The emerging class struggle over health care in the US

29 June 2017

Following the announcement on Tuesday that the Republicans would be putting off a Senate vote on their health care bill until after the July 4 congressional recess, the Democrats and Republicans continued their stage-managed debate over measures that will have devastating consequences for millions of Americans.

The media’s presentation of a bitter feud over the direction of health care policy is a political fiction. The newspapers and television networks report on the statements of one or another lawmaker and his or her attitude to the plan recently unveiled by Senate Republicans as if this will have any real impact on the trajectory of ruling class policy.

The more decisive verdict was delivered on Tuesday by Wall Street, which saw its biggest one-day drop in six weeks after Republican Majority Leader Mitch McConnell put off a Senate vote this week. The message was clear: the corporate and financial elite wants its money, and it wants it now. The health care measure includes a $700 billion tax cut for the rich—a down payment on the money to be freed up by depriving the elderly and poor of their health and even their lives.

The American ruling class is engaged in a form of social arson no less criminal or deadly than the policies that led to the Grenfell Tower fire in London.

McConnell responded on Wednesday by promising that a new version of the bill will be ready by Friday for a vote sometime in July.

Charles Schumer, the Democratic Senate Minority Leader from New York, reacted to the summons of the market by reiterating his call for a “bipartisan” solution, a mantra repeated by virtually all congressional Democrats. “Democrats are genuinely interested in finding a place where our two parties can come together on health care,” Schumer said. That Schumer gets more campaign money from the hedge funds and banks than any other senator, Democratic or Republican, is sufficient to demonstrate what type of child will issue from such a union.

Schumer did not comment on the apparent contradiction between his claims to be fundamentally opposed to the Republican plan and his calls for a bipartisan compromise. His position exposes the fact that the two sides share a basic agenda.

The Democrats assert that they want to “fix” Obamacare. What does this mean? They are not talking about expanding coverage to include the 28 million still without insurance under the Democratic plan, or increasing the inadequate subsidies, decreasing absurdly high deductibles and copays, and preventing the insurance companies from raising premiums. “Fixing” Obamacare is a euphemism for incorporating the demands of the insurance industry for even fewer restraints on their profit-making and tighter eligibility requirements for consumers.

The public has seen this type of political theater countless times, and the outcome has invariably been the same. The Republicans set the marker as far to the right as possible and the Democratic “opposition” results in a deal to impose new and more drastic cuts to health care and other social programs. The most significant and fraudulent of these dog-and-pony shows was the passage of the Affordable Care Act, or Obamacare, itself.

The Republican proposal is not in fact a “repeal” of Obamacare. It incorporates the structures set up by the Democratic measure, such as the exchanges for purchasing policies from private insurers, designed to more fully subordinate the health care system to the capitalist market and encourage the demise of employer-sponsored health coverage, placing individual workers even more at the mercy of the insurance giants.

The central purpose of Obamacare is to shift costs from corporations and the state to the working class, with health care increasingly rationed on a class basis.

The so-called “health insurance” that many people now have under Obamacare is, in effect, a transfer of funds to the giant insurance companies. Deductibles for lower-priced “bronze” plans now average more than $6,000 for an individual and more than $12,000 for a family. Deductibles for so-called “silver” plans (which make up 70 percent of the market) are on average more than $3,000 for individuals. In other words, after paying hundreds of dollars a month for health insurance, workers must pay thousands more before they begin to receive any benefits.

Corporations have been systematically cutting or eliminating coverage, encouraged by Obamacare’s coming tax on more “generous” employer-provided health care plans. More than 80 percent of employer-based plans now have an annual deductible ($1,478 on average, up 2.5 times since 2006). In countless contract disputes throughout the country, health care cuts are a central demand of the companies, invariably accepted and forced through by the trade unions.

The subsidized purchase of private insurance under Obamacare has created the framework—a voucher system—for dismantling what remains of government-provided health care. The American ruling class is setting its sights on the bedrock health care programs of the late 1960s—first Medicaid, the already grossly underfunded state-federal health insurance program for the poor, which will be effectively dismantled by the Republican bill, then Medicare, the health care program for the elderly. Behind these health care programs lies Social Security, the federal pension program wrenched from the ruling class through the explosive class struggles of the 1930s.

The hypocritical criticisms of the Republican plan by the Democrats and the various middle-class organizations that orbit the Democratic Party not only cover up for the reactionary character of Obamacare, they completely ignore the central issue: capitalism.

There is no solution to the massive health care crisis that does not take on the domination of health care by giant pharmaceutical and insurance companies, which operate under the ever-present whip of Wall Street and its demands for higher profits and dividends. These giant corporations must be expropriated and the wealth of the financial aristocracy seized to finance emergency measures to address the health care crisis and establish a system of universal health care, guaranteed as a basic social right.

Whatever tactical differences the Democrats have with the Trump administration on health care are entirely subordinate to their basic objective: escalating US military aggression in the Middle East and internationally. The hysterical Democratic campaign over alleged Russian hacking and Trump collusion with Moscow has as its central aim forcing a shift in administration policy toward a more rapid and comprehensive expansion of the US war for regime-change in Syria and a more aggressive policy toward Russia.

But as the Democrats well know, military escalation abroad is inextricably bound up with the intensification of austerity and class war at home.

In asserting its right to health care, the working class cannot allow itself to be drawn behind any section of the political establishment. It must proceed with its own methods—those of class struggle. The health care counterrevolution is generating enormous opposition, which is beginning to emerge in innumerable forms. Millions confront conditions that spell death or disaster for themselves, their parents and their children.

As the World Socialist Web Site wrote earlier this month, “The interaction of objective conditions of crisis, both within the United States and internationally, and the radicalization of mass social consciousness will find expression in the eruption of class struggle. The decades-long suppression of the class struggle by the trade union bureaucracy, the Democratic Party and the affluent sponsors of various forms of identity politics is coming to an end. The social counterrevolution of the ruling elites is about to encounter an upsurge of the American working class.”

The Socialist Equality Party is fighting to make conscious this objective movement. Emerging struggles against all of the deplorable conditions of life under capitalism—the destruction of health care, declining wages, unemployment, brutal working conditions, the attack on public education, mass indebtedness, the witch-hunting of immigrants—must be brought together in a common political fight against the Trump administration and both big business parties, based on a socialist and internationalist program.

Joseph Kishore

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