Tuesday night, Bernie Sanders held a live-streamed town hall to discuss the prospects and potential for a single-payer Medicare for All health care system. On the panel, among physicians, nurses, students, and international health ambassadors sat a few corporate executives. Each praised the cost effectiveness of the Medicare for All system and insisted that the program made “good business sense.”
As Sanders’s legislation becomes increasingly popular, it’s likely that a few more business leaders will trumpet their support. But Medicare for All advocates should be skeptical of members of the business community, even when they purport to be on our side.
There are three big reasons that socialists and progressives should be wary of capitalist advocates for any social policy, and in particular for Medicare for All. First, focusing on cost-effectiveness for corporations is bad politics in the long term, since it reinforces the idea that businesses’s profits are as important as ordinary people’s needs. That puts the Left in a position of weakness whenever we pursue other reforms that don’t save CEOs any money, but are just as worthwhile.
Second, when progressive and left-wing politicians and political organizations neglect to keep capitalists at arm’s length, the latter’s outsize resources give them outsized influence — often resulting in weakened policy and a diluted program. In order to ensure the eventual passage of comprehensive policy that benefits workers, not just employers, proponents of Medicare for All need to walk a fine line, stoking divisions within the capitalist class without giving the business community a seat at the table.
And third, national single-payer health care will not come to fruition without a major mobilization of the American working-class majority. That is going to require naming class enemies and building class consciousness, a project that will be muddled and undermined by any willing embrace of business leaders with decidedly different material interests. Relatedly, the transformative potential of Medicare for All is bound up in its ability to awaken the militancy of the American working class after decades of political dormancy. For this to happen, workers need to be placed front and center in the struggle against the private insurance industry.
A Penny Saved
The Left understands employers and workers to be locked in perpetual struggle. This is the basic conflict at the heart of capitalism: employers seek to extract as much value from workers’ labor as possible, while workers resist this compulsive exploitation with various demands for security and freedom. Sometimes workers’ demands actually do benefit one slice or another of the private sector. But more often than not, reforms that help ordinary people hurt capitalist interests overall — and worker empowerment means capitalist disempowerment, in the aggregate.
With that dynamic in mind, it doesn’t make sense for people who are motivated by the desire to free people from capitalist exploitation to adopt the “good business sense” rhetoric of employers. It’s true that, even though Medicare for All will wipe out an entire mega-industry, there are employers in other industries who will find it financially beneficial. But that fact is incidental. The point of pursuing Medicare for All isn’t to save corporations money, it’s to save working people’s lives, and to empower average Americans to make choices on behalf of their health and happiness instead of their existing or potential medical debt.
Left-wing proponents of Medicare for All shouldn’t hesitate to drive home how much money the average worker will save with a transition to single payer. But the moment we insist a policy is a social good on the basis of the benefits reaped by the business community, we’ve ceded the political goals of our project. Let’s say Medicare for All failed to save employers money: would this make the demand any less worthy? From a capitalist perspective, yes, but from a socialist perspective, of course not.
Mimicking business rhetoric is self-defeating for the Left. Medicare for All is one of many struggles on the horizon, and not only are there tons of instances where capitalists don’t benefit from reforms leftists seek, but capitalists do not benefit from any overall increase in worker power, solidarity, consciousness, and capacity. Progressives and socialists should be explicit and consistent in the message that capitalists’ profits are not the objective. Indeed, oftentimes capitalists will lose money and power from policy interventions that empower everyone else — and that’s great.
Taking Care of Business
The second issue concerns the privileged position business holds in American politics and society.
The American state is dominated by corporate interests. The political mobilization of the business community is often the decisive factor determining social policy outcomes. In fact, when the business community acts in unison it is difficult if not impossible for countervailing institutions and organizations to overcome their influence. This is due to both the tremendous resource advantage individual firms and organized business groups wield and business’s advantageous structural position within the economy — consider that the army can force workers to work, but it can’t force capitalists to invest. And with this kind of leverage, business groups routinely win concessions regarding social policies that they perceive hurt their bottom lines.
When the capitalist class is divided, however, popular forces have an opportunity to operate and put pressure in the cracks. As such, we should welcome business dissensus when it comes to Medicare for All. In order for Medicare for All to become a reality advocates will ultimately need to isolate the insurance industry from the larger business community — we want chaos in the Chamber of Commerce.
But that doesn’t entail welcoming business elites themselves. Even the most liberal business elites will seek to minimize the harm single-payer might inflict on profitability. If we let the liberal business elite come to appear as credible and trusted allies in this fight, they will undoubtedly try to shave down coverage, ease the tax burden on the wealthy, or implement means-testing in hard times. Not only would such concessions hurt the efficacy of a single-payer Medicare for All system, they would make the whole program more vulnerable to conservative sabotage.
Elevating business leaders among the broad coalition of Medicare for All advocates — which includes vastly greater numbers of workers, students, physicians, and yes, even socialists — would ultimately amount to inflating their own already outsized influence. If we want a robust version of Medicare for All, one that won’t be vulnerable to chiseling down and one that benefits the working-class majority, it’s workers that must be front and center.
A Workers’ Movement
Single-payer health care will wipe out a multibillion dollar industry that currently holds significant influence over both major parties. The only way to achieve it is to pose a popular threat to politicians, one that’s more compelling than the financial and political incentives dangled by the private health insurance industry. This means a coordinated mass mobilization of the working-class majority. As the saying goes, they’ve got money and we’ve got people.
But the working class has been down and out for a long time. With no substantive representation in neoliberal two-party politics, and having suffered a sustained assault on its own institutions (namely unions and socialist organizations), the working class is fragmented and unaware of its own power. Not only class militancy but basic class consciousness is idling at a historic nadir. This means that in order to achieve the working-class mobilization we know it will take to win Medicare for All, we need to rebuild class consciousness — and that requires naming class enemies.
The American working class will not cohere in the numbers necessary to destroy the private insurance industry unless it understands itself to be a class. Much of the work of single-payer organizing lies in convincing people they’re being duped and exploited by the rich. Because Medicare for All is a fairly clear-cut case of egregious, unnecessary exploitation that impacts hundreds of millions of people’s lives at the most intimate level, it’s well-suited for this necessary conversation about class interests and class enemies. It’s also the most popular and radical demand for large-scale decommodification we’ve seen in over a generation. Put it this way: at this moment in American history, single-payer requires class war, and class war requires single-payer.
And there’s no better way to torpedo this tricky and necessary political project than to publicly identify CEOs as allies. Americans already suffer from a benevolent bosses complex — our corporate media fawns over billionaires, celebrating their philanthropy and thanking them for giving us jobs instead of asking what they did to earn all that money in the first place and whether it ought to be equitably redistributed. In the struggle for Medicare for All, reproducing the benevolent boss dynamic makes it difficult to unite the broadest layers of the working class to fight for a common political goal and identify a common class enemy. In order to win not just single payer but other fights against capitalists, we must become comfortable demonizing elites.
What’s more, we don’t need them.
Whatever political credibility the famed American businessperson once had, their legitimacy as a group has collapsed. Most workers, students, and retirees simply don’t trust capitalists. This is cause for celebration. Instead of getting the stamp of approval from liberal business elites, we should focus on bringing the single-payer gospel to every working person that has ever had to pay exorbitant prices for prescription drugs, used an emergency room when they had no coverage, or who simply can’t afford their rising premiums.
Of course, mobilizing and organizing the mass of American workers has always been harder than courting a clique of liberal elites. But the rewards of doing so far outweigh the risks of cozying up to our erstwhile enemies.