for nationalization of health care in the interest of the entire class.
Hopes for legislative victories within the framework of the Democratic Party have soured. New leadership is arising and grappling with questions of power and political independence. The antagonism between the private ownership of the corporate health industry and the unmet social need for real health care is confronting us with a vision of what is possible, and turning a total transformation of health, wellness and healing into a revolutionary necessity.
January/February 2012.Vol22.Ed1
This article originated in Rally, Comrades!
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