A new stage in the US health care counterrevolution
8 May 2017
The passage by the US House of Representatives of the American Health Care Act is a political milestone. Never before has the US ruling elite revealed so nakedly the goal of its health care “reform” efforts of the past quarter-century. Millions of working people are to be deprived of health insurance and access to health care in order to finance a trillion-dollar payoff to the financial aristocracy.
The centerpiece of the legislation is the gutting of Medicaid, the government health insurance program for the poor, and its effective termination as an entitlement program. This will be the prelude to the destruction of Medicare and Social Security.
The massive cuts in health coverage in the bill have sparked popular outrage. Every significant occupational group in health care provision, from family physicians to psychiatrists, and advocacy groups for those suffering from cancer, heart disease, lung disease, multiple sclerosis and other illnesses have all spoken out to denounce the cruelty of the legislation endorsed so enthusiastically last Thursday by President Donald Trump.
While Democratic politicians in Congress pretend to share the public outrage, their objections to this monstrous piece of class-war legislation are purely cosmetic. The Republican legislation only does more crudely what Obamacare aimed to do more deviously, behind a cloud of reformist rhetoric: cut the cost of health care provision for American corporations and the capitalist state by shifting the burden to working people.
Like Obama’s Affordable Care Act, the Republican AHCA takes as its point of departure a health care system based on the subordination of the health needs of a vast and diverse population to the profit requirements of the giant corporations that control hospitals and the insurance, pharmaceutical and medical equipment industries, and to the Wall Street banks that dominate the economy as a whole.
As spokesmen for the ruling class have repeatedly declared, a basic problem of the US social welfare system is that the population is living too long. Advances in medical treatment and technology mean that it is now possible to live much longer than the actuarial projections on which Social Security and Medicare were originally based. What would, in any decent and humane society, be considered a great advance, is regarded by the financial aristocracy as an outrageous diversion of money from its accumulation of mansions, yachts and private islands, as well as the expansion of its arsenals for war and internal repression.
As the AHCA demonstrates, this is to be remedied by dramatically increasing the death rate.
The legislation that passed the House includes a huge tax cut for the wealthy and for insurance companies and drug and medical device manufacturers, worth about $600 billion over the next ten years. Even more important, as far as the ruling elite is concerned, it cuts $880 billion from Medicaid spending and $300 billion from subsidies for the purchase of health insurance, while providing a myriad of ways for removing millions of people from the health insurance rolls.
One particularly obtuse Republican congressman, Raul Labrador of Idaho, rebuked critics at a town hall meeting who claimed that the Medicaid cuts would lead to premature deaths. “That line is so indefensible,” Labrador said. “Nobody dies because they don’t have access to health care.”
Actually, a 2009 study published in the American Journal of Public Health found that 45,000 deaths every year were linked to lack of health coverage, and that uninsured working-age Americans have a 40 percent higher risk of dying than their insured counterparts. More recent studies have found that life expectancy among white middle-aged workers is beginning to decrease under the combined impact of deindustrialization, social cuts and the collapse of infrastructure, particularly in rural areas.
Continuing and intensifying these pernicious trends is the goal of the AHCA, and is bound to be preserved in whatever piece of legislation emerges from the Senate and is signed into law by President Trump. That is why the legislation effectively ends protection for those with preexisting conditions, which includes anywhere from 50 million to 130 million people, depending on how the term is defined. Those who are most at risk of developing serious illnesses, and therefore most in need of insurance, are to be shunted into medical ghettos (called “high-risk pools”), where they can be subjected to whopping rate increases or denied coverage altogether.
There are numerous other reactionary provisions in what appears to be a pro-corporate wish list drawn up to appease the ultra-right “Freedom Caucus” Republicans, who torpedoed the first version of Trumpcare earlier this year. The bill defunds Planned Parenthood for a year, hitting millions of working-class women; it eliminates federal funds to fight epidemic dangers such as Ebola and Zika; it cuts off federal support for public health vaccination programs; and it provides a backdoor method for employers to reestablish lifetime limits on health benefits, which 59 percent of employers imposed before Obamacare made such limits illegal.
The Democrats will spare no effort to portray the Republicans as heartless servants of the super-rich, but this description applies equally to them. Both parties agree that health care must be limited to what is compatible with the profit interests of American big business, and given the global capitalist economic crisis, health care costs are seen as a competitive disadvantage. Hence the bipartisan determination to cut costs at the expense of the health and lives of millions of working people.
The socialist solution to the health care crisis takes as its point of departure the needs of working people and society as a whole, not the financial “health” of giant corporations and banks. The Socialist Equality Party calls for the establishment of a system of universal, free health care for all, based on placing the entire health care system—insurance companies, drug companies, medical equipment companies, for-profit hospital chains—under public ownership, managed democratically to serve human needs, not profit.
Establishing such a system would be part of the reorganization of the economy as a whole along socialist lines, through the nationalization of the major corporations under workers’ control and the establishment of a rationally planned economy. The fight for this perspective requires the mobilization of the working class as a political and revolutionary force, independent of and against both the Democratic and Republican parties.