Democracy is a more radical idea than socialism. That has been noted by a fair number of democratic socialists, including one of the steady campaigners on the left wing of the British Labor Party, Tony Benn, who died in 2014. By stressing democracy first and foremost, he plainly did not abandon the full range of his socialist commitments. On the contrary, the extension of democracy into the workplace and the advance of workers into public life has been the real ground of social democracy. Without democracy in basic goods and services such as health care, housing and education, the ability of people to participate in public life and politics is deeply undermined.

We, the people, did not gain ground in civil and human rights simply through the Constitution. That notion is a Sunday school reading of our history. Only social movements finally persuaded politicians and legislators to acknowledge a new balance of power. In every period of open class struggle, both the reform bills passed by legislators and the restrictions enacted by corporate power are concurrent stories.

The New Deal under President Franklin Roosevelt was not a gift of the gods, but the hard-won new bill of rights extracted from the state by labor strikes and by the occupation of factories. Of course, that reform required allies from all classes, including writers, artists, teachers, doctors, scientists and principled members of other professions. But we must never forget the historical foundation of that legislation, including the migration of workers across oceans and continents to the farms, mills, mines and sweatshops of New York, West Virginia, Illinois, Arizona and California. Class consciousness was forged in the fire of class struggles, under the gunfire of police and hired strikebreakers, as well as in the actual fire at the Triangle Shirtwaist Factory in New York City on March 25, 1911.

The fire began at the end of the working day and spread quickly. One of the doors on the ground floor was locked, and the ladders of the fire brigade only reached to the sixth floor, about 30 feet below the flames. There were few fire exits. From the first sound of the alarm until the fire was nearly extinguished, not more than a half hour passed, and 146 people died. Almost all of them were Italian or Jewish immigrants. Most were women, and many were in their teens. Some died on the factory floor, some died jumping from the windows, and some died when a fire escape collapsed.

Frances Perkins, who later became Roosevelt’s secretary of labor, was one of the witnesses. Among the many notable dates on the calendar of labor history, Perkins marked March 25, 1911, as the day the New Deal began.

The Vietnam War (or the American War, as the Vietnamese call it) has overshadowed the more populist programs introduced under President Lyndon Johnson. In 1965, both Medicaid and Medicare became the law of the land. This was a significant reform of national health care, but our class-divided system was spelled out in the two-track system. Medicaid was a kind of medical welfare system for people with the lowest incomes, whereas Medicare covered citizens over the age of 65 or those with severe disabilities, regardless of income. Thus, dual eligibility for both Medicaid and Medicare is possible for some people. This limited reform was attacked as “socialized medicine” by the most antisocial cheerleaders of capitalism. In fact, both corporate parties had no intention of confronting the many private interests that still compete to drive up the cost of drugs and medical care.

Much of the New Deal was later demolished. At a time when black single mothers were stigmatized on op-ed pages and in scholarly books, President Bill Clinton promised on the campaign trail in 1992 “to end welfare as we know it.” He later kept that promise, but first, he signed the Violent Crime Control and Law Enforcement Act in 1994, with a budget of $10 billion for prison construction. The same bill ended federal funding for inmate education and expanded the death penalty.

In 1996, with Vice President Al Gore and Lillie Harden, a black mother and former welfare recipient, standing beside him at an outdoor White House ceremony, Clinton signed the Personal Responsibility and Work Opportunity Reconciliation Act. The law toppled one of the pillars of the New Deal’s Social Security Act, namely Aid to Families with Dependent Children, and it was replaced by a more meager program. As for Harden, she had a stroke in 2002 and died 12 years later, unable to qualify for Medicaid or afford the monthly bills for her medications.

To their great honor, two assistant secretaries at the Department of Health and Human Services—Mary Jo Bane and Peter Edelman–resigned in protest shortly after Clinton signed the bill into law. Edelman wrote a last memorandum to his staff, stating, “I have devoted the last 30-plus years to doing whatever I could to help in reducing poverty in America. I believe the recently enacted bill goes in the opposite direction.”

Clinton also presided over a period of deregulation that might have made liberals howl under a Republican administration, but left most of them sleepwalking under the spell of a “centrist” Democrat. The repeal of the FDR-era Glass-Steagall legislation meant that insurers, retail banks and investment banks were free to merge again. And then, as Dan Roberts wrote in The Guardian on April 19, 2014, “A Financial Services Modernization Act was passed by Congress in 1999, giving retrospective clearance to the 1998 merger of Citigroup and Travelers Group and unleashing a wave of Wall Street consolidation that was later blamed for forcing taxpayers to spend billions bailing out the enlarged banks after the sub-prime mortgage crisis.”

The long, bipartisan war of attrition against labor unions had more dramatic episodes under President Ronald Reagan, but Clinton also was fully committed to the corporate state and the taming of wayward workers. Republicans were more willing to smash unions outright, whereas Democrats were more incremental in seeking to turn unions into an arm of management.

Barack Obama vaulted into the national limelight when he gave the keynote address at the 2004 National Democratic Convention. He spoke against gloom and naysayers, and for hope and unity. In fact, his message was as generic as a Hallmark greeting card, but he played his audience like a grand piano: “Well, I say to them tonight, there is not a liberal America and a conservative America—there is the United States of America. There is not a black America and a white America and Latino America and Asian America—there’s the United States of America.”

The single truly signature piece of legislation under Obama’s administration, the law that we will remember in our sleep, was the Affordable Care Act. The ACA was promptly tagged “Obamacare” by Republicans, and many of them vowed to destroy it, thereby proving that actual class and political divisions do exist, and that racial animus is not so remote from the nationalism of the right wing. By partisan reflex, many Democrats made defense of the ACA the outer limit of what they were willing to promise in the realm of health care reform.

When “centrist” Democratic politicians face demands for expanded and improved “Medicare for all,” which is the practical path toward a single-payer system in this country, they also face a political dilemma. They cannot claim that the genius of the market will deliver the optimal health care program, or they will simply sound like their corporate cousins in the Republican Party. At the same time, they are unwilling to exclude the insurance companies from the poker game in Congress.

In California, for example, Sen. Dianne Feinstein prefers evasive maneuvers when her more liberal constituents press her to endorse health care bills they favor on the state and federal levels. She states on her website, “I am an original cosponsor of the Medicare-X Choice Act of 2017 (S. 1970), which was introduced by Senator Michael Bennet (D-CO) on October 17, 2017.” Instead of a single-payer system, this bill tries to resurrect the “public option,” mimics the private options available on the ACA exchanges and involves a three-year rollout period beginning in rural areas. It’s a jalopy made of spare parts designed to break down in traffic. But it is also designed to distract the public from serious health care reform.

Feinstein is a zealous defender of the ACA against Republican attacks, which also entails a defense of private insurance plans offered through Medicaid. However, the more reform-minded members of her party believe a single-payer health care plan really should be a litmus test for the support of candidates, and they joined in the refusal to endorse Feinstein for a fifth term at the last state Democratic convention. Of course, her name, her donors, her personal wealth and the party machine are still in her favor.

In the May 2, 2017, issue of MapLight, a website “revealing money’s influence on politics,” Andrew Perez wrote that Feinstein had recently told her constituents at a San Francisco town hall meeting, “If single-payer health care is going to mean a complete takeover by the government of all health care, I am not there.”

Perez added, “A week later, Feinstein was even further from there, benefitting from a fundraising event at the Washington, DC office of Avenue Solutions, a lobbying firm that represents major health insurers, pharmaceutical companies and the primary trade association for doctors. The industries have historically opposed efforts to create a universal, government run health care system—an idea supported by 58 percent of U.S. adults. Feinstein supporters at the event were expected to kick in $1,000 to $5,000 for her re-election bid.”

Among the donors to Feinstein, Perez noted Tom Daschle, former Democratic Senate majority leader, who worked as a lobbyist for Blue Cross Blue Shield; Fred Greafe, a lobbyist for the Federation of American Hospitals; and political action committees run by pharmaceutical companies such as Merck & Co. and Amgen.

When we step away from the partisan pugilism over the ACA, we get a clearer picture of what the ACA does and does not mean for health care reform. The ACA did extend medical coverage, especially through Medicaid, though it left millions of Americans uninsured. This was a direct consequence of placing the profits of insurance companies once again before the care of patients. The ACA enshrined “the individual mandate,” a retrograde feature copied from a Republican health care program in Massachusetts, once known as “Romneycare.”

In plain language, a person seeking health care through the ACA is forced to buy a private insurance plan brokered through state and county agencies, or pay a fine. In the words of the HealthCare.gov website, “If you can afford health insurance but choose not to buy it, you may pay a fee called the individual shared responsibility payment. (The fee is sometimes called the ‘penalty,’ ‘fine,’ or ‘individual mandate.’)”

For many people, those plans remain only marginally affordable, or are still beyond their means, especially because insurance companies are gaming the new rules and jacking up rates even for the poor. For those below a defined poverty line, Medicaid is supposed to provide a subsidy, but ACA’s rules have allowed some states to opt out and refuse the federal funds that would benefit many of their citizens. The bureaucratic obstacles in coordinating care and funding do benefit the bureaucrats, of course. And insurance companies are still evolving as corporate predators, eating each other whenever given the opportunity.

A new study titled “Health Care Spending in the United States and Other High Income Countries,” published last week by the JAMA (Journal of the American Medical Association) Network, states:

“The United States spends more per capita on health care than any other nation, substantially outpacing even other very high-income countries. However, despite its higher spending, the United States performs poorly in areas such as health care coverage and health outcomes. Higher spending without commensurate improved health outcomes at the population level has been a strong impetus for health care reform in the United States.”

Health Care for All, Not Profits for a Few

Hillary Clinton, on the presidential campaign trail in January 2016, told voters in Iowa that the health care reform plan favored by Vermont Sen. Bernie Sanders was pie in the sky: “People who have health emergencies can’t wait for us to have a theoretical debate about some better idea that will never, ever come to pass.” Beholden to her big donors and to the big insurance companies, she labored with zeal to put private profit above public health. As for “theoretical debate,” she has her own theories, of course. The Goldwater Girl refashioned herself as a New Democrat, and when Donald Trump took the White House, she announced during a TV interview that she had become “a member of the resistance.” In college, she briefly flirted with the radical ideas of the late community organizer Saul Alinsky, but her true and abiding passion is public service to the corporate state.

Sanders deserves credit for opening up a much wider public conversation on class inequities in this country, including in the provision of health care. The Democratic National Committee responded with wrath and sabotage toward his candidacy and presidential campaign. Sanders has an instrumental view of the Democratic Party, because it gives him more leverage in Congress. So when he bowed out of his presidential campaign, he advised his supporters to go knock on doors for Clinton. Anyone who expects Sanders to campaign in earnest for independent political action against both corporate parties has not been paying attention to his public record. Still, without illusions, we must acknowledge that Sanders remains one of the most trusted elected officials in the nation.

One third of Democrats in the Senate, eager to jump in front of a movement they rarely had the courage to lead, have now signed on to Sanders’ Medicare for All Act. Likewise, in the House of Representatives, half the Democrats signed on to the Expanded and Improved Medicare for All Act, HR 676, first introduced by Rep. John Conyers. After Conyers’ resignation following charges of sexual harassment, Rep. Keith Ellison took the lead in sponsorship, and more than 60 percent of House Democrats are now cosponsors.

A moment comes in every social movement when career politicians steal the language of serious reform to introduce familiar regressive features into “progressive” legislation. This is such a moment. Above all, a comprehensive health care plan must include safeguards against the usual side deals with private insurers, pharmaceutical lobbyists and corporate consortiums of hospitals. If a reform is built on familiar quicksand, it will be more easily eroded by competing private interests.

In an article titled “The Healthcare Bait-and-Switch,” Glen Ford wrote in the March 8 edition of Black Agenda Report: “Predictably, however, Hillary Clinton’s favorite think tank is still trying to make sure single payer health care never happens. The lavishly funded Center for American Progress (CAP) last week unveiled their counterfeit, sound-alike health care plan, dubbed Medicare Extra for All, whose sole purpose is to distract and confuse a public that is demonstrably ‘ready’ for single payer. The CAP scheme, like Obamacare, keeps the private insurance corporations at the center of the money-stream, doesn’t cover everyone, charges fees, co-pays and premiums, doesn’t save much money, and would fail to provide millions with adequate coverage.”

Dr. Margaret Flowers of Health Over Profit and many other health care activists favor National Improved Medicare for All (NIMA), and thus also favor HR 676 over the Sanders bill in the Senate, which Flowers has called “deeply flawed.” Readers further interested in the policy differences should consult the website of Physicians for a National Health Program (PNHP) and Health Over Profit. The mission statement of Health Over Profit is clear: “We believe that we must have a healthcare system in the United States that has health for everyone as the bottom line, not profits for a few. We believe that a National Improved Medicare for All system, as embodied in HR 676, is the best way to achieve this goal.”

The Lessons of Canadian Health Care Reform

In both local and national efforts, voters and activists can learn lessons from the history of health care reform in Canada. No single nation offers a simple prescription for health care activists in the United States, but Canada achieved a true social democratic reform of its health care system. As we might expect, Canada also has been subject to the corporate erosion of health care and social values. Even so, our northern neighbor is closer to us than Scandinavia, and we should pay attention to the Canadian pioneers in health care.

As Lorne Brown and Doug Taylor wrote in the July 3, 2012, issue of Canadian Dimension, “Medicare was born in Saskatchewan on July 1, 1962. It would be the first government-controlled, universal, comprehensive single-payer medical insurance plan in North America. It was a difficult birth. The North American medical establishment and the entire insurance industry were determined to stop Medicare in its tracks. They feared it would become popular and spread, and they were right. Within 10 years all of Canada was covered by a medical insurance system based on the Saskatchewan plan, and no serious politician would openly oppose it.”

Saskatchewan, the home base of “agrarian socialism,” had been governed since 1944 by the Co-operative Commonwealth Federation (CCF) led by Tommy Douglas. He served as a minister of health, and as premier of Saskatchewan from 1944 to 1961. After stepping down as premier, he was elected as the first federal leader of the newly formed New Democratic Party (NDP), the successor party of the National CFF. Douglas had written in favor of certain eugenics policies (widely discussed across the political spectrum in the early 20th century) in a university thesis he wrote in 1933. He never did so in public life. We know he changed his mind about such policies, based on his implementation of therapy programs and vocational training for the mentally ill and disabled as a health minister of Saskatchewan. He was a resolute opponent of fascism and Nazism during World War 2. Medical care had always been among the core issues of the CCF welfare state program. As early as 1947, universal hospital insurance had been introduced, and by 1958, it was adopted as a federal-provincial jointly funded program across Canada. This created the economic and political foundation for the universal medical insurance plan Douglas proposed for Saskatchewan in 1959. Despite storm and stress, basic social democracy in health care was established in Saskatchewan two years later, and then throughout Canada. To this day, Douglas remains one of the most admired public figures among Canadians.

Without the workers and socialists of Canada, the Canadian public health care system would have remained a distant hope and a doomed ideal. Indeed, a majority of doctors in Saskatchewan went on strike for 23 days, but the social democratic government brought in doctors from Britain, the United States and other provinces. Those doctors were among the most class conscious within their profession. Their ethic of solidarity owed much to the labor movements of the United States and Britain. The British labor movement was strong enough to put a Labor Party government in power after World War II, and the British national health care system was a solid gain across all lines of work and class for the whole nation. Any system of medical care will have faults and failings, but there would be public uprisings in Canada and Britain if any party in power tried to steal away comprehensive public health care.

The ethic of solidarity is now so well established in Canadian health care that hundreds of doctors, nurses and medical students signed a recent public statement against pay raises for doctors, arguing that medical funds should be redistributed to improve the wages and working conditions of nurses, assistants and clerks. Nurses took the lead in this effort, joining earlier sit-ins to publicize worsening conditions in hospitals and the risks to both patients and staff. As they stated, “We also wish to remind the government that the current situation is far from normal or inevitable and is largely caused by the cuts it has imposed on the public network.”

One lesson we can draw from their experience is that nothing won through class-conscious movements can be taken for granted. Our gains do not stay won without vigilance and solidarity. In periods of reaction, these gains must be defended from business as usual by workers and citizens committed to public health and social values.

For reasons of outreach, organizing and legislative strategy, any reform in public policy will surely have a stronger base of support if it is not limited to left-wing groups, voters and parties. At the level of social movements and civic resistance, conversations across all party lines are always necessary. They also raise the general level of civic respect. But because the right wing will never give up redbaiting, honest socialists also must never follow any retrograde party line of “centrism.”

We Are Many, They Are Few

Rise like lions after slumber

In unvanquishable number—

Shake your chains to earth like dew

Which in sleep had fallen on you—

Ye are many, they are few!

— Percy Bysshe Shelley

We, the people, will go on paying the price for police repression, imperial wars and the blowouts of high finance, so long as we vote by rote for the parties of corporate dictatorship. The flaming downward spiral of bipartisan “pragmatism” makes every big election a protection racket. Sure, one mafia boss will twist your arm, but the other mafia boss will break it. The lesser of two evils is the last word in “progressive” advice we can expect in every regressive campaign season.

The bipartisan candidates of hope and change only hope their con game will vault them to high office, where they prove willing and able to extend the reach of drone wars and state surveillance. This means you, Barack Obama. They may sometimes be glass-ceiling careerists, but they will not be class-conscious feminists. This means you, Hillary Clinton. They may be phony populists willing to hold a news conference with steelworkers, but they still treat the proles as extras in the spectacle of power. This means you, Donald Trump.

So where are we likeliest to find comrades and allies? Workers, students and younger people are likelier to teach us truly new lessons, and they may learn in turn from older allies if generational bridges have not been burned. Young people are far less influenced by redbaiting than many of their elders, because the old Cold War has receded into history. Red scares don’t affect them when they encounter socialists in public life or among friends and coworkers.

The early women’s health care movement proved to be a powerful influence on later movements, such as the AIDS Coalition to Unleash Power (ACT UP). Women often were the living links between both movements. The history and practical achievements of such movements are being passed along through archives, video documentaries and public forums.

The Green New Deal of the Green Party is a practical program of basic social democracy, oriented to peace, economic democracy and ecological sanity. In the last presidential campaign, Dr. Jill Stein, the Green Party candidate, was the most informed and eloquent advocate of comprehensive health care reform. She was slandered as an opponent of vaccines, but in fact, she advocates solid research and science. She has noted that Thiomersal, a mercury-related preservative in some childhood vaccines, was phased out in the European Union, the United States and in a few other countries. Hardly an alarmist statement.

Stein also was a strong opponent of the corporate bribery of Congress, and an equally strong advocate of reforms in the electoral system. So, of course, she was smeared as a puppet of Russian President Vladimir Putin. Why? Simply because she paid her own way to Russia to encourage dialogue on peace and democracy, and ended up seated with him at a public dinner. These charges against Stein were efforts to change the subject from the real issues of her campaign.

In Seattle, the labor campaign for a minimum wage of $15 an hour was central to the success of Kshama Sawant, a socialist, in gaining office in the City Council. And the Sanders campaign stirred up a wave of new recruits to the Democratic Socialists of America, though that group remains small and marginal in relation to the inner circles of the Democratic Party. Even if their numbers grow, its hope of reforming that party would mean a fight to the finish against the “centrist” old guard.

All of us owe a great moral and social debt to the good doctors who hold fast to the Hippocratic oath and who put the health of the public above private profit. The work of doctors and nurses is a living example of public values day by day, and in all the hours of the night shifts, and in all the emergency rooms and hospital wards of the world. Nurses have been my personal heroes in the times I was most sick and when so many friends and comrades were lost in the AIDS epidemic. Now nurses are on the front lines of the labor movement, and are among the most strategic and successful opponents of the corporate state. Forming councils of workers and neighbors, of doctors and nurses, of artists and writers, is not a utopian goal over the horizon. Any form of organization begins with a conversation among friends and comrades. Start small, and start now.

The power of the ruling class is not, finally, in its armies and firepower, nor in its police and prisons. Its power must first be disarmed in our own minds and hearts, and in the growing strength of our solidarity. We are many, they are few.

Further Readings and References

Physicians for a National Health Program (PNHP)—California Capital Chapter—BLAST #15

Dr. Andrew Coates, in an Sun Magazine article by Tracy Frisch, explains why the ACA was “one step forward, two steps back.” Any reform plan that places private insurance as a foundation stone will also obstruct full provision of health care.

This video interview with Dr. Michael Rachlis of Canada, and is the most enlightening video presentation of Canadian health care history and current public policy I have yet found.