Can We Ever Get Equal Care for All?

Charles Andrews

Can we ever get equal care for all? We can't -- at least, not by going down dead-end roads.

A year ago hope was alive for equal health care for all. Bush was defeated, and the Democrats won control of both houses of Congress. Throughout 2009, though, every week brought a slap across the face or a punch to the stomach. CEOs of insurance companies, drug corporations, and hospital chains visited the White House several times each. In the summer President Obama announced his deals with them. In return for pledges to trim costs later, federal law would give insurers millions of new mandatory customers. The other special interests got cozy deals, too, while the corporate cost-cutting pledges turned out to be vague and unenforceable.

Meanwhile, committees of Congress refused even to listen to supporters of Medicare for All. If anyone used those words or the equivalent label "single payer," she would not be heard unless she stood up in a hearing and shouted. She would then be gaveled down and arrested. Meanwhile, a senator nominally representing the minuscule population of Montana, HMO-funded Max Baucus, hosted backroom discussions.

Supposedly, 87 representatives in Congress had pledged support of the longstanding Medicare for All bill, John Conyers' HR 676. It was all for show. The "progressives" hold 40 percent of the votes needed for passing any bill in the House, but they did not act as a group to get any significant reform, let alone single payer, into the final legislation.

Nor did trade unions bring their members into the streets demanding Medicare for All (with rare exceptions like the National Nurses United). Instead, they deployed lobbyists to compromise, compromise, and compromise again, desperate to protect a few rooftops from the flood of corporate muck sloshing through Washington.

Just a year after the election of November 2008, AFL-CIO health campaign manager Nick Unger admitted to a "lack of energy and even negativity" among Illinois single payer advocates. "Many of their troops in the outside the Beltway field have 'battle fatigue' or worse. It gets harder to ask for one more call."

The monster legislation was big and ugly, but it keeled over with one blow -- the refusal of Massachusetts voters to accept the Democratic candidate who endorsed it. The Democratic Party is stunned. Its leaders are scrambling to find another way to serve corporate wealth. It's the only meal ticket they know.

Can we ever get equal care for all?

"Organize More!" Is Not a Solution

It's a Gift is a classic comedy movie by W. C. Fields, but if common people want something in this society, they've got to fight for it. That's well-known wisdom.

After defeats like the health care farce of 2009-10, we usually tell ourselves to organize a broader, more militant movement. But that is not much of an answer. In fact, it would be an evasion of the problems that we face trying to get something done in today's rotten economic and political order.

Yes, masses in motion are necessary, and movements are the only way that real change is won. They are built on a wave of decision among common people to take a leap of hope, contribute energy, and endure deprivations. People weigh such decisions, determining whether a call to organize gets a response.

Successful movements do more than show how many people support their demands. They impose political and economic costs on the ruling class. On the other side, the rich (divided into various interests but united as a class) calculate the price of conceding a reform versus the costs of enduring and repressing a movement. There is no formula for these judgments, but we can learn something by comparing the push for robust Medicare for All with two great periods of social movement and reform in the twentieth century: the 1930s labor movement and the broad turmoil of the 1960s centered on the anti-war and civil rights movements.

The 1930s

In the 1930s workers in factories, shops, and on the road won industrial trade unions, hitting more than a third of labor force by 1945. Corporations and the government were compelled to recognize the right of employees to negotiate as a united group with the employer. It happened in the middle of the Great Depression when the unemployment rate reached 25 percent.

With their new trade unions, workers won wage increases, some control over job descriptions and hours, vacations, and a range of pension and other benefits. The federal government took on the role of enforcing labor standards. Perhaps the most enduring achievement of the decade was the enactment of Social Security.

Working people went on strike, occupied factories (taking good care of the machinery, but conveying an implicit threat if police were sent into the plants), sacrificed income, and fought bloody battles with corporate thugs to get their unions.

Corporations had to confront the reality of production shutdown and the prospect of constant unrest. These were real costs. In addition, common people began to consider the foundations of the social order, and the ruling class had to worry about really big challenges to its rule.

Big business could choose massive repression, throwing aside the niceties of democracy and relying on the sovereignty of hired fists. In Germany, the steel magnates, bankers, and military officers took that road. In the United States, perhaps the ruling class understood that a thousand-year Reich would not last more than a dozen years.

Capitalists needed labor peace one way or the other. They chose to accept industrial unions and social welfare programs. In return, industries staffed by millions of so-called semi-skilled workers ran pretty smoothly, churning out profits that paid the dividends and interest, creating stock-market and real-estate wealth.

The 1930s upsurge of workers succeeded because corporations needed them in the factories and shops. It succeeded because a mass movement swelled, drawing people in and making it almost natural to pay the price required to win.

The 1960s

The U.S. ruling class has thrown its weight around the world from the Monroe Doctrine of 1823 stating that Latin America was a "sphere of influence" belonging to the United States, to the quick conquest of the Philippines and Cuba at the end of the nineteenth century, to the friendly dominance obtained over Europe in World Wars One and Two while cutting in U.S. petroleum corporations on the Mideast oil bonanza.

There was domestic opposition but nothing serious -- until Vietnam, a country whose people simply would not give up. The U.S. ruling class dug in, determined to show Third World countries that they could not cross the United States. The government found itself calling up millions of youth in the draft. More than 50,000 U.S. soldiers died and many more were wounded and traumatized in the inferno of people's war.

A huge anti-war movement was born in the United States. It is best known for its mass protests, a million people marching on Washington while on the same day another 500,000 filled San Francisco.

The crunch point of the movement, however, where popular opposition and governmental determination to wage war collided head on, was resistance to military service and disruption in the armed services. Draft dodging was honored with public burnings of Selective Service registration cards. Military bases around the U.S. were infiltrated with anti-war agitation and support for soldiers. In Vietnam, U.S. soldiers refused orders, or, forced onto patrol, suddenly radioed to headquarters that their lieutenant had been shot or grenaded. In effect the troops conducted a huge, rolling mutiny. The young men were unwilling cogs in a war machine, and they simply refused to function as such. Action and consciousness advanced in step with each other: as in the 1930s, millions of people began to reconsider the foundations of the social order.

Again, the ruling class had to choose between conceding reforms and taking the velvet wrap off its dictatorship. The rumor had it that President Nixon floated the option of canceling the 1972 elections. Finally, however, the U.S. ruling class realized it had to settle with the Vietnamese people. At home the rulers gave up on the draft, turning to a much smaller "professional" military staffed by rivulets of poor rural and ghetto youth.

Preceding the anti-war movement by a few years and overlapping it was a civil rights movement. Black people in the South started a campaign to overcome formal segregation, made infamous in signs of separate water fountains for "white" and "colored." Black people created a way to impose costs on local government and business: the sit-in.

Several million Black people had already left the South in the preceding twenty years, and they became the northern and western wings of the civil rights movement. Blacks were about one in eight of the U.S. population. They had considerable support, but their movement bears special characteristics because of the basic proportions. Without going into detail about the civil rights movement, we can note that it destroyed formal segregation. Black people won access to all levels of society, but the movement did not achieve fundamental equality. Although a Black middle class developed and won a place in the capitalist economy, the economic inequality of the mass of Black people was not overcome.

Culture

It is also worth noting that both the 1930s and 1960s saw a wide cultural upsurge. The labor movement of the 1930s widened into new literature and even a popular grassroots aspect in some of the movies from Hollywood. Stuffy upper-class arrogance was mocked and forced into hiding. Similarly, the 1960s anti-war and anti-racist movements broadened into a new youth culture, an independent mass cinema that cracked Hollywood's brittle formula entertainment, and a revival of rebellious theory and politics after the anti-communist repression of the late 1940s and the 1950s.

The Economic Antagonism over Equal Care for All

Using your private health insurance is like walking through a minefield. What will they refuse to cover? How much are the deductibles and co-pays? If you cope this year, you know the terms will get worse next year.

Tens of millions of families confront these problems because health care industries, plus their inputs from information technology and other sectors, make up one-sixth of the economy, and because health care is a growth business dominated by huge insurance corporations, hospital chains, and pharmaceutical giants.

A movement to get Equal Care for All would draw from a wide range of the population. It includes most workers who are paid low- and middle-level wages, since employees need to get health coverage through the job or a universal national plan. It includes their family members, which highlights another outrage of the current system. Many married persons depend on their spouses' health plan, a recipe for turning family tensions into serious stress.

On the other side, the rich who own and direct corporate wealth do not want a huge sector of the economy functioning primarily to meet the needs of common people. Why not? For three reasons.

One, an ideological, political, and institutional precedent in health care might become only the first demand for equal and secure conditions of life and work.

Two, health care and education are growth sectors. The rich like to dump money-losing industries on the government (incidentally helping to give "socialism" a bad name) while they keep the industries that enjoy expanding revenues and profits.

Third and most important, the capitalist economy has reached a historical limit. Big new industries generating both hefty profits for capital and, as a result of popular struggle, lots of good jobs for working people no longer arise. That used to be the pattern; it was repeated in the railroad, steel, and automobile industries. No more. Yes, technology marches on, but the new industries of the last several decades -- electronics, information processing, and biotech -- have not paid off for common people. In people terms, Detroit was a giant and Silicon Valley a dwarf.

Instead, the great majority of common people have found and kept jobs only by making endless concessions to the Profit Man. Work hours and stress have increased, and real income has stagnated since 1973. (An analysis of this development, its causes, and the implications for our economic order is in this writer's new book, No Rich, No Poor.)

Less Policy, More Punch

The problem for the movement to get Equal Care for All is how people make it costly for the ruling class to deny their demand. In the 1930s a huge, militant strike wave did it. In the 1960s anti-imperialist sentiment crested in actions that broke enough gears in the military machine.

A similar effect today might result from waves of political strikes. Like all strikes, they stop the flow of revenue and profits. The aim of a political strike, however, is not to get a contract with one employer or in one industry, but to extract a social principle from the ruling class. We want equal health care guaranteed to everyone, free in the same way that local parks are free: you don't pay to get in.

In the history of the United States, the outstanding national political strike action was the one centered around May 1, 1886. The demand was legislation for an eight-hour day. About 350,000 workers walked out and demonstrated.¹ It was a Saturday, the last day of the work week.

That was a long time ago. Defensive political strikes still happen in Europe. In 1995 in France, for example, the government tried to increase health care premiums and various taxes while proposing to raise the retirement age of government workers. The latter began a series of strikes in October. Private-sector workers and the unemployed supported them with demonstrations, including a Paris rally of nearly one million people. By December, sections of private business employees began going out on strike, too, all for the political demand to cancel the social welfare cuts. The government was forced to withdraw almost all of them.

One way or another, the equal health care movement needs similar punch. Rallies, meetings, petitioning of legislators, and massive demonstrations need to flow toward action that goes beyond words. On one side are those who accept this fact, who give voice to it in agitation and educational work, who watch events for hints and pointers. On the other side are those who operate on an unspoken delusion. They believe that sooner or later the ruling class will listen to the voice of the people, as though reason, the general welfare, and overwhelming majorities ever mattered to the rich.

No one says, "Don't continue to educate, seek new committed fighters, and watch the horizon closely." The lessons of 2009, derived by the method of historical comparison, serve the work well:

• Social turbulence is like a storm. You can get ready, but ten thousand activists cannot start one.

• Equal Care for All cannot be won by rational persuasion of the ruling class, nor by incremental back-door schemes like a "public option."

• Most likely, a successful equal care movement will, like the examples of the 1930s and 1960s, be part of a broad upsurge, a social-cultural stirring that touches off discontent and re-examination over all sorts of inequities and unmet needs.

• Equal Care for All challenges the economic order. For one thing, its essential humanity shows up the depravities of profit supreme. That's always been true. There is another reason now: capitalism can no longer grant major reforms and absorb the cost in broad-based growth and prosperity.

With the 2008 change of governing party in the White House and both houses of Congress, with rhetoric of "change you can believe in," people justifiably let hopes be raised after years of living under crude overlordship. But the events of 2009 doused us with a pail of cold water. Such defeats do not tell common people that a better life is impossible. A loss tells us to fight a different way.

Common people make society go, and oppression builds up the latent force that throws it off. The more the human spirit is confined, the bigger the explosion.

1 Philip S. Foner, History of the Labor Movement in the United States, vol. 2, New York, International, 1975, p. 103.

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