On June 28 the Supreme Court declared Obama’s health reform, the Affordable Care Act (ACA), constitutional. Many “progressive” voices cheered this as a great victory while the Tea Party “conservatives” screamed that the president’s reform was equivalent to socialism and must be stopped. Other health reformers were quick to point out that the new law, having survived a court challenge, would still not do much. Physicians for a National Health Plan (PNHP), for example, pointed out that this puny reform leaves 26 million uninsured and provides inadequate coverage for millions more.
What lessons can communists learn from all this noise? Primarily, it is that neither side of this “debate” represents the interests of workers. The Tea Party racists, cackling about the un-constitutionality of the law and calling Obama a socialist are clearly enemies of the working class. But less clear is that liberal politicians like Obama are no better. In more than three years of the Obama presidency the working class has continued to suffer devastating racist attacks, in employment, health care and education. One cannot ignore the unprecedented campaign of racist deportations that Obama has overseen. For workers, choosing one group of bosses and politicians over another is a lethal mistake.
For communists, the slogan “To each according to need,” has guided us since the days of Karl Marx. In other words, we don’t rely on any politicians, who all serve one section of bosses or another. Their system, capitalism, is not based on the needs of workers. Capitalism always has been, and always will be a system of profit, greed, racism and sexism. Capitalism is a system where workers only have worth as long as they can labor and produce profit for a boss. The principal lesson of Obamacare (as the ACA is called) is that only a system truly based on the needs of workers — communism — will bring us decent health and health care.
PNHP explains why people in the U.S. can’t have the health reform we need: “the ACA perpetuates a dominant role for the private insurance industry. Each year, that industry siphons off hundreds of billions of health care dollars for overhead, profit and the paperwork it demands from doctors and hospitals; it denies care in order to increase insurers’ bottom line; and it obstructs any serious effort to control costs.”
The PNHP and other liberal critics of Obamacare have shown that eliminating the $400 billion profit and overhead taken by the insurance companies would pay for insuring the rest of the people who need care. They lay it all out at (http://www.pnhp.org/resources/administrative-waste-consumes-31-percent-of-health-spending).
What they don’t talk about is why such a logical and well-documented change is impossible under developing fascism, a period that, among other things, includes the intensification of the disciplining of the working class. What this means is that workers, while suffering greater attacks, become politically aligned with bosses. The rulers primarily use racism and nationalism to convince workers to stand behind “their” bosses and politicians. U.S. bosses require this political allegiance from workers because the bosses need to defend themselves against increased attacks from their capitalist rivals.
Rather than improving access to care for ordinary working-class people, all over the world health care systems are privatizing, eliminating access by people with limited income. In Sweden, a country that comes to mind when someone says “socialized medicine,” the first private, for-profit medical service in decades started in the 1990s. According to a study by Ake Bergmark of Mid Sweden University, “In 2000, St Görans’ Hospital in Stockholm … became the first general emergency hospital in Sweden to be transferred into private ownership.” Privatization in the United Kingdom, begun under the Thatcher administration in the 1980s, has continued with public medical facilities in Britain increasingly suffering neglect and under-funding. Similar “market reforms” of public health care are seen across Europe. Professor Howard Waitzkin of the University of New Mexico has documented the dismantling of public hospital and health systems in several countries in Latin America under pressure from the International Monetary Fund controlled by the U.S.
The most dramatic fall in mortality rates ever witnessed in a large country occurred in China in the generation following the communist-led revolution there in 1949. The leading slogan in medicine, as in other spheres at that time, was “Serve the people.” Perhaps most shocking to people who still associate the word “socialism” with China is the current complete dominance of market forces in Chinese medical care.
Now, in a large new provincial children’s hospital in Lanzhou, China, visitors were taken aback to see a giant electronic display in the main lobby listing the exorbitant prices for medical services. In the newborn intensive care units of China, according to an article by Huanhuan Wang published this year in the U.S. journal Pediatrics, about two-thirds of the infants who die from respiratory failure do so because their parents could no longer afford the cost of the breathing machines that were keeping them alive. Clearly the slogan leading development in recent years is the one coined by the pro-capitalist Chinese leader Deng Xiaoping in the 1980s: “To get rich is glorious.”
With these worldwide trends of privatization and “market reforms” at work, is it realistic to think that increased access to good medical care (or to education, transportation, housing or employment) is in the cards? Reforms that created the modern welfare state, with its government-supported services to improve the living standards of workers, did not come about because of some kind-hearted politicians. These reforms in Western Europe and other rich capitalist countries resulted from workers’ class struggle and consequent ruling classes’ fears of the possibility of revolution. They were afraid that their workers would follow the lead of the Soviet working class and seize power by force.
Sweden did not invent socialized medicine. The Soviet Union was the first country to make medical care a right of every worker, a revolutionary innovation that was launched when workers took power in 1917 and which was largely in place with a vast network of health care facilities by the early 1930s, as described in detail by Newsholm and Kingsbury in their 1933 book, Red Medicine (available at http://www.marxists.org/archive/newsholme/1933/red-medicine/index.htm).
Today, living conditions are worsening for working-class families around the world as the Great Recession deepens and fascist conditions intensify. Obamacare will have virtually no impact on this reality. Not every working man, woman and child has the promise of a healthy and productive life because some silver-tongued capitalist politician gives the perfect speech or because some billionaire makes a “gift” to charity of the money he stole from workers.
This new world will be created only after we workers fight a long and bloody revolution to take power away from the exploiters who rule the world today. Can this happen? It was already begun twice in the last century. There is no reason our Party can’t learn why those revolutions reverted back to capitalism. PLP can lead a revolution for workers’ power in the years ahead that answers the working class’s needs.