“If we have no business with the construction of the future or with organizing it for all time, there can still be no doubt about the task confronting us at present: the ruthless criticism of the existing order, ruthless in that it will shrink neither from its own discoveries, nor from conflict with the powers that be.” — Karl Marx

Lecture & Discussion
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US Health Care Reform:
Another Historic Moment in the Administration of the Nation’s Poverty

An editor of the German Marxist quarterly GegenStandpunkt
Oakland, California
January 3, 2010

Just in time for Christmas, the Senate has passed its own version of the healthcare reform bill, jumping yet another hurdle on the path to “change” in the way Americans receive and pay for medical care. Yet controversy continues to rage. On the one side, President Obama has deemed the bill the single most significant piece of legislation since the creation of Social Security, and many Democratic lawmakers have solemnly declared that, despite the many bitter concessions they have had to make, this is the moment of their legislative lifetimes. On the other side, Republicans have expressed their utter revulsion at both the substance of the bill and the manner of its construction. And on the liberal left, there is disappointment and even disgust at how politicians have once again failed to put an end to the scandal that is the current American healthcare system.

Meanwhile, average citizens get to follow the ups and downs of the negotiations in Congress, listen to the pleas and arguments of big and small business, weigh the options and come to a conclusion about which is worse: their current inability to pay for the most basic care or their inability to pay for compulsory insurance, the risk of financial ruin posed by a serious illness or by unbearable healthcare costs on the companies that employ them?

These people would do well to pay attention as to why, despite all the rancor of the debate, elites on both sides of the aisle regard healthcare reform to be so urgent. Without far-reaching change, two things they regard to be much more important than the health of individual citizens will face impending doom: the nation’s economy and the solidity of the national budget. On that basis, the population’s poor bill of health raises some urgent questions for the ruling class: Is the health of the nation’s competitiveness in danger? Does the illness of broad swathes of the population represent a disadvantage in international competition that America can no longer afford? That requires a solution. How to extend basic care to a greater portion of the population without imposing unbearable costs on “the economy”, i.e., the profits of employers, while making sure that America’s premier growth industry can emerge stronger than ever?

This gives us no reason for joy or even “cautious optimism,” but raises some unwelcome questions of a more fundamental kind:

The answers to these questions illustrate why the hopes for a “historic moment” in the history of American healthcare are not only woefully modest, but hopelessly wrongheaded. We invite you to find out why.