Workers Vanguard No. 943
25 September 2009
Obama Takes Aim at Medicare, Union Health Plans
For Socialized Medicine!
Expropriate the Health Care Industry!
For Free, Quality Health Care, Including for All Immigrants!
For Free Abortion on Demand!
It would be hard to find a more blatant expression of the capitalist profit system than the plans afoot to “reform” the catastrophe of health care in America. The commodity trade here is in human lives and the life-sucking health insurance giants and drug companies are the ones who will continue to be laughing all the way to the bank. In his September 9 speech to Congress, Obama packaged his health care “reform” plan as a means to provide coverage for the nearly 50 million uninsured Americans. He also claimed his plan would protect those with insurance from being subjected to the tender mercies of the HMOs, which deploy an army of administrators to “insure” that you get the least coverage possible, if they don’t just cut off your benefits entirely—particularly if you have a life-threatening illness.
The Democrats’ posture as “friends” of working people makes them effective political representatives for enforcing the rule of a system that is based on exploitation and oppression. Restoring the profitability and competitive edge of U.S. imperialism, where health care costs are the highest and the health of the majority of the population the worst in the advanced industrialized countries, is the real name of the “health care reform” game. As characterized by Wendell Potter, a former CIGNA insurance executive who is now an industry whistle blower, what’s being put forward today might as well be called “The Insurance Industry Profit Protection and Enhancement Act.”
With the official unemployment rate crowding 10 percent—and double that when the underemployed and those who have stopped looking for work are added in—the number of those with no health insurance increases day by day. Obama invokes the plight of the uninsured, with promises of a level of care not much above a pledge to pick up the dead bodies, in order to massively cut health care costs. Some $600 billion in savings is to come from reducing government spending on Medicare and Medicaid. Also being eyed for the ax by the health reform executioners are the now non-taxable employer-paid health programs won through the hard-fought union battles of the past. What are described as “gold-plated insurance” policies are not those of Wall Street CEOs, who have ready access to the best medical care money can buy, but the coverage available to many union members and their families. The current proposal by Democratic Senator Max Baucus is that the government levy taxes on these plans in the name of funding...health care!
The bitter reality of what is being palmed off as insuring the rights of all Americans to medical care was captured by liberal New York Times columnist Bob Herbert (18 August), heretofore among the more vapid enthusiasts for Obama as “change we can believe in”:
“Insurance companies are delighted with the way ‘reform’ is unfolding. Think of it: The government is planning to require most uninsured Americans to buy health coverage. Millions of young and healthy individuals will be herded into the industry’s welcoming arms. This is the population the insurers drool over.
“This additional business—a gold mine—will more than offset the cost of important new regulations that, among other things, will prevent insurers from denying coverage to applicants with pre-existing conditions or imposing lifetime limits on benefits. Poor people will either be funneled into Medicaid, which will have its eligibility ceiling raised, or will receive a government subsidy to help with the purchase of private insurance.
“If the oldest and sickest are on Medicare, and the poorest are on Medicaid, and the young and the healthy are required to purchase private insurance without the option of a competing government-run plan—well, that’s reform the insurance companies can believe in.”
The liberals, trade-union bureaucrats and reformist left plead for Obama not to abandon his promise of a “public option,” i.e., a minimal government-funded program to compete with the insurance magnates, or maximally to institute a “single-payer” system as exists in Canada and much of Europe. All of this is predicated on the belief that the capitalist state, the very purpose of which is to defend the profits and rule of the bourgeoisie, can be made to serve the interests of those the capitalist rulers exploit and oppress.
The national health care programs that exist in other industrialized countries were instituted to placate combative working classes. While representing real gains, these programs have been consistently whittled away according to both the budgetary considerations of the capitalist rulers and the overhead they deem necessary to rein in working-class struggle. Under capitalism medical care is rationed to all but the few who can afford to buy it. This does not change when the bosses’ state becomes the administrator.
“Big Government”: A Racist Rallying Cry
Free, quality medical care for all should be an elementary right. But achieving that will require a genuine socialist assault by the multiracial working class to rip the “health” industry out of the hands of the profit-gorged insurance giants and drug companies. Only with the destruction of this entire capitalist system of exploitation, which measures human life in dollars, can the wealth generated by those who labor be committed to providing the highest level of medical care for all and eradicating the poverty and hunger that condemn countless millions to a life of misery, disease and early death.
Despite its Stalinist bureaucratic degeneration, the Soviet workers state, with its planned economy, was able to provide all with a job, housing, health care and education. An examination of the tragedy that has befallen the peoples of the former Soviet Union since capitalist counterrevolution in 1991-92 speaks volumes about the “magic of the marketplace.” In capitalist Russia today, millions are starving, more than 40 percent of the population lives in poverty, infant mortality has skyrocketed and life expectancy has plummeted. It is equally telling that Cuba, once a backward neocolony of the U.S., has since the overthrow of capitalist/imperialist rule provided health care to all at a level comparable to that available in the U.S., despite the poverty of the island, enforced by the U.S. embargo and further exacerbated by the 1991-92 counterrevolution in the USSR.
There is plenty of justified fear and apprehension, especially among unionized workers and the elderly, over the current health care “reform” schemes. But the howls of the racist yahoos, bible-thumpers, militiamen and other reactionaries mobilized by the Republican right wing and their media shock jocks that Obama’s plan is a prescription for a veritable “communist” takeover of America are genuine lunacy. At the same time, such lunacy is a very real reflection of the anti-black racism, anti-immigrant nativism and sexual bigotry that have long been wielded by the American bourgeoisie to preserve its class rule.
Obama is branded by the color of his skin, but he is also the top cop of American capitalism, responsible for enforcing a system built on the forcible subjugation of the majority of the black population at the bottom of society. Jimmy Carter—who in the 1970s openly proclaimed the virtues of “ethnic purity”—decried as racist South Carolina Congressman Joe Wilson’s “you lie” outburst during Obama’s speech to Congress. Carter’s remarks are an expression of the appreciation by the more rational wing of the U.S. bourgeoisie of the necessity to uphold the credentials of America’s first black president to effectively oversee their plantation, and extract further sacrifices from the working class, blacks, immigrants and the poor.
That the U.S. is the only major industrialized country on the face of the planet without a national health care program is, in large part, testament to how the race/caste oppression of black people has been used by America’s rulers to divide and weaken the working class, furthering the exploitation of labor and the destitution of all the oppressed. In this country, cries against “big government” have long been synonymous with axing social programs such as health care and welfare by painting these as a drain on the tax dollars of “hard-working folks” to benefit the ghetto poor. Black people are always disproportionately hit by unemployment, poverty and lack of health care.
But what was first visited on the most vulnerable—single welfare mothers, desperate immigrants, people with AIDS—is now increasingly the reality for the working class as a whole. Thus, the fight for decent health care must link the fight for black equality with the struggle to end all injustice and exploitation. For full citizenship rights for all immigrants! For free abortion on demand and democratic rights for gays!
The lurid stories of government “death panels” that would order a shot of morphine to end granny’s life are particularly demented in a country where pain-relieving opiates are parceled out in ever diminishing doses for the sick and dying. The same religious fanatics who terrorize abortion clinics and assassinate abortion doctors in the name of “life” are a moving force to ensure that you die in agony in the name of God, with campaigns against the right of those whose bodies are ravaged by incurable diseases to end their misery through assisted suicide. A sector of the Catholic hierarchy, which has been in the forefront in fighting against the right of the dying not to suffer, has been condemning the evils of health care reform as an assault on the “unborn” and on that most sacred right of all for the capitalist rulers of this society, private property.
Nevertheless it needs be recognized that the powers that be have little interest in continuing to fund “excessive” medical care for those reaching the end of their lives. One can be assured that the Brooke Astors of the world will be immune to such cost savings. At the same time, the ruling class plans to raise the retirement age to assure that Social Security is not too burdened by excessive longevity. Simply put, for the ruling class, Americans are living too long.
Obama has made clear that his plan would not provide for “illegal” immigrants and their families and that “no federal dollars will be used to fund abortions.” This would be in line with the reactionary Hyde Amendment, signed into law by Carter in 1977, eliminating abortion coverage from Medicaid. Meanwhile, the situation for immigrants, who labor at the most dangerous and debilitating jobs, continues to worsen. In fact, since Obama took office, Homeland Security raids and deportations of immigrants have exceeded those carried out two years ago in a similar period under Bush.
The Labor Lieutenants of the Capitalist Class
Such health care benefits as the multiracial working class has won have been the product of militant class struggle against the exploiters. The dearth of strikes over the past decades helped pave the way for the bosses to butcher health care, pensions and other union gains with impunity. They have overwhelmingly gotten away with it thanks to the acquiescence of the union misleaders, who share the bosses’ concern of maintaining the profitability of American capitalism.
Obama’s election was celebrated as the arrival of the moment when things would be finally turned around in favor of the unions that had contributed $450 million to elect a Democrat to the White House. In fact, in his short time in office Obama has proved far more effective in gutting the unions than his Republican predecessor. Obama’s appeals for “sacrifice” to salvage American capitalism from the most severe economic crisis since the Great Depression were readily saluted by United Auto Workers (UAW) leader, Ron Gettelfinger. In the assault on the UAW orchestrated by the White House to foot the bill for bailing out the auto bosses, Gettelfinger accepted worthless GM and Chrysler stock to fund over half the union’s retiree health care trust. That is, he robbed medical care from aging workers whose years of backbreaking labor on the production lines were a serious and chronic detriment to their health, while those still working continue to see their health benefits massacred.
But perhaps the most flagrant expression of the trade-union bureaucracy’s commitment to maintaining the profitability of American capitalism at the expense of the very lives of union members is the role played by Service Employees International Union (SEIU) leader Dennis Rivera. Describing him as Obama’s “point man” on health reform, a New York Times (27 August) article reported that “Washington insiders are impressed and surprised that it was a union leader—Mr. Rivera—who forged a coalition including giant drug makers, the health insurers, the American Hospital Association and the American Medical Association that helped secure their pledges to cut hundreds of billions of dollars in costs.” In bed with the Obama administration and the health industry, the trade-union bureaucrats betray the genuine concerns of their members and leave the field of protest open to the crazed, racist right wing.
Leading accomplices in a “health care reform” package that will mean the massive leveling down of medical care for union members and their families, the SEIU tops also readily acknowledge that these deadly cuts will cost the jobs of hospital workers. For his part, newly installed AFL-CIO chief Richard Trumka is “drawing a line in the sand” against Democrats who oppose the now all but dead “public option,” according to the Huffington Post (18 August). Even in the unlikely event that a public option is included, it would be little more than a prescription for a health care ghetto for the most destitute, leaving the HMO and drug company moneybags with the whip hand.
For the Socialist Reconstruction of America!
The situation cries out for a revival of labor struggle to defend and extend the health, pension and other benefits won through the class battles of the past. But that means getting rid of the labor traitors, who long ago junked the very class-struggle means through which the unions were forged. The road forward lies in building a new leadership of the unions, which will lead the vitally necessary battles against America’s bourgeois masters. Such a leadership would lead the fight for free health care for all and for expropriating the health insurance and drug companies without compensation.
An article in the Left Business Observer (25 August) cited a founder of Physicians for a National Health Program who noted that CEOs who might privately support a single-payer health program are “reluctant to embrace it publicly for fear of encouraging would-be expropriators.” The fear as he put it is: “If you can take away someone else’s business—the insurance companies’ business—you can take away mine.” And that is precisely what is needed—the expropriation of capitalist expropriators who have looted the wealth of this country which was created by labor. For that, we need a revolutionary workers party, one which doesn’t respect the property “values” of the bourgeoisie but instead leads a revolutionary assault on and overturns through socialist revolution this decaying system. Only through the establishment of a workers government and a planned economy can the tremendous wealth, resources and medical technology of this society be put to providing for the many, not for the profits of the few.
We reprint below an article originally published in Women and Revolution (No. 39, Summer 1991), journal of the Women’s Commission of the Spartacist League/U.S. Titled “Wealth Care USA,” the article traces the history of medicine for profit in the U.S. and its roots in the class exploitation, racist reaction and sexual bigotry that are the foundation stones of American capitalism.
The Debate Over “Socialized Medicine”
Wealth Care USA
(Women and Revolution pages)
In 1948 that conservative bastion of wealth and prestige, the American Medical Association (AMA), smelled Armageddon in the air when Democrat Harry S. Truman won the presidential election. To the horror of organized medicine, prominent in Truman’s platform was a proposal for national health insurance. Outraged by this dire threat to doctors’ income and position, the AMA mounted what was at the time the most expensive lobbying effort in American history, running ads, publishing articles in the bourgeois press and sponsoring public meetings to stop this “creeping socialism.” One pamphlet demanded in a typical flight of reactionary hyperbole, “Would socialized medicine lead to socialization of other phases of American life?... Lenin thought so. He declared, ‘Socialized medicine is the keystone to the arch of the Socialist State’.” (According to Paul Starr, in The Social Transformation of American Medicine, the Library of Congress could not locate this quotation in Lenin’s writings.)
Harry S. Truman, the imperialist Commander-in-Chief who dropped the atom bomb on Hiroshima and Nagasaki, the American Cold Warrior who presided over the Korean War, was undoubtedly mighty indignant at being tagged a Communist for a proposal to ensure that “our people would continue to get medical and hospital services just as they do now”—that is, subject to all the class, race and sex biases of this bigoted society. But in 1948 the AMA’s intransigent opposition to any organized health plan perceived as a threat to “fee for service” private practice was already legendary. Since 1920 the AMA had denounced all such plans as the insidious doom of quality health care and had in 1938 attempted to destroy the Washington-based Group Health Association, a nonprofit cooperative providing health care to employees of the Federal Home Loan Bank. For this last the federal government had even moved to prosecute the AMA under the Sherman Anti-Trust Act, but the AMA remained intransigent.
Truman’s electoral promises soon foundered in the sweeping tide of anti-Communist McCarthyite witchhunting. Health insurance was “socialism” straight out of the Soviet constitution, according to Republican Robert Taft, who walked out of Senate hearings on Truman’s bill. In 1948 even simple public health measures like fluoridated water were “Communist plots” to the McCarthyites.
Yahoo fears to the contrary, such plans had existed for decades in Europe without threatening the capitalist status quo. Rather, European politicians knew that welfare plans could help defuse class struggle, win votes and cement an alliance with the pro-capitalist “leaders” of the workers movement. Truman, like Roosevelt before him, was a member of that liberal wing of the bourgeoisie that seeks to soften a bit of the jagged edges of exploitation in order to better reap profits and make war.
Access to health care should be a simple democratic right, a necessity just like education, a place to live, a job. Like every other basic right worth having, decent health care must be fought for in hard class struggle. It was no accident of history that Truman made his proposal amid a bitter series of strikes by the United Mine Workers (UMW) for union-controlled health benefits, part of a massive postwar strike wave that swept millions of workers out of the factories and onto the picket lines. Working in the country’s most dangerous trade, miners had been incapacitated by hideous rates of illness, crippled and killed by black lung disease. Notoriously corrupt company doctors had systematically whitewashed the severity of illness and injury. In 1946 Truman seized the mines when miners struck for a health and pension fund; in 1947 Congress passed the union-busting, slave-labor Taft-Hartley law, which specifically forbade union-controlled, company-funded welfare plans. But the miners struck again and again, defying government threats, until they won an unprecedented “cradle to grave” union-controlled health plan. While McCarthyite reaction killed Truman’s insurance proposal, the miners’ historic victory opened the way for other unionized workers to win health benefits. But the miners paid a big price for their victory: UMW head John L. Lewis made a deal with the coal bosses not to protest the loss of thousands of mining jobs to mechanization.
Medicine for Profit in Capitalist America
Today the U.S. crisis in health care is so bad that liberal social critics point out with alarm that the United States and apartheid South Africa are the only two industrialized countries in the world without a national health system of some kind. In America the grotesque inequities in medical care are a symbol of the injustice, inequality and indignity of this society. If you have money, you can get the best health care in the world, right on the cutting edge of the most advanced medical technology; that’s why Saudi princes come to New York for medical attention. But if the bucks aren’t there, and you don’t have really good private insurance, you can suffer lifelong debilitation from treatable diseases like asthma or you can die when treatment could have saved your life.
Health “care” in America means black children in Harlem die of measles and malnutrition, and workers suffer one of the highest rates of on-the-job accidents and industrial disease in the world. Hospitals specializing in the wallet biopsy just throw poor patients out; the paltry Medicaid fee doesn’t pay enough. “Until DeTar [Hospital] pays my malpractice insurance, I will pick and choose those patients that I want to treat,” declared Michael Burditt, MD, when he rejected a seriously ill, pregnant Hispanic woman who had come to the emergency room; she ended up giving birth in an ambulance without a doctor’s attention! But the millionairess Sunny von Bülow (whose story is told in the blood-chilling Reversal of Fortune), comatose for years and not expected to recover, gets a weekly coiffure and manicure in her hospital bed while space-age machines keep her breathing.
Our rulers know they’re sitting on a bomb waiting to go off: for years now health care has been a major issue in strike after strike. Workers and their families are suffering and dying because they’re denied care that touches on the most fundamental and the most intimate parts of life—sickness, birth and death. The health care disaster is having a widening impact on all sections of American society, except for the very rich. Even well-paid people, once relatively secure in a network of employer-provided health insurance, private physicians and well-run private hospitals, are threatened as companies cut benefits, doctors and hospitals raise rates, unemployment results in loss of health insurance.
The current health crisis has its more immediate historic roots in the economic crisis of U.S. capitalism signaled by the 1971 devaluation of the dollar, followed shortly by the U.S.’s humiliating defeat at the hands of the Vietnamese Revolution. Since then the American ruling class has sought to counter its decline by squeezing the population harder to restore profitability; domestically it’s meant rampant union-busting and budget-cutting. Under Democrat Jimmy Carter the miners’ historic “cradle to grave” health system was destroyed when the coal bosses and the government undermined union control in the bitter months-long Great Coal Strike of 1978. And Ronald Reagan opened a decade of union-busting attacks when he fired the PATCO air controllers for daring to strike against the federal government. That defeat signaled a broad capitalist assault on hard-won union benefit programs.
The bankrupt American empire thinks it can solve its economic crisis through military adventures like the bloody imperialist war in the Persian Gulf. While spending billions to bomb Iraq back to a pre-industrial age, our rulers decide this country can’t afford health, education, housing, jobs for American workers and the poor. With the decline in American industry, they don’t need a healthy, literate working class. But even on their own terms, where dollars count more than human lives, the bourgeoisie has a real problem: the anarchic medical system is out of control and costing too much money, so much so that even conservative holdouts like the National Association of Manufacturers are beginning to call for expansion of some government programs to cover the poor. Meanwhile, the U.S. government has announced plans to ration Medicare expenses, inevitably depriving the elderly of access to expensive new procedures.
Capitalist America: Class, Race, Sex Bigotry
Why does the United States have no national health system? Why is public health so feeble and preventive medicine nearly nonexistent? The answer is deeply rooted in this country’s history. In the United States public health began late and remained weak. Until the Civil War destroyed the slaveholding system, the capitalist class, impeded by the slavocracy in its attempts to institute a federal road system and to create a national bank and a protective tariff for industry, was certainly not going to forge a national board of health. Post-Civil War efforts foundered on “states’ rights,” intransigent capitalist opposition to cleaning up working conditions and slum tenements, and “social Darwinist” blame-the-victim bigotry.
Further, the power of the American capitalist class; the race, ethnic and sex divisions in the working class; the vastness of the country with the accompanying regional divisions; the absence of explicit, formal class barriers as in Europe with its aristocratic vestiges—all of these factors have served to vitiate the development of class consciousness in American workers. The same powerful class and social forces stymied the emergence of a mass workers party in this country. In Europe, the development of such a party, like Britain’s Labour Party or the German Social Democracy, went side by side with the institution of national health care.
From 1912 to 1920 a debate raged in the U.S. in reform-minded and medical circles over federal and state proposals for government-organized health insurance. While the American Medical Association was prominent in defeating these proposals, it was only one factor in a complex web incorporating hospitals, insurance companies, the giant pharmaceutical corporations and government officials. The web was spun from the deep-seated class and race divisions in this country. Capitalists seeking to lower wages and benefits, commercial insurance companies reaping cash from insecurity and fear, pharmaceutical companies hungering for profits: in the absence of a powerful, class-conscious labor movement able to fight for basic social needs, which could at least have provided a social counterweight to the moneygrubbing in the health industry, these forces soon established an iron grip over health care in the United States. They used every weapon in the bourgeois arsenal of social reaction: anti-woman bigotry, religious and ethnic hatred, class bias, race prejudice, national chauvinism.
Race-hate, woman-hating, religious bigotry—that was America in the early years of the 20th century. The post-Civil War South, where Jim Crow had crushed the freed slaves into poverty, illness and ignorance, was virtually an impoverished agricultural colony of Northern capital. In 1915 the KKK was reborn in the lynching of Leo Frank, a Jewish businessman framed up for the murder of a white woman. In the brutal Northern industrial slums, thousands of mothers and infants died at birth each year. Working conditions were appalling: in 1914, 35,000 workers died in on-the-job accidents; 700,000 suffered injuries like severed fingers and crushed limbs. In 1911, 147 young women, mostly Jewish and Italian immigrants, died horribly in the Triangle Shirtwaist fire in New York City; dozens leaped to their deaths because the bosses had them locked in. Bosses bitterly fought any regulation of safety conditions and the paltry workmen’s compensation plans which had just become law in some states; many of these plans were declared null and void by the courts.
The American robber barons only counted the dollars flowing in as their “divide and conquer” assault on the working people raked in Wall Street profits. By pitting workers against each other, by bringing in desperate blacks as scabs to break strikes, by fomenting chauvinist hatred of the millions of non-English-speaking immigrants on the job, the bosses had succeeded in crippling the workers movement. In the 1910s, less than 6 percent of American workers were members of the American Federation of Labor (AFL). The Gompersite labor lieutenants of the capitalist class organized their job-trusting unions against blacks, women, immigrants, feeding into antagonisms consciously fostered by the capitalists.
While the American Socialist Party endorsed health insurance in 1904, it was increasingly a party of middle-class, white “reformers,” alienated from more militant sections of the working class, many of whom were non-English-speaking immigrants. And the militant, class-struggle Industrial Workers of the World renounced “politics” on principle. Their mass base among migrant workers in the West, where they were crushed by the bosses and their government, lacked the potential clout of the industrialized workers in the Eastern cities.
History of the Health Insurance Debate
While working people lived and labored in brutal squalor, medicine was making miracles. When in the last decades of the 19th century Louis Pasteur and Robert Koch began to identify the pathogens responsible for many killer diseases, they began a bacteriological revolution which soon enormously increased medicine’s effectiveness. The discovery of anesthesia and asepsis opened up enormous potential both for the relief of human suffering and for profit in hospital surgery. The demand for doctors’ services and hospital beds—and the expense of medical treatment—soared.
By 1914 many European countries had passed some form of national health insurance. Far from comprehensive and certainly not free—only a fraction of the population was covered and workers had to pay some part of the cost out of their wages—these plans represented a significant reform within the confines of the capitalist system and were won as a concession to the combativeness of the European workers movement. In 1883, shortly after passing the Anti-Socialism Laws to squash the German Social Democratic Party, Bismarck instituted the first national sickness program:
“Chancellor Otto von Bismarck created the German system of social insurance as a dike to hold back the rising tide of socialism. As he told a visiting British observer, he wanted ‘to bribe the working classes, or, if you like, to win them over to regard the State as a social institution existing for their sake and interested in their welfare’.”
—Ronald L. Numbers, Almost Persuaded: American Physicians and Compulsory Health Insurance, 1912-1920
Insurance plans soon spread to Austria (1888), Hungary (1891), Luxembourg (1901), Norway (1909), Serbia (1910) and even backward tsarist Russia (1912). More influential in the United States was the British National Insurance Act, put forward in 1911 by Liberal Party chancellor of the exchequer David Lloyd George, later British imperialist war leader. Consciously seeking to diminish class conflict by integrating the working class into a welfare system and to win workers’ votes to the Liberal Party, Lloyd George summed up his hopes for health insurance with the comment, “You can not maintain an A-1 empire with a C-3 population” (quoted in Paul Starr, The Social Transformation of American Medicine). When the British Medical Association threatened a boycott, the government succeeded in buying the doctors off with promises of physician control of local health committees and guaranteed remuneration.
Social reformers in the U.S. expected health insurance to sweep the U.S. as it had Europe. It was in tune with the spirit of Progressivism popular in liberal bourgeois circles before World War I. Seeking to “clean up” the worst abuses of capitalist exploitation (but blind to the hideous oppression of black sharecroppers in the Jim Crow South), Progressives argued for woman suffrage and for legislation to protect child and female labor. And they certainly realized that the illnesses of the poor were communicable to the rich; disease was rampant in the fetid working-class slums of the big cities, where tuberculosis, the “captain of death,” spread in dusty sweatshops and filthy tenements without sunlight or fresh air. In motivating health insurance the American Association for Labor Legislation (AALL) emphasized that sickness was the leading immediate cause of “charity cases”; thus social relief enabling a sick person to keep his job would “reduce illness itself, lengthen life, abate poverty, improve working power, raise the wage level, and diminish the causes of industrial discontent.” But despite such appeals to capitalism’s “best interests,” by 1920 health insurance was a dead issue.
Enter the Doctors
In 1847 a small group of physicians had founded the American Medical Association primarily as a means to combat “sectarians,” that is, nontraditional physicians such as homeopaths, who were seen as a threat to the wealth and social position of the medical profession. (The AMA even denounced the Surgeon General of the U.S. for cooperating with a homeopathic physician to save the life of Secretary of State William Seward, when he was shot the night of Lincoln’s assassination!) As a classic petty-bourgeois professional layer primarily engaged in private practice, doctors have no strategic social power in capitalist society. Their economic motive is simple: to charge as exorbitant a fee as they can squeeze out of patients. Their social outlook is to avoid what has befallen teachers: proletarianization, the worst fear of a petty-bourgeois professional. In the key years 1890 to 1920—culminating in the victory of the bourgeois right wing—the AMA consolidated as a conservative force championing “fee for service” and opposed to any “third party” intervention in the “doctor-patient relationship.”
Organized medicine boosted its prestige by becoming rich, white, WASP, native-born and male. Through “reform” of medical education, the AMA succeeded in cutting the number of medical schools from 131 to 95 in 1915 and reducing overall admissions to eliminate a “surplus” of doctors. Only two black medical schools, Howard and Meharry, remained out of an earlier seven. Deliberate policies of discrimination kept immigrants, Jews, blacks and women out of medical schools. By 1920 blacks and foreign-born doctors were almost completely unrepresented on hospital staffs. Ethnic, race and religious discrimination against both doctors and patients was a leading factor in the establishment of religious and ethnic hospitals like Mount Sinai in New York City.
Both North and South, hospitals were strictly segregated against blacks. The AMA itself was almost lily-white. While blacks could join on a national level, most doctors were members through a local medical association. Black doctors in the South were effectively barred; in 1895 blacks had established their own organization, the National Medical Association (NMA), which, reflecting the desperate needs of black patients, had a longstanding position in support of national health insurance. In 1950 the AMA finally moved to put token pressure on Southern locals to admit black doctors. But as Edward H. Beardsley wrote in A History of Neglect: Health Care for Blacks and Mill Workers in the Twentieth-Century South, “there was feeling among some blacks that the AMA was only hoping to strike a deal with the NMA over national health insurance. Earlier, AMA leaders had approached their black counterparts with a vague offer of recognizing black medical societies as AMA affiliates if the NMA would join against Truman’s ‘socialized medicine’ scheme.”
Public Health in America: Stillborn
As Harvard medical historian Paul Starr documents, doctors viewed public health as a threat and defended a “vigilantly guarded border” between private medical practice and public health’s shrinking mandate. “Doctors fought against public treatment of the sick, requirements for reporting cases of tuberculosis and venereal disease, and attempts by public health authorities to establish health centers to coordinate preventive and curative medical services.” Crying “parasitism” and “abuse,” doctors were instrumental in banishing urban dispensaries, “medical soup kitchens” where the poor could be treated for free. Similarly, in April 1902 over 1,000 doctors and druggists denounced New York City’s internationally renowned Department of Health for “unfair competition” and “municipal socialism” because it sold its overstock of diphtheria antitoxin at cost. The department was forced to stop all sale of the antitoxin for this hideous disease, one of the 19th century’s biggest killers of children.
Thus, by 1912 when the Progressivist American Association for Labor Legislation first set forth its proposals for health insurance on the state and national level, the AMA had some experience with getting its way. Interestingly, at first the AMA endorsed the insurance proposal as “inevitable.” But soon doctors learned that its defeat was possible. According to Ronald L. Numbers:
“During this period nothing seems to have played a greater role in molding opinion than money. In the early days of the debate, when poorly paid American physicians believed that they, like their British brethren, might benefit financially from compulsory health insurance, it seemed like an attractive idea.... [But] the incomes of physicians were increasing without insurance. The average income of taxed physicians in Wisconsin, for example, rose 41 percent between 1916 and 1919. Wartime inflation was responsible for much of this, but an unprecedented decline in the total number of physicians undoubtedly had some effect.”
But more important than the position of the AMA was the clout of big business. Organizations like the National Association of Manufacturers and the National Civic Federation opposed compulsory insurance plans. An especially powerful enemy was the burgeoning commercial insurance business. The enormous profits of the Prudential Insurance Co. (founded in 1875) and the Metropolitan Life Insurance Co. sprang from selling “industrial” life insurance policies to working-class families. These grisly policies of death paid costs for terminal illnesses and funerals only. A huge army of insurance agents visited families weekly, immediately after payday, to collect the 15 or 25 cents premium, a very high percentage of a workman’s pitiful wages. The fear of a pauper’s burial was so great that in 1911 individual Americans spent $183 million on these burial policies—about as much as Germany spent on its entire social insurance program!
The AALL program’s inclusion of death benefits directly threatened the life insurance giants, who proved its most bitter opponents. The chief spokesman for the insurance industry was Frederick L. Hoffman, Prudential actuary and vice president, who churned out pages of propaganda smearing compulsory health insurance as unnecessary, fraudulent and un-American. The insurance industry also financed the opposition of the Christian Science faith healers.
Faced with such powerful enemies, compulsory insurance needed powerful friends. But while some state union federations supported it, AFL head Samuel Gompers denounced it. When in 1916 Socialist Party Congressman Meyer London introduced a bill for compulsory health insurance into the House of Representatives, Gompers was the only witness to testify against it. In a hypocritical diatribe against government paternalism, Gompers claimed that compulsory insurance would stand in the way of the workers’ attempts “to strive and struggle for their own emancipation through their own efforts.” Of course the labor-traitor Gompers (who also opposed legislation for the eight-hour day, the minimum wage and unemployment insurance) did nothing to organize “striving and struggling” for the vast majority of workers, who were still unorganized. The job-trusting, Jim Crow AFL leadership was a criminal obstacle to workers power. The key element of organized class struggle, which both Bismarck and Lloyd George had sought to buy off with their social insurance schemes, was crippled in the United States. When the capitalists looked at the health care equation, they saw only that their bucks would go to premiums and to sick pay which they believed would only encourage “malingering.”
The final blow to the Progressives’ reform plan was the entry of the United States into World War I in 1917. True, when hundreds of thousands of young Americans failed their army physicals, health reformers used military necessity to bolster their arguments for health insurance. But this appeal to chauvinism was swamped in imperialist war hysteria targeting radicals, antiwar militants, women’s rights activists, socialists, unionists—any challenge to the U.S. war drive. Chauvinist reaction killed dead any chances for health care reform, while health insurance opponents reveled in its German connection. (In his 1918 address, the AMA’s president called on AMA members to turn in German doctors to the cops.) The powerful witchhunting Creel Committee on Public Information commissioned a series of articles by Frederick Hoffman “exposing” German sickness insurance as a “fraud.”
The California League for the Conservation of Public Health (an Orwellian name indeed) propagandized in a pamphlet entitled “What Is Compulsory Social Health Insurance?”: “It is a dangerous device, invented in Germany, announced by the German Emperor from the throne the same year he started plotting and preparing to conquer the world.” A front group for California commercial insurers, the Research Society of Social Economics, passed out thousands of copies of a pamphlet displaying a picture of the Kaiser over the caption: “Made in Germany. Do you want it in California?” This disgusting chauvinist barrage turned Californian voters against insurance, which was defeated in a statewide referendum.
The 1917 Russian Revolution, greeted by the working-class masses as a beacon of hope amid imperialist slaughter and exploitation, gave the enemies of health insurance yet another inflammatory theme which only intensified in the postwar upsurge of anti-communist reaction. In 1919 a prominent New York physician-lawyer, John O’Reilly, screamed that health insurance advocates were “Paid Professional Philanthropists, and busy-body Social Workers Supporters, Defenders, Associates of the Forces of unrest known as the I.W.W. and Bolshevists; the disciples of Lenin and Trotzky whose Gospel is the Destruction of those things worth while for which men and women have given their lives.” Others attacked insurance advocates using nasty anti-Semitic slurs and claims of “sexual license” and “religious hatred.” Thus organized medicine played its small but dirty part to whip up the bloody crackdown on labor struggle after the war. Capitalist reaction spawned the union-busting, the anti-communist Palmer Raids, the mass deportations of foreign-born workers and the vicious race riots of the postwar years.
Bitter Fruits of “Wealth Care”
While the rise of the militant CIO in the 1930s paved the way for the establishment of union benefit plans like the UMW’s, American medicine for profit, born in capitalist reaction, remains locked in to anarchic, limitless greed. When AIDS hit the U.S. in the 1980s, the response of the ruling class and the medical establishment was to be predicted: criminal neglect, outright gloating over a disease that targeted homosexuals as well as increasing numbers of drug users and the poor. Medicine has become not only a source of enormous profit, but a sort of moral priesthood of the arrogant privileged sermonizing against the “guilty” who are sick for their sins; “public health” has turned into a criminal manhunt. In a truly vicious and twisted victimization of a young black woman, recently a Florida appeals court upheld the conviction of Jennifer Clarise Johnson under a law designed to punish drug dealers giving drugs to children: she supposedly delivered cocaine to her baby through the umbilical cord before it was cut after birth!
Today, about 34 million Americans have no health insurance at all—and that’s not counting the tens of millions who have pitifully inadequate coverage like Medicare and Medicaid. Medicaid fees are so low that many doctors simply turn patients away—for a visit to a doctor in New York Medicaid paid $11 in 1989! For years death rates and infant mortality rates for black people have been worsening as poverty lashes them with malnutrition, wretched housing, lack of medical care. Ghettos are devastated by epidemics of diseases supposedly conquered by modern medicine: tuberculosis once again spreading; measles, easily prevented by vaccine, rampant because vaccinations for common childhood diseases, once free, now cost several hundred dollars. In contrast to every other industrialized country on the globe, in the United States sexually transmitted diseases are increasing: syphilis, once almost eradicated, now the cause of thousands of babies born with a terrible, crippling congenital condition; gonorrhea, now spreading in drug-resistant forms.
Just over a year ago in “Excess Mortality in Harlem,” published in the New England Journal of Medicine (18 January 1990), doctors reported that life expectancy for black men in Harlem was lower than for men in Bangladesh, one of the world’s most impoverished countries. The two authors of the report concluded, “A major political and financial commitment will be needed to eradicate the root causes of this high mortality: vicious poverty and inadequate access to the basic health care that is the right of all Americans.” But it has only gotten worse. Harlem Hospital, virtually the only health facility for the 125,000 inhabitants of Harlem (where private physicians are practically nonexistent), is faced with loss of accreditation and withdrawal of federal Medicaid and Medicare funding.
Conditions on the job have deteriorated too as the bankrupt American empire has intensified the exploitation of labor. Some 4,000 coal miners die every year from black lung disease, and 10,000 of the 160,000 miners on the job show evidence of the disease already. In February 1989 the so-called “Labor” Department of the U.S. government discovered widespread and massive cheating by mining companies in testing mine air for coal dust, the cause of the illness. After stalling for months while miners continue to get sick, the government finally announced fines as low as $1,000 per violation, a meaningless slap on the wrist!
The health care “system” in the U.S. shows again and again that the capitalists don’t want to let human life get in the way of their profits. Understandably outraged, ACT UP activists, through militant stunts like blockading Wall Street and protesting at Catholic masses, try to pressure government into putting more money into AIDS care and AIDS research. But only intransigent class struggle has won even the little piece of the “miracle of modern medicine” that workers and the poor now have. And as the miners’ long years of struggle show, even those gains can be reversed by renewed capitalist attack.
Medicine for profit is too locked in for the American capitalists to implement a universal government-provided health system like the one in Canada or Britain. But even if it were possible, it’s no answer either. In Britain, nobody who can afford a private physician’s fees ever goes to National Health, and the already inadequate care is fast disappearing as the government slashes services. While the Canadian system provides better general health care to the population as a whole, many people can’t get access to expensive procedures requiring high-tech medical equipment because there isn’t enough money in the tight budget.
The struggle for decent health care exposes the gaping holes in all the pathetic patchwork reform schemes advocated by liberal social workers, social democrats and officials of the twin capitalist parties. The treacherous U.S. labor bureaucrats, the grandsons of Samuel Gompers, today pass motions calling for a national health system and argue about it at their fancy poolside confabs in Bal Harbour. But such schemes are just bandaids for cancer, more halfway measures guaranteed to ration medical care by class, race and sex. The AFL-CIO executive board couldn’t even pass a motion to support women’s right to abortion, let alone fight for equal rights for blacks, women and gays. The working class must oust the trade-union bureaucrats, the labor lieutenants of the Democratic Party—the party of Harry Truman and Jimmy Carter—and build a revolutionary, class-struggle workers party which will take up all the struggles of the exploited and oppressed, and fight for a workers government.
Free, Quality Health Care for All in a Socialist World!
The crisis of medical care cries out for a socialist revolution which will lay the basis for a society which will end all exploitation and social oppression. Health means much more than shots and pills and surgical knives: it is a decent place to live; plenty of good food to eat; knowledge of human biology; air clean of pollution; safe, decent working conditions; the principles of public health rigorously applied. Medicine can’t save lives ruined by poverty and malnutrition. Right now a deadly epidemic of cholera is spreading rapidly throughout South America, the first since 1895. Its genesis is quite simply the collapse of the sewage system. Groaning under millions of dollars of debt to imperialist banks, Third World countries can’t maintain even a basic social infrastructure.
In this complex industrial society, it will take worldwide planning based on scientific knowledge to establish both public health and the best care for the individual. The AIDS pandemic only underlines the urgency of this truth. What we need is free, quality health care for all—communist medicine, where the wealth of resources on our planet go to the service of the people, not to production for profits.
When we have thrown out the vicious capitalist system which sells human life for dollars, we will be able to build a new socialist society where human life, human worth and human dignity count. Doctors will be servants of the people; hospitals will be havens to heal the sick; research on vaccinations, new medical techniques and improved drugs will be internationally coordinated and to the benefit of all. When the workers of the world are in charge of this planet, the only limits of human health will be scientific—and these will be constantly enlarged by thoughtful, energetic research.