Health outcomes in the United States are abysmal. We have the highest maternal mortality rates, infant mortality rates, rates of chronic and preventable disease, and heart disease rates of any rich country in the world. But our exceptionally poor health is not due to any unique biological defects in the American people, nor is it related to some kind of amorphous American culture of unhealthiness. For instance, we manage to have lower rates of smoking than Italy, France, and the U.K., yet still have lower life-expectancies than all of these countries.
Americans’ unhealthiness isn’t a product of something intrinsically wrong with us. It’s a product of something wrong with our larger social and political systems.
Our health is a social issue. It is linked to our jobs, our environment, our access to basic social needs and ultimately to the politics that shape our daily lives. Consider the health effects of chronic injuries and long-term exposure to dangerous chemicals in the places we work, or the asthma, lead poisoning, and cancers caused by exposures to unregulated environmental carcinogens and pollutants in the places we live. Think of the diseases caused by restricted access to healthy and affordable food, or the tragic “diseases of despair” such as opioid and alcohol addiction, suicide, and gun violence. Even our ability to avoid asbestos poisoning or safely deliver a child depends on housing stock, federal interest rates and rent prices.
Each of these so-called health “crises” stems from the brutal and deteriorating social conditions of life for American workers. They are all inescapably and fundamentally political.
Beyond these “upstream factors,” the soaring cost of healthcare explains more than any other single factor why so many Americans are so unhealthy. Even if you manage to avoid dangerous working conditions or environmental hazards, maintaining your health depends on your access to health insurance. And with nearly 30 million uninsured and an additional 30 million underinsured, many Americans are effectively locked out of getting needed medications or regular check-ups. Even if you’re lucky enough to have health insurance, avoiding bankruptcy court depends on whether or not that insurance is good enough to cover the medical services you need and your ability to pay exorbitant monthly premiums. If you are a part of the working-class majority in this country, your health depends largely on whether or not you can afford to pay the high costs of healthcare.
All of this means that for most people, most of the time, our health depends less on our personal choices, culture, lifestyle, or biology. Instead, our health is determined by social conditions — working conditions, housing conditions, the education and healthcare systems. And in the U.S., these conditions are shaped by the marriage of corporate interests and political elites.
The healthcare system in America — a profit-driven, limited-coverage, patchwork, employer-based, multi-payer model — is a nightmare for working people.
The problem is straightforward: it is not profitable to insure sick people. The profit motive in healthcare creates a vicious cycle of smaller health returns for the sick and greater costs overall. Since insurance companies know that the sick are not profitable “consumers” of health insurance, they seek to restrict coverage; they do this through coercing sick people into dropping their plans or pushing more costs onto the sick themselves. But the results of restricting coverage is a smaller “risk pool”: each insurer is trying to cover fewer people and shove more costs onto the insured in an effort to maximize their profits and minimize their risks. As a result, healthcare costs have skyrocketed.
Despite productivity growth, technological innovation, and the mandate included in the Affordable Care Act, these costs continue to rise while wages stagnate. The U.S. spends more on healthcare per capita than any other rich country, despite the fact that our system covers fewer of its residents. Since 1999, health insurance premiums have increased by a staggering 213%. And those high costs are increasingly pushed onto workers.
Without commensurate wage increases, it is workers, not CEOs or investors, who shoulder the burden of every insurance premium increase. Employers today pay less proportionately into their workers' health insurance than in any period since the introduction of employer-sponsored healthcare in the decade after World War II.
What’s worse is that much of these high costs are artificially imposed from above. Health insurance companies and hospitals inflate their costs by expanding their organizations with billions of dollars of bureaucratic waste, hiring more claims and billings managers (managers who are trained to restrict coverage) and paying their CEOs obscene salaries (an average health insurance executive makes $20 million per year). Roughly 30% of all healthcare costs in the country are administrative. By comparison, the government-run Medicare system only spends 3% of its revenue on administration.
These high costs and burdensome fees have led to windfall profits in the healthcare industry — profits that have not trickled down to healthcare workers or their patients.
Despite the titanic earnings of the medical-industrial complex, healthcare providers — nurses, care workers, physicians, and support staff — are increasingly squeezed. The working conditions in hospitals, clinics, and nursing homes are increasingly precarious, over-populated, and unsafe while wages in the healthcare industry stagnate.
This exploitative model of healthcare is driven by profit for the few and not the needs of the millions. The beneficiaries of our system are not the sick or the healthcare providers — they are the owners and operators of major health insurance firms, big pharmaceutical corporations, and giant hospital groups. The CEO of Centene, a healthcare corporation, makes nearly $80,000 a day. Yet the vast majority of workers emptying your sick partner’s bedpan, giving your grandmother a sponge-bath, or helping you walk down the hallway after surgery — in other words those who actually provide healthcare — don’t make that kind of money in a year.
It’s easy to see why health insurance companies insist that the system is working. For them, it is. Every health insurance premium taken out of a worker’s paycheck represents an instant and direct transfer of wealth from the bottom to the top. Healthcare premiums are little more than a regular tax on workers to line the pockets of health industry oligarchs.
Of course, all these added expenses — the exorbitant salaries of health insurance CEOs, the bloated administrative costs, and the rising costs of pharmaceuticals — are also borne by large employers who pay into their employees’ health insurance plans. Yet corporate executives beyond the health insurance industry are dead set against any form of public health insurance.
Why? Because for them it is not simply about their bottom line, it’s about class power. Our financial and business elite are against any reform that limits or regulates their power, especially those that lessen workers’ dependence on the market and waged work.
While major employers and the corporate class care about their profit margins, they are also aware that the current system chains employees to their jobs. Employer-dictated healthcare helps create a pliant and captive workforce that is less willing to strike or walk off the job, even as working conditions worsen and wages remain static, for fear of losing its healthcare. Insurance companies directly benefit from the high costs of healthcare, but employers will stomach paying rising premiums so long as it gives them a bargaining chip against their workers.
Further, large employers do have a plan to reduce their healthcare costs. The corporate class already shirks healthcare cost increases by shifting the burden onto workers, and in the long run they plan on replacing the existing employer-sponsored system altogether. Our bosses would prefer something even more backward: a system where workers are given vouchers to “shop” for their insurance on the market. Such a system would relieve employers of their responsibility to protect their workforce and atomize workers further such that they are pitted against each other on the market.
Finally, it’s important to remember that the ruling elite look out for their own. In their eyes, any social benefit that comes at the expense of profit sets a dangerous precedent. Removing healthcare from the market challenges their power to manage their workers and affirms the state’s right to decommodify social goods and services. Every corporate executive, financial baron, tech guru, and industry titan knows that if we were to socialize health insurance, their industry could be next.
For now, major executives will tolerate the high costs of health insurance in order to maintain their dominant position in the class struggle. Unfortunately for them, the majority of American workers cannot tolerate these costs, and the demand for a new system of social health insurance — Medicare for All — has become increasingly popular.
Medicare for All is a simple concept. It means the establishment of a single, public, universal health insurance system, managed by the federal government, where everyone, regardless of their employment or immigration status, will have insurance.
It means comprehensive care: all services provided by a medical professional will be covered. It means free, on demand, unlimited care at the point of service, paid for not on the backs of the sick but through taxes on the rich. That means no fees, no co-pays, and no deductibles. And it means the establishment of a jobs program to replace the existing jobs lost if the private health insurance system were abolished.
Medicare for All represents the leading edge of a renewed egalitarian and even democratic socialist mood among the American working class. The demand has won the support of the labor movement: the AFL-CIO endorsed the call at its most recent convention, and National Nurses United, alongside a variety of independent nurses unions around the country, are enthusiastic supporters.
This is largely because the realization of Medicare for All would put more monthly take-home pay back in workers’ pockets. The program would also take healthcare off the bargaining table for union workers, so they would be in a better position to bargain for wage increases and better working conditions rather than protecting an increasingly flimsy and expensive healthcare package. The support for Medicare for All among nurses and support staff is also borne out of their own experience as caregivers in a fractured and broken health system and their desire for a more rational and just alternative.
For democratic socialists, the fight for Medicare for All means even more.
First, Medicare for All represents a core demand of democratic socialist politics. The call for socialized health insurance epitomizes an oppositional working-class politics and speaks to the immediate needs of most Americans. The idea itself challenges the rule of capital, the political elite, and the profit motive.
Its popularity has exposed the contradictions in the Democratic Party: polling suggests that 70-80 percent of registered Democrats support the demand, yet party leaders like Nancy Pelosi consistently mock single-payer advocates. Ideologically, advocating for Medicare for All opens space for socialists and progressives to speak to a frustrated electorate tired of the politics of the billionaire class.
In other words, the demand alone affords us the unique opportunity to carve out a real democratic socialist politics nationally — and, in the process, expose both the weakness of market liberalism and the lunacy of reactionary alternatives.
Second, campaigning for Medicare for All offers us the ability to build a mass constituency for democratic socialist politics and durable ties between our organization and a broad working-class base.
The institutions of the working class and the left have been destroyed over the past forty years of defeat. As a result, the newly reborn democratic socialist movement is isolated from the mass base we need to realize any progressive reforms. Campaigning for positive programmatic demands like Medicare for All can have the galvanizing potential to unify the working-class majority and integrate our organization with that popular base.
Through campaigning for Medicare for All, we can also avoid the charity approach to politics so often associated with non-profit activism. Instead, we aim to build bonds of solidarity and legitimacy as a democratic organization committed to the needs and interests of our own members, connecting them to the desires and aspirations of the majority of Americans.
Finally, the realization of Medicare for All would, for the first time in the history of the United States, establish a universal social program.
It would mean the appropriation and socialization of more than one-sixth of domestic GDP. It would signal a decisive turn away from market-dependence and toward social freedom — not only in the realm of health but in all spheres of life. As a result, it would build the capacities of individual workers to organize and strike.
And, of course, the realization of Medicare for All would make this country a much healthier and more egalitarian place. By virtue of the dramatic improvement most people would see in their health and day-to-day lives, the program would generate a built-in constituency among the electorate: those who benefit from the new system would soon become enthusiastic and vocal defenders of it.
In this way, Medicare for All represents a transformative demand: a demand that not only builds working-class unity but swings the political pendulum towards working-class power.
All of this points to why Medicare for All has been the lasting legacy of Bernie Sanders’s Presidential platform and why the call has become the leading demand of progressives around the country. Nevertheless, most of our political elite stubbornly oppose the program. In many cases these politicians are simply the puppets of health insurance companies; in other cases they are feckless frauds. And it would be a mistake to assume that even those high-ranking Democrats that currently support Medicare for All will fight for its passage.
We shouldn’t expect that the political, financial, and business elite will warm up to our ideas or invite us to the table. But we can force them to carry out our demands.
In order to get politicians to buck their donors and side with the majority they are supposed to represent, we have to threaten them with a mass, popularly-based political movement. In the absence of a workers’ party and amidst the weakening of union power, it’s crucial that we use this opportunity to bring that movement together. Of course, the scale and breadth of the movement we need cannot be built overnight. And it will not be convened through high-profile press conferences, celebrity stunt activism, or quixotic electoral bids.
The movement of the kind we need to achieve Medicare for All will only be built through connecting with millions of people across the country, in their neighborhoods, town halls and workplaces. It will only be built through the painstaking process of person-to-person organizing. It will be galvanized with the knowledge that there are no guarantees of victory or even short-term success. And it will be organized with the certainty that when we win, it will mean much more than the achievement of Medicare for All. It will mean establishing a piece of real democratic socialism and the beginning of a new working-class movement for the 21st century.