What’s the next step toward Medicare for All?

Sean Petty, a registered nurse in New York City and member of the board of directors of the New York State Nurses Association, makes the case that single-payer health care advocates can advance the struggle politically and organizationally.

Taking to the streets for single-payer health care in Los Angeles (Molly Adams | flickr)

Taking to the streets for single-payer health care in Los Angeles (Molly Adams | flickr)

THE PRESS conference earlier this month where Bernie Sanders announced his “Medicare for All” legislation shows both the massive opening and the serious challenges facing the struggle for truly universal health care in the U.S.

Sanders’ legislation comes after a summer of successful struggle to stop Trumpcare. The Senate Republicans’ latest attempt to “repeal and replace” Obamacare collapsed this week after a handful of both hard-right and more “moderate” Republican senators came out against it.

Donald Trump tweeted angrily about John McCain, but a very important reason for the defeat of the various Trumpcare proposals was the upsurge of protest organized by liberal organizations, unions and other health care advocates.

The angry demonstrations at events held by Republican lawmakers throughout the year, as well as actions in Washington, helped expose how the GOP plans for “repeal and replace” would have worsened an already ailing system governed by Obamacare–particularly by dismantling Medicaid and Medicare. Beyond the protests, popular opinion ran heavily against Trumpcare.

This opposition went far beyond single-payer advocates, but it helped our movement by reminding millions of people how critical federally funded health care is–and getting them to more seriously consider Medicare for All as an alternative to both Trumpcare and Obamacare.

The effect of this on Sanders’ proposal has been telling. For almost three decades, the mainstream of the Democratic Party has systematically undermined and marginalized proposals for single-payer health care. But this month, 16 Democratic senators, including most of the known hopefuls for the 2020 presidential nomination, lined up in support of Sanders’ legislation.

Of course, it’s easy for liberal Democrats to support Sanders’ bill when it has no chance in becoming law under a majority Republican Congress, with Donald Trump in the White House. The Democrats can appeal to millions of people persuaded by the case for Medicare for All, without having to face the fury of the for-profit health care industry.

But even at the level of purely rhetorical support, Sanders’ legislation is a big deal. It is a crack in the political edifice on the issue of single-payer health care, which opens up opportunities to mobilize greater pressure from outside Washington. Whether the crack gets widened or sealed up is a critical question facing our re-energized movement.

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THIS IS a useful moment to pull the lens back and look at what it will take to make Medicare For All a reality.

The first dynamic to understand is that we haven’t seen anything close to the opposition that will cohere among the health care industry and the ruling class as a whole when a Medicare for All proposal like Sanders’ gets closer to being enacted.

Health care accounts for as much as one-fifth of all economic activity in the U.S., according to estimates. There is a considerable amount of wealth at stake in the profits of the prescription drug industry, from medical supply and equipment sales, and, of course, for private insurance.

Medicare for All would allow the government to bargain with health care companies with an unprecedented leverage and economic scale–and it would be a huge blow to private insurers, even if it doesn’t totally eliminate them. Moreover, Sanders’ bill is filled with taxes on the rich and powerful–higher taxes on business, wealth taxes, a more progressive income tax structure, and even a one-time tax on offshore financial holdings.

The opposition to single-payer will manifest itself in two general ways.

The most blatant will be an extremely well-funded propaganda campaign that claims Medicare For All would produce “death panels” and financial ruin to every household in America.

The resounding defeat last year of a Colorado ballot initiative that would have changed the state constitution to permit universal coverage for every resident gives a taste of how the economic and political powers–including plenty of Democrats who claimed to oppose Trumpcare this year–would line up against single-payer.

Likewise, in California and New York, it was Democrats who did the dirty work of the insurance industry in blocking legislation to move toward a statewide Medicare for All system.

The second, less obvious way opposition will take shape is the “Trojan Horse” effect.

Right now, powerful mainstream Democrats like Elizabeth Warren, Cory Booker and Kristen Gillibrand have nothing but nice things to say publicly about Sanders’ bill. But there has been and will be intense pressure to water down single-payer legislation.

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NONE OF this means the fight for Medicare for All is unwinnable.

In fact, Sanders’ introduction of this legislation–at this political moment and with support beyond himself, at least for now–shows how easily a government-run system that guarantees universal coverage could be embraced by the majority of people.

Right now, Sanders is probably the most popular politician in the country. Certainly, he is at the federal level, where his favorability rating being higher than his unfavorability is unique. Sanders stands for a progressive political agenda that has partially filled a massive void in mainstream politics.

His Medicare for All bill isn’t perfect. Members of Physicians for a National Health Program are critical of the legislation for allowing co-payments for some medical necessities, including drugs and biologics. There are questions about how far-reaching and systematic its funding mechanisms are, and whether four years is too long of a rollout.

But supporters of Medicare for All have shaped the bill in important ways. It bars deductibles and most co-pays, fully funds abortions and covers undocumented immigrants. The pressure to reverse these important provisions will be relentless. The larger the movement–and the larger the Left within that movement–the more people we will have a bill worth fighting for.

With Medicare for All, Sanders–in stark contrast to Democratic Party leaders–is offering something concrete and popular that would change most everyone’s life for the better.

But Sanders’ popularity obviously isn’t enough. The most important factor that will determine whether we see such a program in our lifetime is whether the widespread popularity and unprecedented momentum is organized so that it becomes an active force, felt in workplaces, communities and the media.

There are many ideas about how to build from the grassroots. Do we need a national march? Do we need to focus on “base-building”? Do we need different forms of coalitions and activist organizations? The answer is all of the above–but the question of strategy and timing will take some time to figure out.

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ACTIVISTS AROUND this issue need to recognize that we won’t win this battle by continuing to do what we currently are doing, just on a grander scale. Whatever organizing we do, we need to be clear on some things.

First, this isn’t an inside game. Medicare for All won’t be won by concentrating on how many members of Congress we persuade, but on how many tens of thousands of people are convinced to take action in various forms for single-payer.

Our organizing needs to be focused on this fact. We need to figure out how to build networks and organizations that can bring in larger numbers of activists, who can then make collective decisions about how to reach the next layer of people.

One step in this direction would be to broaden our approach to the issue–which needs to center both how transformative a future Medicare for All system would be, but to highlight the suffering that goes on in the health care status quo as the price we pay for not having single-payer.

In the public mind, the health insurance industry should be no different than the tobacco industry. We need to create a climate where health insurance industry profits are seen for what they are–blood money–and any politician unwilling to do something about it is treated accordingly.

Second, health care has to become a central issue of a re-inspired labor movement. Many people currently think of health care as related to their job, so there’s a natural connection.

Unions already played a role in mobilizing opposition to Trump’s health care disaster–though not in the numbers they could have. But Medicare for All could become a main issue for labor.

One possibility would be to organize workplace committees in support of Medicare For All. This has already taken shape in National Nurses United and New York State Nurses Association, and could be built on and serve as a model for other unions.

For health care unions, in particular, the question of workplace issues and how to make the health care system accessible come together, creating the basis for a stronger struggle.

We need to think in unprecedented ways about how to use union power to win this struggle. In this context, I could see an argument for a national day of strike action for Medicare For All.

Striking for political reasons–or really striking in general–isn’t something the labor movement is very familiar with in recent decades. But the tradition does exist. Also, the unions that are strongest on Medicare for All are also unions with more experience of going on strike recently.

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THERE ARE many other initiatives being discussed to build wider and active support for Medicare for All.

One that has been discussed this year is a proposal from some members of the Democratic Socialists of America for a national march for single-payer in Washington, D.C.

If such a mobilization gave expression to the wide support for Medicare for All that has developed especially through the course of this year, it would be a major step forward in projecting the importance of this issue. But that also raises the question of organization: What forces would be involved in planning and carrying out such a march?

National initiatives like a march or a day of action in support of Medicare for All can be focus for local organizing to win wider numbers of people to activism on this issue. There will also be more statewide initiatives, as in California and New York. And possibilities for local organizing around health care develop all the time–including workplace action backed by unions, up to the level of strikes.

One opportunity for organizing will arise soon–Sanders is supposed to tour the country to build support for his legislation. Our organizations need to find ways to meet people inspired by Sanders’ proposal and bring them into organizing.

There’s a long way to go before we’ll have built organization that can express the widespread sentiment for Medicare for All. But activists can use the opportunities as they arise to build in that direction.

https://socialistworker.org/2017/09/28/whats-the-next-step-toward-medicare-for-all

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Bernie Sanders brilliantly responds to President Trump’s threat of stripping Congress’ health insurance

The Democratic socialist says all Americans should have the same health care that members of Congress have

Independent Sen. Bernie Sanders turned the table on President Donald Trump in an interview with Jake Tapper Sunday, pointing out that he ironically agreed with the commander in chief on one issue of health care.

To start the interview, Tapper asked Sanders what he thought of Trump’s threat to revoke lawmakers’ health insurance. Members of Congress receive gold-level Obamacare policies that are largely subsidized by the government.

Sanders pushed his universal health-care agenda in his response to the question.

“I would turn that around a little bit and say to the president of Unite States that, yes, every single American, in every state of this country, should be able to get the health care that members of Congress have,” the senator from Vermont said.

Sanders did not mince his words when it came to Trump’s cynical plan to defeat Obamacare by undermining the exchanges and driving insurers out of the markets.

“It’s incomprehensible that we have a president of the United States who wants to sabotage health care in America, make life more difficult for millions of people struggling now to get their health insurance that they need,” Sanders said.

“Maybe the president should stop his tweeting for a while and understand that America today is the only major country on Earth not to guarantee health care to all people and the solution is not to throw tens of millions of people off of health insurance,” he added.

Sanders suggested that Congress returns to regular order, so that they can come up with solutions to make the health care system in America better. He said that there should be a public option available for all Americans.

 

How to sell single payer health care: It’s a great policy, but has a huge political drawback

Workers are not going to want to see employer-provided benefits disappear right as their taxes go up

The very public battle over Trumpcare — which seems like it may, fingers crossed, be collapsing due to the public rejecting the ejection of millions of people from the health care system — seems to have had the side benefit of increasing public interest in the idea of a single payer government-run health insurance system. Polling shows that anywhere from 33 percent to 44 percent to 58 percent of voters back the idea of single payer, and in blue states that theoretically have the tax base to pull off statewide system — such as New York or California — single payer likely could garner more support.

And yet one of the bluest of states, California, has once again failed to get a single payer bill off the ground, in no small part because it was, as David Dayen at the Intercept argued, “a shell bill that cannot become law without a ballot measure approved by voters.”

Dayen blames single payer proponents for not “committing to raising the millions of dollars that would be needed to overcome special interests and pass that initiative”and accuses them of “hiding the realities of California’s woeful political structure in favor of a morality play designed to advance careers and aggrandize power.”

When one looks at the players involved, it’s hard to deny Dayen’s accusation. But it’s also worth pointing out that single payer, as it’s currently constructed, faces a major political obstacle that even a lot of electoral hustle may not be able to overcome: People really do not want to see their taxes raised to pay for it. Proponents of single payer aren’t doing enough to address that objection.

The good news is that there are ways to address these voter concerns. The first step, however, is admitting that tax raises are a real problem.

Polling data shows this. The majority of California residents, 65 percent, say they want a single payer system, but that level of support drops to 42 percent if it will require a tax raise.

Proponents of single payer tend to counter this objection by pointing out that these taxes will replace spending on private health insurance and would reduce health care spending overall. That is true in a macroeconomic sense, but it fails to take into consideration that the majority of people below Medicare eligibility age get their health insurance through their employers.

The perception is going to be, like it or not, that single payer is shifting the responsibility for paying for health insurance off of employers and onto the shoulders of workers. People aren’t going to care about reduced health care costs if they think their bosses reap the bulk of the savings.

Why that gets so frequently overlooked, I have no idea. Otherwise, progressives seem to grasp that squeezing the workers while letting the bosses off the hook tends not to go down well with voters. The problem might be that there’s been a longing for single payer for so long in progressive circles that any objections are written off as neoliberal corporatist nonsense — a theory I suspect much of the response to this article will prove.

But if one accepts that this is a problem, then there’s all sorts of creative ways to address it. One way is to dispense with single payer bills and instead have states offer a Medicaid buy-in that employers can access, with the hopes that the lowered costs will allow Medicaid to eventually conquer the market. Or perhaps payroll taxes are structured so that employers pay a larger chunk, so workers don’t feel the pinch.

I say it’s time to get freaky with it. My proposal: Write the bill so that it requires employers to compensate their employees who lose their health care benefits with a raise in their paycheck. Then the plan could be marketed as “health care for all, plus a raise at work.” Higher taxes go down easier if you’re getting a raise to cover them.

The best part is that this could be a win/win situation. One of the bigger problems facing employers is that insurance premiums are rising while the value of what they get for it is not improving. Giving the money to employees directly in cash would actually be cheaper in the long run because employers would be escaping that inflation pressure. Employees see more money in their paychecks while the per-employee costs for the employer don’t rise as fast.

Ideally the raise would be one that’s equivalent to what the employer pays annually to the insurance company to cover that employee’s health care plan, but that could be negotiable depending on how much the employer will be on the hook for in higher payroll taxes. The details are less important here than sending the message to voters that single payer is not about shifting the health care burden away from employers to employees.

This is just one idea, of course. There may be — probably are! — other ways to deal with this political problem that make more sense economically. The main issue here is that the larger economic savings of single payer sound great in the abstract, but will be hard to sell if voters don’t feel that they personally are seeing those savings in their checking accounts. As long as single payer proponents fail to address that political problem, there’s very little chance of getting a single payer bill off the ground.

Amanda Marcotte is a politics writer for Salon. She’s on Twitter @AmandaMarcotte

New Poll Shows Nation Moving Left on Healthcare, Embracing Medicare for All

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The poll shows that 62 percent of Americans believe it is the federal government’s responsibility to guarantee healthcare for all

“There is a significant increase in people who support universal coverage,” Robert Blendon of the Harvard T.H. Chan School of Public Health told AP. (Photo: Molly Adams/Flickr/cc)

In the face of “cruel” attempts by the Republican Party to strip health insurance from more than 30 million Americans with the goal of providing massive tax breaks to the wealthy, a new poll published on Thursday finds that a growing majority of the public is “shifting toward the political left” on healthcare and expressing support for a system that ensures coverage for all.

“The Democratic party needs to stop fumbling around incompetently for a positive vision and instead unify behind the one already supported by the overwhelming majority of its voters.”
—Matt Bruenig
The poll, conducted by the Associated Press in partnership with the NORC Center for Public Affairs Research, shows that 62 percent of public believes it is “the federal government’s responsibility to make sure that all Americans have health care coverage.”

As AP‘s Ricardo Alonso-Zaldivar and Laurie Kellman note, this is a dramatic shift in popular attitudes over a very short period of time.

“As recently as March,” they observe, “the AP-NORC poll had found Americans more ambivalent about the federal government’s role, with a slim 52 percent majority saying health coverage is a federal responsibility, and 47 percent saying it is not.”

This most recent poll also found:

  • Only 22 percent of Democrats want to keep Obamacare as it is, and 64 favor changes to the law.
  • 80 percent of Democrats believe it is the federal government’s responsibility to ensure coverage for all.
  • 80 percent of Americans believe Republicans should work with Democrats to improve Obamacare.
  • 13 percent of Americans support the Republican plan to repeal Obamacare without a replacement, a proposal the Congressional Budget Office (CBO) estimates would leave 32 million more Americans uninsured.

These latest survey results are consistent with increasingly vocal grassroots support for a Medicare-for-All style system that “leaves no one out.” Prominent Democrats have joined the groundswell of enthusiasm; former Vice President Al Gore and Sen. Elizabeth Warren(D-Mass.) are two of the more notable figures who have openly advocated a move toward single-payer in recent weeks.

“There is a significant increase in people who support universal coverage,” Robert Blendon of the Harvard T.H. Chan School of Public Health told AP. “The impact of the debate over dropping coverage looks like it has moved [more] people to feel that the government is responsible for making sure that people have coverage.”

This soaring support for Medicare for All at the grassroots has been bolstered by recent analyses showing that a single-payer system would be more affordable than the current for-profit system—a fact that refutes President Donald Trump’s baseless claim on Wednesday that single-payer would “bankrupt our country.”

All of these factors, argues welfare policy analyst Matt Bruenig in a recent piece for Buzzfeed, amount to an irrefutable case in favor of moving beyond Obamacare to a healthcare system that ensures universal coverage.

“Now that the Republicans have failed [in their attempts to repeal Obamacare], the time is ripe for a serious single-payer push,” Bruenig writes. “Policy institutions need to work hard to hammer out the details of a single-payer plan, and the Democratic party needs to stop fumbling around incompetently for a positive vision and instead unify behind the one already supported by the overwhelming majority of its voters.”

 

Health Care in America: Where is the Socialist Solution?

Photo by Molly Adams | CC BY 2.0

The introduction of the Republican legislation to “repeal and replace” Obamacare is no more than latest scrimmage in the ongoing one-sided war against the poor and working class. The “Affordable Care Act” (ACA, better known as Obamacare) proved to be both unaffordable and unable to provide comprehensive care for millions. Nevertheless, with the ACA being one of the only tangible “victories” Democrats could claim for an administration with a dismal record of noteworthy accomplishments, neoliberal Democrats and the party’s liberal base led by Bernie Sanders are now coalesced around the ACA and have vowed to defend it to the bitter end.

Yet, camouflaged by the hot rhetoric of confrontation and the diversionary struggle of the duopoly, the common agenda and objective interests being protected in this healthcare battle are quite clear. No matter what version of the healthcare bill passes or if the ACA remains in place, it will be a win for the market-based, for-profit beneficiaries of the U.S. system. As long as healthcare remains privatized, the real winners of healthcare reform will continue to be the insurance companies, hospital corporations and pharmaceutical and medical device companies.

That commitment to the interests of the insurance/medical complex ensures that the interests of healthcare consumers, the uninsured, the elderly and the sick will continue to be sacrificed to maintain a healthcare delivery system in which thousands suffer premature deaths from inadequate preventative treatment, millions are unable to afford coverage and millions who have private insurance fear using it because of prohibitive co-pays and deductibles.

That is why during the current debate the insurance companies have been largely silent. There is no need to engage in public debate because having largely written the ACA they are again deeply involved in the construction of the current legislation. Their interests will be protected even if it means forcing Republicans to embrace policies that are at odds with their professed philosophies – like including government subsidies for low-income people to purchase insurance. In fact, the only comments from insurance companies in this debate were related to their supposed concern that the Senate bill might not provide enough assistance to those who need help to pay for healthcare. They want what is being called a “stabilization fund” to reduce the numbers of people who might opt out of coverage because they can’t afford it.

The Senate bill provides those funds, but they are temporary and are scheduled to end after 2019. Which means that people will be forced to make an unpalatable decision after that – purchasing insurance with higher out-of-pocket costs like $10,000 deductibles or electing to go without insurance altogether. If history is a guide, many will opt out. In fact, the Congressional Budget Office predicts that the current bill will push 22 million people back into the ranks of the uninsured with the potential loss of millions of customers and potential profits for healthcare corporations.

But the companies have a plan should those funds prove inadequate to hold substantial numbers in the system: Increase individual premiums by at least 20 percent more than the double-digit increases already under consideration.

Coming to the aid of the Insurance/Medical complex: Ted Cruz and the Consumer Freedom Amendment

Insurers need large numbers of healthy people on the rolls, as their premiums help defray the cost of care for those who are sick. Because insurance companies are for-profit operations they set rates based on the risk pool in a market. With the potential loss of customers if the government does not provide adequate long-term subsidies, middle-class consumers who earn too much to qualify for temporary premium assistance will bear the brunt of any premium increases.

The Cruz amendment to the legislation has a solution to the possible increase in premiums and healthcare costs in general. The so-called “Consumer Freedom Amendment” represents the typical extreme individualism and anti-social sentiments of the right wing. It essentially advocates for reducing the burden on healthy consumers paying into system to help cover higher-risk fellow citizens.

The Washington Post’s analysis of the Cruz amendment suggests:

“Under Senator Cruz’s plan, insurers could sell cheaper, stripped-down plans free of Obamacare coverage requirements like essential health benefits or even a guarantee of coverage. These sparser plans would appeal to the healthiest Americans, who would gladly exchange fewer benefits for lower monthly premiums.

But insurers would also have to sell one ACA-compliant plan. The sickest patients would flock to these more expansive and expensive plans because they need more care and medications covered on a day-to-day basis. As a result, premiums for people with expensive and serious medical conditions like diabetes or cancer would skyrocket because all those with such serious conditions would be pooled together.”

And how would the elderly and people with pre-existing conditions pay for the increased premiums that they would face under the current Senate bill and Cruz’s amendment? “The $100 billion stabilization fund for states could help cover costs for the resulting pricier coverage for those with preexisting conditions under this amendment.”

In an ironic twist that both exposes the class interests of this initiative and its hypocritical approach to the question of the role of the government, Cruz’s amendment affirms that role in the form of subsidies for the sickest citizens and calls for an expansion of government resources to cover them.

The Cruz plan would segment the insurance market into healthier and higher-risk segments. High risk individuals along with the already-sick and the elderly would be pushed out of the market because those premiums would soar even with state subsidies, since insurance companies would still set premium rates to maximize profits.

Given the lose-lose options for consumers now being debated in Congress, the only rational objective for the majority of the people in the U.S. is to move toward the complete elimination of the for-profit healthcare system.

Socialization of Healthcare: The Only Solution

The ideological and political opposition to state-provided healthcare is reflected in the ACA and the various repeal-and-replace scenarios. Through mandates, coercion and the transfer of public funds to the insurance industry, the ACA delivered millions of customers to the private sector in what was probably the biggest insurance shams in the history of private capital. And that gift to the insurance companies is only one part of the story. The public monies transferred to the private sector amounted to subsidies for healthcare providers, hospital chains, group physician practices, drug companies and medical device companies and labs as well.

The Republican alternatives to the ACA variably supplement the corporate handouts with more taxpayer-funded giveaways. And once the private sector gains access to billions of dollars provided by the state, they and their elected water-carriers fiercely resist any efforts to roll those subsidies back.

The subsidies coupled with the mergers and acquisitions of hospital corporations and insurance providers over last few years and a general trend toward consolidation of healthcare services in fewer and fewer hands underscored the iron logic of centralization and concentration of capital represented by the ACA and was a welcome development for the biggest players in the healthcare sector. The movement toward a monopolization of the American health-care market means that rather than the reduction in healthcare costs that is supposed to be the result of repeal and replace, the public can instead expect those costs to escalate.

Many on the left have called for a single-payer system similar to those that work well (if not perfectly) in Britain, the Netherlands, Finland and elsewhere in Europe. But even with an “improved Medicare for all” single-payer system, costs will continue to increase in the U.S. because they cannot be completely controlled when all of the linkages in the healthcare system are still firmly in the hands of private capital.

The only way to control the cost of healthcare and provide universal coverage is to eliminate for-profit, market-based healthcare. Take insurance companies completely out of the mix and bring medical device companies, the pharmaceuticals companies and hospitals chains under public control.

The ideological implications of the Cruz amendment are that it reflects a growing public perception both domestically and internationally that healthcare should be viewed as a human right.

Putting people at the center instead of profit results in healthcare systems that can realize healthcare as a human right. This is the lesson of Cuba where the United Nations World Health Organizationdeclared that Cuba’s health care system was an example for all countries of the world.

That is the socialist option, the only option that makes sense and the one that eventually will prevail when the people are ready to fight for it.

Ajamu Baraka is the national organizer of the Black Alliance for Peace and was the 2016 candidate for vice president on the Green Party ticket. He is an editor and contributing columnist for the Black Agenda Report and contributing columnist for Counterpunch magazine. 

Understanding Republican Cruelty

The Senate majority leader, Mitch McConnell, is having a hard time selling his health insurance plan.Credit Eric Thayer for The New York Times

The basics of Republican health legislation, which haven’t changed much in different iterations of Trumpcare, are easy to describe: Take health insurance away from tens of millions, make it much worse and far more expensive for millions more, and use the money thus saved to cut taxes on the wealthy.

Donald Trump may not get this — reporting by The Times and others, combined with his own tweets, suggests that he has no idea what’s in his party’s legislation. But everyone in Congress understands what it’s all about.

The puzzle — and it is a puzzle, even for those who have long since concluded that something is terribly wrong with the modern G.O.P. — is why the party is pushing this harsh, morally indefensible agenda.

Think about it. Losing health coverage is a nightmare, especially if you’re older, have health problems and/or lack the financial resources to cope if illness strikes. And since Americans with those characteristics are precisely the people this legislation effectively targets, tens of millions would soon find themselves living this nightmare.

Meanwhile, taxes that fall mainly on a tiny, wealthy minority would be reduced or eliminated. These cuts would be big in dollar terms, but because the rich are already so rich, the savings would make very little difference to their lives.

More than 40 percent of the Senate bill’s tax cuts would go to people with annual incomes over $1 million — but even these lucky few would see their after-tax income rise only by a barely noticeable 2 percent.

So it’s vast suffering — including, according to the best estimates, around 200,000 preventable deaths — imposed on many of our fellow citizens in order to give a handful of wealthy people what amounts to some extra pocket change. And the public hates the idea: Polling shows overwhelming popular opposition, even though many voters don’t realize just how cruel the bill really is. For example, only a minority of voters are aware of the plan to make savage cuts to Medicaid.

In fact, my guess is that the bill has low approval even among those who would get a significant tax cut. Warren Buffett has denounced the Senate bill as the “Relief for the Rich Act,” and he’s surely not the only billionaire who feels that way.

Which brings me back to my question: Why would anyone want to do this?

I won’t pretend to have a full answer, but I think there are two big drivers — actually, two big lies — behind Republican cruelty on health care and beyond.

First, the evils of the G.O.P. plan are the flip side of the virtues of Obamacare. Because Republicans spent almost the entire Obama administration railing against the imaginary horrors of the Affordable Care Act — death panels! — repealing Obamacare was bound to be their first priority.

Once the prospect of repeal became real, however, Republicans had to face the fact that Obamacare, far from being the failure they portrayed, has done what it was supposed to do: It used higher taxes on the rich to pay for a vast expansion of health coverage. Correspondingly, trying to reverse the A.C.A. means taking away health care from people who desperately need it in order to cut taxes on the rich.

So one way to understand this ugly health plan is that Republicans, through their political opportunism and dishonesty, boxed themselves into a position that makes them seem cruel and immoral — because they are.

Yet that’s surely not the whole story, because Obamacare isn’t the only social insurance program that does great good yet faces incessant right-wing attack. Food stamps, unemployment insurance, disability benefits all get the same treatment. Why?

As with Obamacare, this story began with a politically convenient lie — the pretense, going all the way back to Ronald Reagan, that social safety net programs just reward lazy people who don’t want to work. And we all know which people in particular were supposed to be on the take.

Now, this was never true, and in an era of rising inequality and declining traditional industries, some of the biggest beneficiaries of these safety net programs are members of the Trump-supporting white working class. But the modern G.O.P. basically consists of career apparatchiks who live in an intellectual bubble, and those Reagan-era stereotypes still dominate their picture of struggling Americans.

Or to put it another way, Republicans start from a sort of baseline of cruelty toward the less fortunate, of hostility toward anything that protects families against catastrophe.

In this sense there’s nothing new about their health plan. What it does — punish the poor and working class, cut taxes on the rich — is what every major G.O.P. policy proposal does. The only difference is that this time it’s all out in the open.

So what will happen to this monstrous bill? I have no idea. Whether it passes or not, however, remember this moment. For this is what modern Republicans do; this is who they are.

The emerging class struggle over health care in the US

29 June 2017

Following the announcement on Tuesday that the Republicans would be putting off a Senate vote on their health care bill until after the July 4 congressional recess, the Democrats and Republicans continued their stage-managed debate over measures that will have devastating consequences for millions of Americans.

The media’s presentation of a bitter feud over the direction of health care policy is a political fiction. The newspapers and television networks report on the statements of one or another lawmaker and his or her attitude to the plan recently unveiled by Senate Republicans as if this will have any real impact on the trajectory of ruling class policy.

The more decisive verdict was delivered on Tuesday by Wall Street, which saw its biggest one-day drop in six weeks after Republican Majority Leader Mitch McConnell put off a Senate vote this week. The message was clear: the corporate and financial elite wants its money, and it wants it now. The health care measure includes a $700 billion tax cut for the rich—a down payment on the money to be freed up by depriving the elderly and poor of their health and even their lives.

The American ruling class is engaged in a form of social arson no less criminal or deadly than the policies that led to the Grenfell Tower fire in London.

McConnell responded on Wednesday by promising that a new version of the bill will be ready by Friday for a vote sometime in July.

Charles Schumer, the Democratic Senate Minority Leader from New York, reacted to the summons of the market by reiterating his call for a “bipartisan” solution, a mantra repeated by virtually all congressional Democrats. “Democrats are genuinely interested in finding a place where our two parties can come together on health care,” Schumer said. That Schumer gets more campaign money from the hedge funds and banks than any other senator, Democratic or Republican, is sufficient to demonstrate what type of child will issue from such a union.

Schumer did not comment on the apparent contradiction between his claims to be fundamentally opposed to the Republican plan and his calls for a bipartisan compromise. His position exposes the fact that the two sides share a basic agenda.

The Democrats assert that they want to “fix” Obamacare. What does this mean? They are not talking about expanding coverage to include the 28 million still without insurance under the Democratic plan, or increasing the inadequate subsidies, decreasing absurdly high deductibles and copays, and preventing the insurance companies from raising premiums. “Fixing” Obamacare is a euphemism for incorporating the demands of the insurance industry for even fewer restraints on their profit-making and tighter eligibility requirements for consumers.

The public has seen this type of political theater countless times, and the outcome has invariably been the same. The Republicans set the marker as far to the right as possible and the Democratic “opposition” results in a deal to impose new and more drastic cuts to health care and other social programs. The most significant and fraudulent of these dog-and-pony shows was the passage of the Affordable Care Act, or Obamacare, itself.

The Republican proposal is not in fact a “repeal” of Obamacare. It incorporates the structures set up by the Democratic measure, such as the exchanges for purchasing policies from private insurers, designed to more fully subordinate the health care system to the capitalist market and encourage the demise of employer-sponsored health coverage, placing individual workers even more at the mercy of the insurance giants.

The central purpose of Obamacare is to shift costs from corporations and the state to the working class, with health care increasingly rationed on a class basis.

The so-called “health insurance” that many people now have under Obamacare is, in effect, a transfer of funds to the giant insurance companies. Deductibles for lower-priced “bronze” plans now average more than $6,000 for an individual and more than $12,000 for a family. Deductibles for so-called “silver” plans (which make up 70 percent of the market) are on average more than $3,000 for individuals. In other words, after paying hundreds of dollars a month for health insurance, workers must pay thousands more before they begin to receive any benefits.

Corporations have been systematically cutting or eliminating coverage, encouraged by Obamacare’s coming tax on more “generous” employer-provided health care plans. More than 80 percent of employer-based plans now have an annual deductible ($1,478 on average, up 2.5 times since 2006). In countless contract disputes throughout the country, health care cuts are a central demand of the companies, invariably accepted and forced through by the trade unions.

The subsidized purchase of private insurance under Obamacare has created the framework—a voucher system—for dismantling what remains of government-provided health care. The American ruling class is setting its sights on the bedrock health care programs of the late 1960s—first Medicaid, the already grossly underfunded state-federal health insurance program for the poor, which will be effectively dismantled by the Republican bill, then Medicare, the health care program for the elderly. Behind these health care programs lies Social Security, the federal pension program wrenched from the ruling class through the explosive class struggles of the 1930s.

The hypocritical criticisms of the Republican plan by the Democrats and the various middle-class organizations that orbit the Democratic Party not only cover up for the reactionary character of Obamacare, they completely ignore the central issue: capitalism.

There is no solution to the massive health care crisis that does not take on the domination of health care by giant pharmaceutical and insurance companies, which operate under the ever-present whip of Wall Street and its demands for higher profits and dividends. These giant corporations must be expropriated and the wealth of the financial aristocracy seized to finance emergency measures to address the health care crisis and establish a system of universal health care, guaranteed as a basic social right.

Whatever tactical differences the Democrats have with the Trump administration on health care are entirely subordinate to their basic objective: escalating US military aggression in the Middle East and internationally. The hysterical Democratic campaign over alleged Russian hacking and Trump collusion with Moscow has as its central aim forcing a shift in administration policy toward a more rapid and comprehensive expansion of the US war for regime-change in Syria and a more aggressive policy toward Russia.

But as the Democrats well know, military escalation abroad is inextricably bound up with the intensification of austerity and class war at home.

In asserting its right to health care, the working class cannot allow itself to be drawn behind any section of the political establishment. It must proceed with its own methods—those of class struggle. The health care counterrevolution is generating enormous opposition, which is beginning to emerge in innumerable forms. Millions confront conditions that spell death or disaster for themselves, their parents and their children.

As the WSWS wrote earlier this month, “The interaction of objective conditions of crisis, both within the United States and internationally, and the radicalization of mass social consciousness will find expression in the eruption of class struggle. The decades-long suppression of the class struggle by the trade union bureaucracy, the Democratic Party and the affluent sponsors of various forms of identity politics is coming to an end. The social counterrevolution of the ruling elites is about to encounter an upsurge of the American working class.”

Emerging struggles against all of the deplorable conditions of life under capitalism—the destruction of health care, declining wages, unemployment, brutal working conditions, the attack on public education, mass indebtedness, the witch-hunting of immigrants—must be brought together in a common political fight against the Trump administration and both big business parties, based on a socialist and internationalist program.

Joseph Kishore

WSWS