Workers Vanguard No. 1129 9 March 2018 For Quality Medical Care for All! U.S. Capitalism Deadly for Black Mothers The United States is a dangerous place for new mothers. Women here face the highest rate of dying from causes related to pregnancy and childbirth in the industrialized world. Maternal mortality is on the rise in the U.S., unlike in both West Europe and Canada. In the most expensive country in the world to give birth, each year up to 900 mothers die and another 60,000 suffer near-fatal complications. Poor and rural women, who suffer from no insurance, deficient hospitals with limited obstetrics care and overall shoddy medical services, are especially hard-hit. The crisis is most acute for black mothers, who are three to four times more likely to die than white mothers. The racial oppression at the core of U.S. capitalism affects health profoundly and in manifold ways. Black people are disproportionately impacted by unemployment and poverty, and therefore at greater risk of diseases that afflict all the poor like asthma, high blood pressure, heart disease and diabetes. Compounding the problem is the de facto segregation of black people: decaying ghettos with decrepit housing, wide exposure to environmental toxins and lack of access to adequate nutrition; substandard public education and low-wage jobs; cop brutality and mass incarceration. As a result, new black mothers face an increased threat of complications like hemorrhaging, preeclampsia, heart attack and stroke. Many of these medical complications are entirely preventable with simple measures like regular monitoring. But they become deadly when these high-risk patients run into unrelenting hurdles just to receive basic treatment. Recently, a growing number of reports have covered the maternal health crisis in America, including the extensive and award-winning “Lost Mothers” series by ProPublica and NPR. This coverage paints a vivid picture of the nightmares that women, and particularly black and poor women, endure. Another spotlight was shone on the issue following champion tennis player Serena Williams’s near-fatal experience last September. After giving birth, Williams suffered from blood clots in her lungs, which she luckily recognized and urged nurses to address. Williams herself noted that poor pregnant women especially have the cards stacked against them, acknowledging that as a celebrity, she had access to top-notch staff and facilities that saved her life. The outcome was very different for Dacheca Fleurimond, a 33-year-old home health aide who delivered twin boys through cesarean section at SUNY Downstate Medical Center in Brooklyn last August and died of a blood clot in her lungs a day later. Fleurimond’s blood was predisposed to clotting, but doctors did not carry out preventative and life-saving measures followed at other hospitals. SUNY Downstate Medical Center, where over 90 percent of expectant mothers are black, has one of the highest maternal complication rates in New York State. As is the norm in black neighborhoods, SUNY Downstate serves patients with high-risk conditions like obesity and cardiac disorders, but care is hindered by crumbling infrastructure, budget slashing and staff cuts. Meanwhile, the rich executives of this “struggling” hospital bask in comfy salaries, and a restructuring consultant was paid a whopping $34 million to help trim costs. Racist Wealth Care, U.S.A. In this wretchedly unequal society, the wealthy minority at the top gets the latest and best treatment, while the bulk of medical care is rationed by race, class and sex. Under capitalism, medicine and health care are beholden to the drive for profits by the pharmaceutical industry, hospitals and insurance companies, which do everything to ensure the sick get the least coverage while they rake in the most money. It is no coincidence that a maternal mortality crisis occurs in a country with a health care system ranked 37th by the World Health Organization. It is also no coincidence that the U.S. is unique among other advanced countries for having no universal health care program. For decades, the notion of a government-run health plan was dismissed as a communist plot at a time when the Soviet workers state assured access to health care for all, despite the usurpation of political power by the Stalinist bureaucracy. With black oppression the cornerstone of American capitalism, anything resembling government-provided health insurance has always triggered furious racist reaction. Right-wing rants against “big government” are racist code language to slash social programs like Medicaid, which is obscenely portrayed as a “redistribution” of income from hard-working folks to “undeserving” black people and other minorities. A case in point was the refusal of most of the Southern states to expand Medicaid coverage as part of the Affordable Care Act. If all states were to expand the program, nearly 3.5 million currently uninsured black adults would be eligible. While these attacks are directed against black people in the first instance, they will also redound against the millions of white working people who make up the majority of Medicaid recipients and who depend on what passes for a social safety net in this country. Historically, America’s rulers have successfully pushed anti-black racism and anti-immigrant nativism to divide and weaken the working class and its struggles, limiting the development of class consciousness. Racial and ethnic divisions stymied the emergence of even a reformist mass workers party here. In Germany, to check the growing influence of the Social Democratic Party, Chancellor Otto von Bismarck introduced national health insurance. The nationalized health systems elsewhere in West Europe—instituted following World War II to counter the authority of the victorious Soviet Union among combative workers—represent defensible gains but have been whittled away by the capitalist rulers. Though single-payer reform could be a rational advance over the current “free market” fraud in the U.S., a single-payer system would do nothing to take the profit motive out of health care. Enormous advances are possible when private profit is removed from the equation. Thanks to its collectivized economy, albeit under Stalinist misrule, the Cuban bureaucratically deformed workers state has a health system that in many respects outperforms the one in the U.S. Despite a longtime imperialist embargo, economic isolation and limited resources, Cuba has three times as many doctors per person as the U.S., and it also dispatches doctors to scores of poor countries. In recent months, a health care delegation from Cuba has even teamed up with medical professionals in Chicago to help improve maternal health and lower infant mortality in the black neighborhood of Englewood on the city’s South Side. In Englewood, where most households are headed by single females, the rate of infant mortality is over three times that in Cuba. Prenatal care is critical for a safe pregnancy and delivery, as is postpartum care for the mother. We Marxists fight for quality health care, free at the point of service, which is a burning need for everyone. The struggle must be for socialized medicine—the nationalization of the hospitals and expropriation of the parasitic insurance giants and drug companies as part of the struggle for a workers government. Only after the multiracial working class shatters the capitalist order can the wealth generated by those who labor be committed to providing the highest level of medical care for all. An egalitarian socialist society will have eradicated the conditions that today condemn countless millions to a life of misery, disease and early death. Separate and Unequal Treatment of Black Women Medical abuse against black women has a long history in this country. Under chattel slavery, female slaves were treated as “breeders” to produce the next generation of property for the racist masters and faced unrelenting barbarity. The pioneering “father of modern gynecology,” J. Marion Sims, was a Southern slaveowner who performed experimental operations on enslaved women without anesthesia. A century later, racist eugenics laws aimed to eliminate the “feebleminded,” targeting impoverished black women for forced sterilization. The rulers then blamed black people for their oppression by alleging bad behavior or lifestyle choices. But there is no “choice” in working a low-wage, backbreaking job to feed a family, having a relative locked up by the criminal justice system and leaving a child alone because there is no maternity leave or affordable day care. Black women workers face triple oppression: as part of a race-color caste, segregated at the bottom of society; as women, bearing the burden of caring for children as well as the sick and old; and as workers, part of the most exploited layer of wage slaves. Race, sex and class oppression generate chronic stress and wear and tear on the body, or what public health officials term “weathering,” which heightens the risk of illness and disease. The tragic case of Erica Garner demonstrates this vividly. Garner became a prominent activist against racist cop killings after her father, Eric Garner, was choked to death in 2014 by Staten Island cops. The racist white cop who killed Eric Garner was never indicted and remains an NYPD officer. In an interview last December, she talked about the stress of struggling with the system that “beats you down to where you can’t win.” Just weeks later, at only 27 years old, she was dead. It was a mere four months after giving birth to her second child, and Garner was put into a coma, having suffered brain damage from cardiac arrest. Her heart attack was brought on by chronic asthma, a condition she shared with her father and so many other black children and adults. She had already survived a prior heart attack as a consequence of her pregnancy, which strained her enlarged heart. We will not forget Eric and Erica Garner! Maternal mortality is especially dire in states of the former Confederacy. A black woman in Mississippi has a greater risk of dying after giving birth than a woman in Mexico or Egypt. In Georgia, black women make up 68 percent of pregnancy-related deaths, even though white and black women have the same rates of cardiovascular disorders and blood infections during pregnancy. But treatment is separate and unequal for black women across the board, whether rural or urban, poverty-stricken or well-off. Facing numerous obstacles, including belittling attitudes from medical professionals, they consistently receive a lower quality of health care than white women, even when accounting for insurance status, income, age and severity of the diagnosis. Take the case of Shalon Irving, a black single woman from Atlanta and a highly educated epidemiologist. Despite a family history of cardiovascular disease, her repeated high blood pressure readings postpartum were not treated with anything resembling the aggressive and urgent action they needed. With her baby just weeks old, Irving collapsed and died of hypertension. Women overall are less likely than men to get insurance through their employer, and given their lower average pay, more women than men are covered by Medicaid. The majority of adults on Medicaid are poor women in low-income or single-parent families, for the most part pregnant women or mothers of young children. Due to endless bureaucracy, the lack of doctors willing to accept Medicaid and the restrictions that limit coverage, expectant black and Latina mothers are frequently forced to delay prenatal care and are stuck without crucial postnatal services. Though Medicaid covers nearly half of all births in the U.S., this woeful coverage is unreliable, as it is left up to the states to determine the scope of services. Hospital administrators regard Medicaid patients, whether black, Latina or white, as a net drain on the balance sheet. Such contempt “trickles down” to the deficient and disrespectful treatment the patient receives. Many hospitals, especially in rural areas, cannot afford the costs of maintaining their obstetrics units due to low Medicaid reimbursement, leading to closures of those units or the hospital altogether. The Trump administration’s threatened cuts to Medicaid would be even more devastating. “Pro-Life” Kills Women The ruling class, represented by both the Democrats and Republicans, makes life hell for working-class and poor families, while upholding the sanctity of the family. The institution of the family, the main source of the oppression of women, plays a crucial role in buttressing class rule. Its function is to reproduce the working class as well as to instill conservative morality and impose social control. Women are expected to embrace the role of mothers and to relish the raising of children. Restrictions on contraception and abortion are closely linked to maintaining women’s social subordination in the family. Hypocrisy, thy name is America. While this country trumpets the absurd notion of the rights of the “unborn,” more than 23,000 babies born each year die before their first birthday. The attacks on Planned Parenthood—where 97 percent of services are primary and preventative care like cancer screenings, annual exams and health counseling—directly harm the children that the anti-woman bigots claim to be saving. The closure of clinics cuts off preventative care for poor and working-class women, whose babies are then more likely to be born sick or die. Nearly half of pregnancies in the U.S. are unplanned (the rate for black women is almost double that of white women), underscoring how vital contraception and abortion are for public health. In the U.S., 90 percent of counties have no abortion clinic, while 50 percent lack an obstetrician-gynecologist. The impact of savage cuts to family planning can be seen in Texas, where the state legislature has passed a slew of anti-abortion measures in the last decade. From 2010 to 2014, maternal mortality there doubled, making it the deadliest state for new mothers. Across whole swaths of the state, particularly the rural south and west, women have no chance of getting to a real hospital when they need one. Meanwhile, under the state’s perverse TRAP laws, aimed at shutting down abortion providers, clinics were required to be equipped as surgical centers, even though abortion is a simple and safe procedure that doesn’t involve such equipment. In fact, the risks associated with pregnancy and childbirth are far greater than those of abortion. Abortion poses the basic question of women’s control over whether or not to have children. So-called “pro-lifers” care little about the lives of mothers or their babies, instead promoting punitive measures against women who engage in anything deemed unacceptable maternal behavior. For example, many hospitals test new mothers for drugs, resulting in scores of child neglect proceedings each year, almost exclusively against minority women. The capitalist state endangers children by frightening women away from prenatal care and treatment for addiction with threats of prison and separation from their children. Each year, 12,000 pregnant women are incarcerated, the majority charged with non-violent offenses like drug possession. This barbarism is compounded by the fact that most states permit the shackling of women during childbirth. While many women, black people and workers cling to the Democrats as the lesser evil, the Democratic Party serves and protects the very capitalist system that consigns millions of women and children to lives of poverty. The Obama administration’s Affordable Care Act was premised on maintaining the profit motive in health care. The first black president did nothing to turn the tide on black maternal mortality, not to mention alleviate the general plight of black people. The assault on abortion rights and health benefits must be defeated. To turn the tide for workers and the oppressed requires unleashing a class-struggle fight for decent jobs, housing and education, which is linked to the fight to uproot the capitalist system of exploitation. We need a multiracial revolutionary workers party that stands as the tribune of all the oppressed to lead the working class to power through socialist revolution. Black women will play a central role in the leadership of that party. A workers America will replace the social functions of the family by collectivizing childcare and housework, bringing women fully into social and political life. Racial prejudice and oppression will become relics of the past along with the social system that produced and nourished them. Once the working class takes power, the emancipation of women and black people can begin.