Historically in the U.S., health care has been provided as part of a social contract between employers and workers. It was intended to keep workers healthy so they could go on working and creating profit for employers. Currently there are various tiers of health coverages from different sources: employer-provided health insurance; people paying for health care out of their own pockets; public hospitals and public programs like Medicaid and Medicare; and charity. But regardless of the source of coverage, at the heart of this system is the assumption that the employers needed the labor of the workers. Plus, of course, there is money to be made in the health care system itself by doctors, hospitals, insurers, suppliers and drug companies.
Today, more and more production is done by computers and robots. This means fewer and fewer workers are needed, and corporations don’t provide health care for workers they don’t need. And globalization means the corporations are competing globally for markets, and the workers are competing globally for jobs. The result is that wages are driven down and benefits like health care are eliminated in the global “race to the bottom.” At the same time, the businesses involved in the health care system itself—as investors, payers, suppliers or providers—push to boost their profits by cutting back care and shifting costs to the workers. Public hospitals and publicly subsidized health care programs are being privatized or eliminated in the name of boosting corporate profits. Meanwhile, the cost of care continues to skyrocket.
Advancing technology and a globalized economy mean the mass of formerly stably employed workers that was once at the heart of the U.S. working class is being replaced by a rapidly growing class of the dispossessed. These are the permanently unemployed, part-time, contingency and low-wage workers, and they have few if any benefits. Increasingly, the system can no longer provide workers with the necessities of life, including health care. In the end, only a new society that distributes the necessities of life according to need, not ability to pay, can satisfy their needs. The dispossessed cannot compromise, because they are fighting for survival. This means that if we base our struggle on the demands of the dispossessed, this will advance the cause of all the workers in the country.
In the health care arena, the demand of the dispossessed is for quality health care provided to all as a human right. The fight for a single-payer system takes us along the path to health care as a human right. We should be wary of proposals that keep the private insurers intact and that in one way or another would force individual workers to take responsibility for paying for their own care. A single-payer system eliminates the private health insurers, guarantees coverage to all, and makes the government responsible for paying for care. Not only will single-payer itself be a step forward, but the fight for it will increasingly bring the movement up against a system that is impoverishing us all. This struggle will allow those fighting to see the necessity and possibility of creating a new society free of want, where each of us can achieve our full potential.
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