With great fanfare Mr. Obama on March 23 signed into federal law the health care reform legislation that the House had passed with a narrow majority two days before. News media sympathetic to the Democratic Party have hailed the new health care legislation as a "historical reform", a "towering achievement", a "landmark win for the American People" who are supposedly closer than ever to the promised land of guaranteed medical services. It has been a remarkable turn of events for a policy that seemed all but dead two months ago, when the Democratic Party lost its ability to pass legislation on a party line basis when it lost its supermajority in the Senate with the election of the Republican J. Brown following the death of Massachusetts Democrat Edward Kennedy.
With the signing into law of the Democrat sponsored health care reform, a page has been turned on a highly charged political drama that has dominated US politics for many months. Yet the spectacle of bitter divisions between America's two main capitalist parties around the question of health care seems to be far from over. Already the Republican Party politicians and their supporters have ratcheted up their oppositional rhetoric, portraying the new bill as a "government health care takeover", an "assault on Americans individual freedoms" and vowing to repeal the new health care legislation. The stage is being set for a second act of vitriolic finger pointing and legalistic maneuvers while both parties fervently position themselves to use the health care issue to gain votes in the next Congressional mid-term elections. So, the circus is far from over!
Both sides are cynical liars
Throughout all these vicious factional ‘debates' within the ruling class, from left to right of the political spectrum, all politicians have a common message: they all want what is best for the nation, for society at large and for every individual of the American population. They all pretend that capitalism has a human face and that this system cares for the health and the well being of those that it exploits. Both sides are cynically exploiting for their own political ends, the very real dreadful state in America of a great part of the medical services accessible to the working class and other strata of the population. Who are they kidding? It is obvious that in America as in any other country there are two health care systems, one for the ruling class and the well-to-do and other for the rest of society. It is true than in the worst-off capitalist countries medical services are practically nonexistent for the working masses, while, at the other extreme, most industrialized countries have a long-standing tradition of a more or less well developed health care system. However for decades now, world capitalism's worsening economic crisis has everywhere put medical services for the working class in the line of fire. The so-called "socialized" medicine under the centralized control of the national states that exists in one form or another throughout Europe is everywhere leaking water. As a result it is not hard at all for the self-interested defenders of the "American health care model" to point to horror stories from the "socialized" care systems. Nonetheless in America things are no better (in many important respects they are worse: according to OECD Health Data for 2004, the US spends nearly twice as much per capita on health care than other industrialized countries, yet has fewer doctors and nurses per 1000 inhabitants, lower life expectancy and higher infant mortality.) The patchwork of government and privately controlled medical services (Medicare, Medicaid, employment based medical coverage....) that pass for health care system for the working class and the destitute, have also been under attack for decades. In every industry that still offers medical insurance as part of the salary paid as "benefits", workers have been paying directly from their wages a growing part of their medical needs in the form of co-payments and direct contributions towards insurance premiums. The Medicare and Medicaid programs have been tweaked around in order to impose austerity measures by both Republican and Democratic administrations alike. In fact the American health care "model" competes very well on horror stories with its European counterparts and even compares badly to them in two points: It costs far more, yet still leaves 15% of the population (45 million people) without any permanent medical coverage.
Behind "Health Care Reform", Capitalism's economic interests
Against the pile of lies of all the left and right wing politicians that pretend to be acting in the best interests of society as a whole, let's be clear that under capitalism there is nothing humanitarian in the way health care is provided for the working class. For capital, medical services are an expense, a part of the total cost of production and reproduction of the commodity labor power and as such subject to the laws of capitalist production. That in some countries the government runs a national health care system directly while in others like the US the state shares the field with the private sector does not in essence make any real difference. In the end, for capitalism as a whole the medical upkeep of the working class is an expense that the national state needs to control in an economically rational way in order to be able to compete in the world market. Indeed, it is worth pointing out that the first state health care was introduced in Germany in 1883 by the monarchist government of Otto von Bismarck essentially for two reasons: first, to increase workers' productivity, and second to stop workers from being attracted to the revolutionary politics of the Socialist Party.
The American bourgeoisie has recognized for years that the American health care system is expensive and inefficient, and, in the end, detrimental to the ability of the national capital to defend its interests in the world economy (to give just one example, in 2005 G Richard Wagoner, then the boss of General Motors, estimated that health benefits added $1,500 to the cost of every car built by GM). Only the right wing extremists in and out of the Republican Party, whose ideology blinds them to the interests of the national capital as a whole, can still defend the supposed virtues of the "American health care model". In fact the so-called health care reform legislation that the Democrats have managed to pass is driven not by altruism, but by the economic needs of American capitalism, and is by no means a "socialist" gift of the American government to the working class. Sure if all goes as planned more workers will have medical coverage as a result of this legislation - though by government calculations 13 million will still go without medical insurance - but this increase in the covered population will be financed in large part directly by the newly insured themselves, who will be obliged by law to buy their own medical insurance or pay a fine to the federal government.
Workers need to defend their own interests
From a working class perspective there is nothing to win in the "Health care reform". Besides the fact that the new legislation will eventually imposed an excise tax on the so-called "Cadillac plans" that still cover many workers, it will do nothing to address the main concerns today regarding their medical needs: the surging share of medical services that workers are obliged to pay from their own wages and the deteriorating quality of the health care that they receive. With the worsening of capitalism's economic crisis, the bosses will continue attacking working class living conditions as they try to make workers bear the brunt of its system collapse. These attacks will often come disguised as "reforms" - health care reform, immigration reform, social security reform... to make them more palatable to the working class. Workers will hear much about the need to oppose these "bad" policies in elections. However the response of the working class to these attacks can only be its intransigent independent collective struggle for the defense of its living conditions. It is only by developing this struggle at the point of production and the streets through the mass strike and its class independent organization (mass assemblies, strike committees...) uniting the unemployed and employed, that the working class can beat back capitalism's attacks. Against capitalism's drive to destroy humanity workers need to oppose their own revolutionary perspective. Eduardo Smith 7/4/10