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Global devastation wreaked by the coronavirus has thrown high-beams on the failures and injustices of the American health care system: 44 million people and growing with no coverage; even those with insurance delay care because they can’t afford deductibles; Black and brown and poor people — already suffering health disparities — at three-fold risk of dying.

health care system

These indictments of the only developed country in the world without a national health care system have given new fire to the fight for universal coverage. TV and internet screens are lit up with calls for “Medicare for All.” Winning this — especially if linked with no copays and inclusion of undocumented migrants — would be a big improvement. It would bring the U.S. into the 20th century, joining the 32 nations that established universal care after World War II.

But is Medicare for All, meaning the government is the sole health insurance provider, enough? Not nearly, and brutal truths revealed by the pandemic show why.

Public Health in a Privatized World

People are dying in hospital halls for lack of beds. Meanwhile, private hospitals are closing or laying off workers — 1.2 million in April — because profitable elective surgeries and clinic visits are on hold. But not only the private sector is failing.

I spent my career in a public safety-net system within this “for-profit” society, New York City’s Health and Hospitals. In the 1990s, we started hearing that proposals for improving care had to be “on the business model.” Toyota’s factory methods were to be our inspiration. Shortening stays and reducing admissions were rewarded. One entire ward in my hospital closed (except when rented out as a movie set); then another.

The power in our hands. The next pandemic could be taken on so differently by a system organized by healthcare workers and engaged users.

This was neoliberalism’s invasion into public health. Since 1975, the U.S. has cut the number of hospital beds by 36.4 percent, even as the population grew by more than half — and most closures were in poor neighborhoods.

Neoliberalism also affected public hospitals through ‘creeping’ privatization. First billing was outsourced. Then areas directly impacting patient care: dietary, custodial services, lab tests, nighttime X-ray readings.

It hasn’t only been the backward U.S. that has sacrificed people’s health to the corporate bottom line, particularly since the 2008 recession. Italy, so devastated by the pandemic, has a single-payer system in which the government provides coverage for all.

However, in the words of Antonello Zecca of Sinistra Anticapitalista (Anticapitalist Left) party: “Our health care system was ravaged by a decade of funding and provision cuts, leaving it a shadow of its former self. … More than 70,000 beds vanished into thin air. … Worse, in recent years, public financial support has flowed into a growing private health care system.”

Similar erosions have taken place across the globe, where public and private systems often compete. Spain’s formerly robust structure has been eroded in the past decade. Prior to Covid-19, about half the hospitals were private. The Spanish government “nationalized” them in order to better coordinate and allocate resources, but made it clear that this was a temporary step aimed at managing them and not challenging their private ownership.

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Profit Rules All

The competition between public and private health facilities is a minuscule part of how the dominant for-profit production cripples healthcare. Another excruciating experience during the pandemic has been watching over 6000 hospitals in 50 states competing for desperately needed supplies, beset with hoarders and price-gougers. Pleading for more N95 masks, New York Governor Cuomo confirmed he has authorized payments at ten times the usual price.

But being at the mercy of profiteers isn’t a pandemic-time aberration; it’s business as usual under capitalism. Healthcare is held hostage to the inflated prices that make the big pharmaceutical companies and their owners among the uber-wealthy, and the result is untold numbers being priced out of optimal care. According to a representative of Doctors Without Borders, nearly a million children die each year from pneumonia, deaths preventable by vaccines their governments cannot afford.

Medical suppliers get their cut as well, often nefariously. Epidemiologists raised concern early on about the need for more ventilators to support the most seriously ill, but supplies have been dangerously limited even in the wealthiest regions.

After the SARS epidemic, a federal agency recognized that smaller, less expensive and easier to operate ventilators were required. A small California company was contracted to make prototypes — which they did. Their intent was to expand production to the global market, providing an option for poorer nations at a fraction of the cost. What happened? The little company was gobbled up by a bigger maker of medical equipment, including pricey ventilators that would have had to compete with the new model. At the company’s request, the government let them out of the contract and dropped the project.

A clear-eyed look at the industry’s track record makes clear that the only way to build a healthcare system that can fulfill the mandate of universal, free, quality healthcare for all is to nationalize every facet of the system: not just insurance, not just hospitals and clinics, but production of medications, equipment and supplies as well.

But even if the entire medical industry is made public property, the make-or-break question is, who makes the decisions?

Case in point: as a condition of its 2009 bailout, General Motors turned over controlling interest — nearly two-thirds of its stock — to the federal government. Under its watch, workers were forced into contractual givebacks and 14 plants were closed. Then the government sold back the stock at a loss.

Public ownership with the minions of the ruling class calling the shots isn’t worth the paper the deed is printed on.

The Power in Our Hands

The next pandemic could be taken on so differently by a system organized by healthcare workers and engaged users. Under our control, the public health system would prioritize prevention, and make strides toward eliminating the racial and economic disparities that contribute to higher risk. Information would be freely shared internationally. Contingency plans would be in place to rapidly repurpose and rev up production and direct resources where they were needed. Supplies and medications on hand would be determined by their usefulness, not profitability, and costs would be vastly reduced. Online monitoring and quarantine could be handled collaboratively with communities, free of government spying and brutal police enforcement.

A nationalized health system under workers control: a radical departure from the status quo, and ultimately the only option that makes sense.

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Susan Williams, MD
Freedom Socialist