Health care reform and the capitalist class

Foremost among the policy objectives of Obama and the Democratic Congress this year is the reform of the American health care system, which is inefficient and ineffective compared to health care in the rest of the West and even in parts of the third world (e.g, 45 countries have a higher life expectancy than the U.S.) The obstacles to passing any reforms meaningful even by bourgeois standards are numerous. For instance, it's common knowledge that no fewer than five of Democratic Senator and chief of the Senate Finance Committee Max Baucus's former staffers -- two of them his chiefs of staff -- are now lobbyists for, among others, Wyeth, Merck, Amgen and AstraZeneca 1. Pharmaceutical giants have generously contributed to Baucus's election campaigns. For the faction of the capitalist class that is arrayed against health reform, Max Baucus is a powerful ally, but only one among many. A 2005 report found that pharmaceutical companies, to say nothing of insurers and the like, had spent 675 million dollars in the previous seven years on lobbying congress. Another 125 million dollars were donated to congressional campaigns 2.

Even so, other factions of the American bourgeoisie are convinced that health care reform is a necessity to shore up sinking profits. Obama, chief spokesman of the American capitalist class, proclaimed in a major television address to the nation that health care reform would help combat the current economic crisis. Health care reform may constrain the profit-making ability of the health care and pharmaceutical sectors, it is only to the benefit of the remainder of the bourgeoisie, to "prevent a particular group of private capitalists from holding the rest of the private capitalist class to ransom" 3. This is something Obama made clear in his statement that health care reform is "about every small business that has been forced to lay off employees or cut back on their coverage, because it became too expensive" 4. But small businesses are not the only ones counting on the state to take on the costs of health care. Writing in Fortune in 2007, Matt Miller brazenly championed an overhaul of the health care system on the grounds that the costs could be shift from businesses exclusively to American taxpayers:

Start with the fact that business now spends a stunning $500 billion a year, or 4% of GDP, on health-care benefits. Let's say we shifted that cost to government--that's right, relieved business of it entirely--and, to make matters simple, combined it with other public funds to give citizens a voucher with which they could buy a private health plan. To pay for this without boosting the deficit, we'd raise taxes by an identical amount--not on business, of course, but on taxpayers broadly, via various gas or carbon taxes that would have the salutary side effect of helping cure our energy and environmental woes.

What would business think of such an idea? Policy suggestions like this would ordinarily be dead on arrival, decried as a record $500 billion tax hike sure to sink the economy. But what if the business community rose as one to force politicians to get past such rhetoric--and publicly trumpeted the need for the new taxes? It's not as far-fetched as it sounds. Look what we'd be doing: We'd free business from the burden of financing health care 5.

Likewise, the CEO of Kelly Services, a Fortune 500 company that employs 750,000 persons annually, stated with a great deal of frankness that "there are employers that don't want the responsibility [of providing health care], and we are in that category. My health-care costs total more than my profits." Transferring that responsibility to the government and taxpayers as a whole makes financial sense for such companies. Benjamin Sasse, an Assistant Secretary of Health & Human Services under President George W. Bush and currently an assistant professor at the University of Texas at Austin, claims that large enterprises "do not want to be seen as more willing to dump [benefits] than their competitors are." Sasse claims that many employers would even be willing to pay higher taxes to avoid the costs of providing health care themselves. And Len Nicholas, health policy director of the corporate-backed and sponsored New America Foundation think tank, suggests that opposition to health care reform from companies outside of the health care sector has been limited because these companies "know high health-care costs put U.S. companies at a competitive disadvantage" 6.

Moreover, streamlining the health care system promises to free up dollars for consumer spending, the hitherto unattained objective of so many of the measures passed in the last year intended to combat the crisis. In Obama's aforementioned television address, he provided the example of a woman who spends 700 dollars a month for her medicines. In fact, in America 15% of the GDP is spent on health care, a figure higher than that of any other developed nation. Rescuing Americans from this crushing expense isn't merely an act of charity. Health care reform would have the effect of transferring consumer spending from the highly profitable health care sector to the sectors of the economy that are in dire need of "effective demand." It should be no surprise that such measures would be undertaken by the state, which after all represents and defends the interests of the collective capitalist class even when this means curtailing the interests of particular capitalists. After all, "the modern state, no matter what its form, is essentially a capitalist machine -- the state of the capitalists, the ideal personification of the total national capital," as Engels wrote 7.

Thus even this brief examination of the motives behind Obama and the Democratic Congress's current drive for health care reform belies any notion that they are acting solely in the interest of the American people, as if they were standing up to "corporate power" for the "little guys," to use the populist language the bourgeoisie uses to obscure the fact that society is divided into definite classes. What's more, we can say that whatever comes of health care reform this time, whatever success it achieves, health itself is an impossibility under capitalism. Consider that...

One could provide many more examples, especially in the realm of mental health, but by now the point should be clear: rather than participating in this bourgeois policy debate, the task of politically conscious workers is to point out that health care reform isn't an act of altruism on the part of "our" representatives, but rather a necessity for the profitability of the American capitalist class and that even if Congress can pass an extensive health care reform bill, profit and health will remain mutually exclusive, since the drive for profit requires capital to cast aside any and all considerations (such as health, the environment and even life itself) that stand in the way of achieving those profits.



  3. Page 24 of Adam Buick and John Crump's State capitalism: the wages system under new management. Buick and Crump were describing the British state's 1868 decision to nationalize the telegraph and postal systems. 


  5. Miller, Matt. "Opening the Capitalist Mind." Fortune; 4/2/2007, Vol. 155 Issue 6, p38-38. 

  6. Arnst, Catherine. "A Secret Wish for Health Reform." Business Week. New York: May 18, 2009. Iss. 4131; pg. 23 











  17. 50 Facts that Should Change the World, 2.0, Jessica Williams. Pages 75-79. Disinformation, 2007. 





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