Sickness & struggle, part 9: The road to health care justice

By David Hoskins


Last of a series of nine articles on the decades-long battle for an adequate health system covering everyone in the United States, with commentary on how to continue the struggle.

Rising unemployment and out-of-control insurance premiums have intersected to cause almost 5 million people to lose their health coverage since the beginning of 2008, according to Families USA. This has exacerbated an already dire health care crisis that has left more than 50 million people uninsured and another 25 million underinsured.

While Republicans have blocked progress up and down the line, the Democrats too have failed to fight for real health reform, despite their control of the White House and both houses of Congress. Instead of providing health care justice, Democrats have opted to advance a bill that redistributes tax money away from poor and working-class people into the coffers of the big insurance companies.

The Democratic Party’s approach delivers the insurance companies a captive market through a mandate that millions of the uninsured must purchase private coverage or face severe financial penalties. It is expected that such an approach will still leave as many as 23 million uninsured as of 2018.

A revolutionary approach to health reform

Radical crises like the one in health care require radical solutions.

Revolutionaries take into account the immediate drive for reform and the long-term struggle for revolution when making demands on the system. Minimum and maximum demands are the result of this process.

“Improved Medicare for all” is an appropriate minimum demand for this period. It is a demand that corresponds to the consciousness of the workers and responds to the crisis in health care. Improved Medicare for all means a single-payer system of national health insurance that organizes health financing through a single public agency and removes private insurance companies as the arbiters of who does and does not receive adequate care. It has been proposed in Congress as H.R. 676.

Improved Medicare for all represents an immediate demand that would fix some of the most glaring problems in health care. But what workers really need is a humane system of health care that entirely removes the profit motive out of the equation, from financing to delivery.

To be fully realized, this maximum working-class demand requires socialism. Socialist medicine — such as that in Cuba — is a system that is publicly financed and administered. Hospitals and clinics are democratically operated, with doctors and nurses working as public employees. Production of pharmaceuticals and medical equipment are public enterprises, designed to meet people’s needs.

Rosa Luxemburg, the great founding leader of the German Communist Party, wrote on the relationship of reform to revolution in her aptly titled pamphlet, “Reform or Revolution.” In this work published in 1900, Luxemburg eloquently asks, “Can we contrapose the social revolution, the transformation of the existing order, our final goal, to social reforms? Certainly not. The daily struggle for reforms, for the amelioration of the condition of the workers within the framework of the existing social order, and for democratic institutions, offers an indissoluble tie. The struggle for reforms is its means; the social revolution, its aim.”

Improved Medicare for all is the right thing to demand now. Only socialism—and by way of getting there social revolution — can provide the final answer for workers’ health care needs.

The road to reform, and revolution

Despite disappointment in the Democratic Party’s health reform legislation, there is a valuable lesson for workers and the oppressed when evaluating the actions of the present government. It is a lesson that revolutionaries should declare at every opportunity:

The Democratic Party is not the answer. It is not even a vehicle for reform, and electing Democrats is not a strategy for advancing working-class demands. With a popular first-term president, a filibuster-proof Senate, and a 79-seat majority in the House, the only reason the Democrats have not waged a serious fight for meaningful health care reform is because they do not want to wage such a fight. The only reason they have not used their super-majorities to pass truly universal health reform is because they are a capitalist party, and it is not in their interest to do so.

Workers will obtain neither reform — on health care or any other issue — nor revolution so long as the responsibility to fight for working-class demands is left up to the corporate-controlled Democratic Party.

Only a revolutionary workers’ party, supported by a mass movement of workers and the oppressed, can lead us down the road from health care reform to revolution. Without such a party and movement it is not possible to achieve either improved Medicare for all or socialist medicine.

Workers World Party has been struggling to build a revolutionary party and contribute to a mass workers’ movement for over 50 years now.

It is this sort of dynamic workers’ movement that is capable of challenging the entrenched interests of the big insurance and pharmaceutical companies. Glimpses of what this movement could look like can be viewed in embryonic form in key actions from 2009.

The April 3-4 National March on Wall Street broadened the attention of the movement as it expanded the focus from concentrating solely on the elected representatives of the bourgeoisie in Washington to taking on the ruling class directly and on its own turf.

In June 2009 the National People’s Summit and Tent City in Detroit challenged a national gathering of bankers and business leaders and put the issue of jobs or income for all on the agenda in that devastated city.

The Sept. 20 National March for Jobs and Tent City in Pittsburgh elevated the issue of unemployment and challenged the G-20 finance ministers and central bankers who had gathered in Pittsburgh that week to bail out the people, not the banks.

This new year offers the opportunity to build on these actions and advance the workers’ movement. Examples of specific actions are those planned by the Bail Out the People Movement on Jan. 15 in New York’s Wall Street and on Jan. 18 by the Martin Luther King Planning Committee in Detroit that will focus on the demand for the right to a job or income for all.

These protests begin the task this year of building the type of workers’ movement necessary to advance working-class demands — whether that is a job or income as a right, a moratorium on home foreclosures, or free quality health care for all.

The working class is sick from this crisis in health care. Struggle is the only path to a cure.


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