A health-care struggle built on solidarity

The crisis of the U.S. health care system was already ongoing despite Barack Obama's Affordable Care Act (ACA), but the Republicans in power in Washington want to make things worse by dismantling the positive achievements of the ACA. Protests against Congress' attempt to "repeal and replace" the ACA show the depths of opposition to Trumpcare--but also broad support for a Medicare for All system, also known as "single-payer," under which no one has to rely on private insurance companies for access to health care.

The fight for single-payer health care and its importance for socialists was the topic of a discussion on the Too Long 4 Twitter podcast, based in California. Participants included Meagan Day, who sits on the leadership body of the East Bay chapter of the Democratic Socialists of America, along with Kristen Sheets, Erica West and Emma Wilde Botta, all members of the International Socialist Organization. The following are excerpts from the discussion, edited for publication--you can listen to the full conversation at the Too Long 4 Twitter page on Soundcloud.

Protesters take to the streets of Los Angeles to demand a single-payer health care system  (Molly Adams | flickr)Protesters take to the streets of Los Angeles to demand a single-payer health care system (Molly Adams | flickr)

Erica: Meagan, why is health care important to you?

Meagan: [With single-payer health care], we are looking at the most popular de-commodification-oriented proposal in decades, and as socialists, we would be fools to pass up the opportunity to talk about what it would mean to dismantle an entire sector of the economy and replace it with social care.

Kristen: Another really appealing thing about health care is that it has a national horizon, as do our organizations. It's important to be a member of a national organization, and be able to connect struggles in different places and work together on a very large project, which is really exciting.

Meagan: To that effect, when we were focusing on SB-562 in California, there were people who were in our corner who were saying that state-level, single-payer campaigns don't make any sense, and it has to be a national effort. I think that's true, actually.

But in the East Bay, we were focused on SB-562, and it allowed us to develop new modes of engagement with the question of health care. We introduced a socialist analysis that was infused into DSA's national convention in Chicago and adopted across the rest of our chapters. So there is some value in trying things on a smaller scale and bringing it up to the national level.

Erica: Emma, I wanted to ask you about your article at SocialistWorker.org on health care. Why is health care important to you?

Emma: Health care touches everyone's lives in a really intimate way. You'd be hard-pressed to find too many people out there in the U.S. today who are satisfied with the cost and the quality of their health care. With the attacks on the ACA, there has been an incredibly inspiring resistance to protect the gains of the ACA and to also demand what we actually want: health care as a human right, not as a commodity.

The California single-payer bill, SB 562, is dead right now and not viable at the moment. But it has excited and inspired a whole new layer of people who are ready to go out and take action.

That's the importance of organization to maintaining that momentum. We can't know exactly what form the fight will take. Maybe it will be Bernie's Medicare for All bill. We'll have to see where we can direct people's energy. I do think that we're in a galvanizing stage and it's really exciting.

Erica: What could society look like if we decommodified health care?

Meagan: There's a concept--which I didn't come up with--about how public programs are "engines of solidarity." Once you secure them, you have created out of thin air a constituency that is militantly committed to defending its right to have something that is not-for-profit. Prior to securing it, it may be that these people didn't even think they deserved it.

We're actually trying to win single-payer health care because we believe it will create stronger mass constituencies that are dedicated to fighting for their right to have sectors of their lives de-commodified.

Kristen: I think that's the reason why, as revolutionary socialists, we support reforms. This is a non-reformist reform. It's a program that makes people's lives better, and that's important.

Secondly, we think that people can be transformed through struggle. If we're not struggling for something and building solidarity between people, bringing people around a cause, we're not going to be able to transform society or have a broad socialist movement that can seize power.

Meagan: And health care is one of those special areas where it is both universal and has disproportionate affects on people who are marginalized in society. That's a really important set of characteristics that socialists should be looking for when they are rallying around a non-reformist reform.

Literally everyone has a body, and everybody's body needs care. That's the universality bit. And unless you are so wealthy that you barely have to worry about anything ever, it's a hassle. It's difficult to get health care. And one of the reasons for this is because there's an intermediary between you and the care you need, which is private insurance companies.

Private insurance companies literally do not need to exist. They are parasitic agents, and they are making it a lot harder for you to access the care that you need.

The uninsured rate is 60 percent higher for Black people than for white people. For Latinos in the U.S., including the undocumented, the uninsured rate is 300 percent more than for white people.

Demanding universal access makes this an anti-racist struggle. These two things are sometimes opposed in liberal discourse: universalism vs. fighting on behalf of marginalized people. We can see in health care how these two things are not opposed whatsoever.

Kristen: You can also see where the feminist fight should be around issues of reproductive justice. So many clinics are being shut down and threatened. It's important to defend the idea that abortion should be covered under every health care plan.

Erica: Yeah, and repeal the Hyde Amendment! In 1972, Roe v. Wade was passed legalizing abortion. In 1976, the Hyde Amendment, a national piece of legislation, was passed, banning the use of federal funds for abortions on a state level. That's something people should know about, because it's fucked up.

Women of color and poor people disproportionally rely on federal funds to get their health care, which means they are locked out of federal funding to get abortions if they need them

Meagan: I want to add something to that idea that single-payer is a feminist fight.

Women are much more likely to be listed as a dependent for their health care than men are. Health care liberation is liberation from dependence on abusive actors, like employers, but also from intimate partners.

There are many women who don't want to leave their relationships because they don't want to lose their health care. They depend on their partner. And many women are also vulnerable to losing their health care if they lose a spouse or partner through death or divorce.

Emma: All of the people who use health care--the majority of us--will be a part of the fight to win single-payer. Also, people like doctors, nurses, orderlies--the people who provide health care--should see themselves as part of the fight.

A lot of doctors and nurses support single-payer health care. The nurses' unions are some of the most militant advocates of single-payer. They see it when patients can't get the care they need. Universal health care would be transformative for the people who do the work of taking care of this population.

Meagan: I also think it's really important that the California bill covers undocumented people. What's important about that from a socialist perspective is that the rhetoric around immigration sees migrants as a drag on society and a net negative. It's racist, and it's embedded in the way we talk about immigration in mainstream discourse.

If we were to successfully extend health care access to immigrants and demonstrate that it works, that the quality of care is not reduced and that people do not pay significantly more, it's a way to demonstrate that social care is not a zero-sum game.

This goes a long way toward changing the parameters of the conversation away from, "I get mine because you don't get yours."

Erica: There's the nebulous idea of single-payer or universal health care that most people want. But at the end of the day, this will be a legislative fight. We have to ask ourselves as socialists: What do we want?

We want to make sure that anything that gets passed includes rights for everyone. It needs to include undocumented people. It needs to include abortion. It needs to repeal the Hyde Amendment. That needs to be part of our work in these coalitions and in strategies like door-knocking. Whatever we're doing, we need to be sure that we bring that anti-racist, anti-capitalist framework to this organizing.

Meagan: We need to be retaining socialist principles and convictions throughout this fight, while also having a united front strategy and collaborating with groups that don't necessarily share our politics.

Organizations are really important. You pull people up through the chain, as opposed to focusing on passing a single bill, and then high-fiving and going home. This is party-building. This is base-building. And this is a life-long struggle.

Emma: And it brings politics to ordinary people and makes it theirs. A lot of people think health care is for experts, or that it's not up to them to decide how to get that care. Anyone who is interested in this and wants to get involved should look around at the organizations. That's the first step.

Single-payer is one of these issues that can bring out millions of people. We need to talk about the right context for it and who would be part of organizing that. Maybe somebody isn't ready to join a socialist organization, but they are ready to get out into the streets with lots of other people. And maybe they'll meet some socialists there.

National marches can turn another layer of people who have been interested in social justice, but hesitant to get involved, into active people in a socialist movement or the broader left movements in the U.S.

Meagan: Definitely. I also think that because of the absolute decimation of the American Left, stemming from the various Red Scares and the anti-union, anti-worker politics of the last three or four decades, we need to repopulate the American political sphere with a socialist presence. That is one of our major goals: we need to be doing it constantly.

Transcription by Sarah Wheels.