The Senate Republicans’ bill to “repeal and replace” Obamacare, unveiled on Thursday and set for a vote next week, comes on the heels of last month’s passage of a similar measure in the House of Representatives. These two bills are a milestone in the decades-long drive by the American ruling class to eviscerate the bedrock social reforms of the 1930s and 1960s.
The central feature of both versions is the imposition of more than $800 billion in cuts to Medicaid, the government health insurance program for the poor and disabled, effectively ending its status as a guaranteed benefit program. The ultimate enactment of this class war legislation, whatever its precise form, will be the prelude to the privatization and dismantling of Medicare, the government insurance program for the elderly, and Social Security, the government pension system enacted at the height of the Depression in the 1930s.
Both the House and Senate bills cut taxes for corporations and the wealthy by more than $700 billion, eliminate requirements on businesses to provide health insurance for their employees, and allow states to exempt insurance firms from having to provide essential benefits such as doctors’ services, inpatient and outpatient hospital care, ambulance service, prescription drug coverage, pregnancy and childbirth care and mental health and substance abuse services.
What is involved here is a social counterrevolution. It has been underway for more than four decades, under Democratic as well as Republican administrations. It was accelerated under the Obama administration following the Wall Street crash of 2008. With the coming to power of Donald Trump, the billionaire personification of the American financial oligarchy, it is being raised to new heights of savagery.
What will be the impact of this legislation on the daily lives of working people in America? People suffering from diseases such as diabetes, asthma, even cancer will suddenly find that they can no longer afford to pay for the drugs upon which they depend to survive. Low income people—an estimated 23 million—will be stripped of all health coverage.
Millions of people will suffer needlessly, and many thousands will die an early death. For the authors of these bills and their corporate backers, this is not an unfortunate byproduct, but the deliberate aim of their health care “reform.” For the richest 10 percent who tower above the lower orders and control the political system and its two major parties, the diversion of money from profits and private bank accounts to keep working people alive and reasonably healthy—especially those too old to serve as a source of surplus value and profit—is an intolerable affront. Life expectancy in America is already declining and mortality rates are rising for the working class, in tandem with the colossal growth of social inequality. The ruling class wants to accelerate this process.
Is it an accident that the Republican plans single out for the biggest attacks low income older adults younger than 65, the age for Medicare eligibility? Insurers will be allowed to charge them five times more than they charge younger people. A 60-year-old woman earning $35,000 will have to spend nearly $6,000 of her own money to buy an insurance policy. It does not take a rocket scientist to understand that many thousands, unable to afford health insurance, will be killed off before they can begin to collect Medicare benefits, or, if they do manage to survive to age 65, will collect far fewer benefits because they will die an earlier death, their health having been undermined.
No one should mistake the verbal protests and parliamentary stunts of the Democrats for a serious struggle in defense of health care. The assault on the basic entitlement programs dating from the 1930s and 1960s was begun in earnest by Bill Clinton, who ended “welfare as we know it” during his term in the White House.
Barack Obama had the gall to denounce the Senate health bill as a “massive transfer of wealth from the middle class and poor families to the richest people in America.” True enough! But Trump is taking off where Obama left off. By means of trillions in Wall Street bailouts and subsidies to the banks and hedge funds that lifted stock prices and corporate profits to record heights, Obama presided over the greatest transfer of wealth from the bottom to the top in US history. Along the way he slashed auto workers’ wages and city workers’ pensions and health benefits and imposed brutal cuts in food stamps.
The explosion of the opioid and heroin epidemic that, along with surging suicide rates, is cutting the longevity of large sections of workers occurred on Obama’s watch. His Affordable Care Act set the stage for Trump’s intensified offensive on health care, slashing health care costs for corporations and the government while increasing out-of-pocket costs and reducing benefits for tens of millions of workers. It implemented the principle of partially subsidizing the purchase of insurance from private companies with government vouchers—the framework long advocated by Republicans seeking to privatize Medicare.
The current policy of the Democrats is to plead with the Republicans to negotiate a bipartisan “compromise” that will “fix” Obamacare, i.e., make further concessions to the profit-mad insurance giants by more drastically slashing benefits and raising premiums and deductibles.
The choice offered by the ruling class—between “Trumpcare” and “Obamacare”—is no choice at all. Both lead to untold suffering, misery and death. The working class will not accept the destruction of social gains for which it fought and bled, wrenching them from an unwilling corporate elite in the course of mass social struggles.
America, along with Europe and large swathes of the world, is heading into a new period of class struggle. What the experience of decades of austerity, war and political reaction shows is that the defense of the most basic social needs, such as health care, is today a revolutionary question. Capitalism in its advanced stage of crisis and putrefaction is incompatible with basic democratic and social rights—including the right to a decent-paying and secure job, health care, housing, education, access to culture and a secure retirement.
The working class must advance its own independent program against both Trump and the Democrats, based on the fight for socialism. Profit must be taken out of health care. The health care industry must be removed from private hands and placed under public ownership and the democratic control of the working class. This requires an implacable struggle against entrenched wealth and privilege, and the political system that enforces them.