Public Comment

Single Payer Struggle and Health Care Crisis

By Marc Sapir
Thursday May 21, 2009 - 10:06:00 AM

For President Obama, single-payer health care financing is now “off the table.” I’m told that Mark Leno, sponsor of SB 810 California’s Single Payer legislation (it passed last year as Sheila Kuehl’s SB 840 only to be vetoed by Governor Schwartenegger), thinks the Single Payer vote in the Legislature should be delayed to the 2010 session. Yet everyone from these politicians to the SF Chronicle admits that there is a health care crisis that must be addressed now. What exactly does the footdragging mean?  

In the aftermath of World War II, essentially all of the advanced Capitalist countries ended up with government-financed health insurance of one type or another. Everyone except, of course, the United States, which was king of the hill. This historical oddity didn’t matter then. The McCarthy era ended the great tradition of trade union militancy of the 1930s that might have forced coverage for every worker in the US. With or without government health insurance, the overall cost of medical care was not a large burden on the economy in those low-tech solo practitioner days. Moreover, the U.S. only needed to maintain the American industrial workforce’s competitiveness temporarily—as a bridge to globalized industrial production, which was to end US supremacy in manufacturing products.  

But something went awry. In 1965 the social revolution we call the Civil Rights movement and Lyndon Johnson’s desire to have a progressive domestic legacy led to the passage of Medicare and Medicaid; at the same time, industrial union contracts typically included health insurance for workers and retirees. As a result of the LBJ legislation, a transformation of the health care system did occur—but it was wasn’t toward government financing in general. It was toward rationalizing the health care system into the largest domestic center of capitalist profit after national defense. Nixon was caught on a tape, laying the groundwork for the HMO revolution that led the way. By the 1980s health care organizations were traded on the stock exchanges more eagerly than the waning rust belt industries of the past, and for good reason. Health care–related stocks within the framework of finance capital, the insurance giants and the medical technology and Pharma revolution, were bringing in huge excessive profits (while creating cost inflation in the range of 8-15 percent a year).  

The remnants of industrial production are crumbling while the overall cost per person of health care in the U.S. is highest in the world, higher than the cost of care in many countries with better outcomes on health indicators. And the cost inflation along with high profits continues. President Obama’s announcement that he will save a trillion dollars via an agreement with the big players to cut the average cost by 1.5 percent is a publicity stunt. Looking at the huge inflation rate in health care, it’s obvious that protection of Medicare alone requires that inflation be close to zero.  

Therein lies an irresolvable contradiction for U.S. capitalism. While the U.S. economy now desperately needs health care reorganization so that the financial sector—profit hungry and driven fundamentally by greed—is prevented from dominating our health care priorities and restricting our access to care, health care is the only thriving sector of the economy. As a result, insuring all and bringing down costs is impossible, short of a public rebellion of the type we have not seen in many decades. The problem is that without the health care profit center the U.S. economy will stagnate. U.S. capitalism has almost nothing else to keep the economy going right now except war and preparations for war—though they have some ideas (e.g., the green economy) for future new investment.  

Currently, as workers have lost jobs by the millions, the only sector that has continued hiring is health care. On the other hand the economic crisis is attacking public-health-sector funding. Yet, the only way to prevent massive layoffs on the administrative side of the vast private health care industry is to allow the cost inflation and the dominance of finance capital to continue. This, for U.S. capitalism, is a contradiction that actually has no short-term solution except worsening the attack (political as well as economic) on the working class. Thus, although the capitalist sectors are split between pro and con on Single Payer, neither side can assert itself strongly for fear of the negative consequences. This may explain the behavior of both Obama and the Sacramento Democrats in limiting and delaying reforms that will contain costs.  

Public financing of health care is hugely popular. Within this environment of crisis and gridlock, the opportunity exists for a Single Payer victory, yet nothing can change until the public rises up and takes matters into its own hands to insist upon public health insurance for all. The moment is ripe, because whether or not we win on public funding of health care the outcome will be bad for capitalism in the U.S. Yet, if we can achieve public financing at least costs can be contained, inflation stopped and the outlook for the public’s health and care will be substantially brighter. Health care is not the only arena where such impenetrable contradictions exist for U.S. capitalism, but it is a central arena at this critical juncture in the nation’s history.  

Obama was elected president amid slogans of hope, change, and si se puede. Truth is, his options are severely constricted. Very little change can be achieved from within the brittle, inflexible remnants of this political economy driven mainly by speculation over the past two to three decades. It’s obvious that Right extremism is standing in the wings, hoping to implement draconian measures when the contradictions lead to ineffectuality in governance. Sweeping changes are needed, but Obama cannot get free of the needs of finance capital sufficiently to move beyond a minimalist approach to change. We might overcome this problem with a new civil rights movement to force the California Democratic Legislature to put Single Payer back on the table this year, and we can organize to demand that Arnold Schwartzenegger sign the legislation (this will be the third time it passes the State Legislature). There is a lot at stake for us all, and inaction is particularly dangerous.  



Marc Sapir is an activist