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Tuesday night, Bernie Sanders held a live-streamed town hall to discuss the prospects and potential for a single-payer Medicare for All health care system. On the panel, among physicians, nurses, students, and international health ambassadors sat a few corporate executives. Each praised the cost effectiveness of the Medicare for All system and insisted that the program made “good business sense.” As Sanders’s legislation becomes increasingly popular, it’s likely that a few more business leaders will trumpet their support. But Medicare for All advocates should be skeptical of members of the business community, even when they purport to be on our side. There are three big reasons that socialists and progressives should be wary of capitalist advocates for any social policy, and in particular for Medicare for All. First, focusing on cost-effectiveness for corporations is bad politics in the long term, since it reinforces the idea that businesses’s profits are as important as ordinary people’s needs. That puts the Left in a position of weakness whenever we pursue other reforms that don’t save CEOs any money, but are just as worthwhile. Second, when progressive and left-wing politicians and political organizations neglect to keep capitalists at arm’s length, the latter’s outsize resources give them outsized influence — often resulting in weakened policy and a diluted program. In order to ensure the eventual passage of comprehensive policy that benefits workers, not just employers, proponents of Medicare for All need to walk a fine line, stoking divisions within the capitalist class without giving the business community a seat at the table. And third, national single-payer health care will not come to fruition without a major mobilization of the American working-class majority. That is going to require naming class enemies and building class consciousness, a project that will be muddled and undermined by any willing embrace of business leaders with decidedly different material interests. Relatedly, the transformative potential of Medicare for All is bound up in its ability to awaken the militancy of the American working class after decades of political dormancy. For this to happen, workers need to be placed front and center in the struggle against the private insurance industry.

A Penny Saved The Left understands employers and workers to be locked in perpetual struggle. This is the basic conflict at the heart of capitalism: employers seek to extract as much value from workers’ labor as possible, while workers resist this compulsive exploitation with various demands for security and freedom. Sometimes workers’ demands actually do benefit one slice or another of the private sector. But more often than not, reforms that help ordinary people hurt capitalist interests overall — and worker empowerment means capitalist disempowerment, in the aggregate. With that dynamic in mind, it doesn’t make sense for people who are motivated by the desire to free people from capitalist exploitation to adopt the “good business sense” rhetoric of employers. It’s true that, even though Medicare for All will wipe out an entire mega-industry, there are employers in other industries who will find it financially beneficial. But that fact is incidental. The point of pursuing Medicare for All isn’t to save corporations money, it’s to save working people’s lives, and to empower average Americans to make choices on behalf of their health and happiness instead of their existing or potential medical debt. Left-wing proponents of Medicare for All shouldn’t hesitate to drive home how much money the average worker will save with a transition to single payer. But the moment we insist a policy is a social good on the basis of the benefits reaped by the business community, we’ve ceded the political goals of our project. Let’s say Medicare for All failed to save employers money: would this make the demand any less worthy? From a capitalist perspective, yes, but from a socialist perspective, of course not. Mimicking business rhetoric is self-defeating for the Left. Medicare for All is one of many struggles on the horizon, and not only are there tons of instances where capitalists don’t benefit from reforms leftists seek, but capitalists do not benefit from any overall increase in worker power, solidarity, consciousness, and capacity. Progressives and socialists should be explicit and consistent in the message that capitalists’ profits are not the objective. Indeed, oftentimes capitalists will lose money and power from policy interventions that empower everyone else — and that’s great.

Taking Care of Business The second issue concerns the privileged position business holds in American politics and society. The American state is dominated by corporate interests. The political mobilization of the business community is often the decisive factor determining social policy outcomes. In fact, when the business community acts in unison it is difficult if not impossible for countervailing institutions and organizations to overcome their influence. This is due to both the tremendous resource advantage individual firms and organized business groups wield and business’s advantageous structural position within the economy — consider that the army can force workers to work, but it can’t force capitalists to invest. And with this kind of leverage, business groups routinely win concessions regarding social policies that they perceive hurt their bottom lines. When the capitalist class is divided, however, popular forces have an opportunity to operate and put pressure in the cracks. As such, we should welcome business dissensus when it comes to Medicare for All. In order for Medicare for All to become a reality advocates will ultimately need to isolate the insurance industry from the larger business community — we want chaos in the Chamber of Commerce. But that doesn’t entail welcoming business elites themselves. Even the most liberal business elites will seek to minimize the harm single-payer might inflict on profitability. If we let the liberal business elite come to appear as credible and trusted allies in this fight, they will undoubtedly try to shave down coverage, ease the tax burden on the wealthy, or implement means-testing in hard times. Not only would such concessions hurt the efficacy of a single-payer Medicare for All system, they would make the whole program more vulnerable to conservative sabotage. Elevating business leaders among the broad coalition of Medicare for All advocates — which includes vastly greater numbers of workers, students, physicians, and yes, even socialists — would ultimately amount to inflating their own already outsized influence. If we want a robust version of Medicare for All, one that won’t be vulnerable to chiseling down and one that benefits the working-class majority, it’s workers that must be front and center.