The health care system and the war against the working class

 

By Steve Halpern

The other day I had a doctor's appointment. This was at the recently constructed Honickman Center of Jefferson University Hospital located at 1101 Chestnut Street in downtown Philadelphia. The parking lot was under the 19 story Honickman building. 

The elevator in the parking lot brought me to the first floor of the building. There, I was met with a security guard and a metal detector. The security guard told me to register at one of a line of screens that took my information. Then, I was transported to the eleventh floor on what appeared to be a state of the art elevator. 

In the room where the doctor examined me, there was a widescreen television with my name welcoming me to the to the facility. This screen enabled me to choose music and art while I waited to see the doctor. 

After my examination, I spoke to someone who scheduled me for my next appointment. This was via the widescreen television. The person who scheduled me for the appointment was at her home in New Jersey. I needed to wait an extra month before she could find a time when the doctor would be available. Other that the delay in scheduling for my appointment, I found the doctor to be helpful and competent in treating my condition.   

The construction cost of the Honickman Center exceeded one billion dollars. From what I could see, there are few, if any hospital beds in this building. I also did not see offices for primary care, mental health, maternity, or pediatric care. These specializations might be among the least profitable.    

On the other side of the Schuykill River in West Philadelphia, the Hospital of the University of Pennsylvania erected their Pavilion building. The construction cost of this medical facility was about $1.7 billion. The Pavilion is only one of several relatively new buildings constructed for the University of Pennsylvania Hospital. 

Hospital Closures  

A few years ago, I attended a demonstration protesting the closure of Hahnemann Hospital in Philadelphia. A few years before that I attended another demonstration protesting the closure of Women's Hospital of Philadelphia. At that demonstration, the President of the Hospital Workers Union 1199, Henry Nicholas, reported that this was one of about 700 hospital closures throughout the country.

Before Women's Hospital closed, the owner, Tenet Healthcare, effectively forced the nurses to go on strike. The strike lasted about one month. A day after the strike was settled Tenet announced the closing of the hospital. During the monthlong strike, Tenet recruited scab nurses from across the country and bussed them to the hospital every day. This was the thank-you that Tenet gave to their employees.

We might also ask a question: If so much money is being spent on health care, why was there an acute shortage of hospital beds and face masks during the COVID-19 pandemic? 

What is going on?

So, these facts beg another basic question. Why are hospitals investing astronomical amounts of money in health care, while at the same time they are closing hundreds of hospitals? 

Dan Cooney was a friend of mine who passed away a few years ago. He was a nurse in the mental health department at Jefferson University Hospital. Jefferson eliminated this department and laid off Dan to make way for a more lucrative orthopedic practice. 

Dan and others spoke to me about how he managed to talk patients through the reasons for their drug addiction and saved their lives. The Center for Disease Control estimated that there were 107,543 overdose deaths in the United States in 2023.

Saying all of that, we need to understand the economics of hospitals. There are many corporations that profit from hospitals. There are the hospital equipment manufacturers. There are the drug companies. Banks receive interest on loans from all those corporations. Insurance companies profit from minimizing payments for health care. Yet the people who work for banks and insurance companies never actually treat patients.

Karl Marx and Frederick Engels wrote their Communist Manifesto in 1848. In that document they argued that the capitalist system has a disease that was never experienced before in human history. This is the disease of overproduction.

In other words, banks need to continually find investments where they can grow the assets they have. However, since banks never actually produce useful commodities there is only one way they can get the capital needed to grow their assets. This is to be obsessed with cutting costs. 

We saw how this system blew up in 2008. Banks floated all kinds of real estate loans, but large numbers of borrowers weren't able to pay back their loans. As a result, the investment companies of Lehman Brothers and Bear Sterns closed. The news media is determined to never report on the real causes for this banking collapse. When the economy continually grows, while there is an obsession to cut costs, a financial collapse is inevitable.

The effects of capitalist economic growth

Today, about six percent of the population has medical debt of about $220 billion. Student loan debt is about $1.7 trillion.

All the astronomically expensive medical facilities I mentioned in this blog are located in Philadelphia. Philadelphia is also the home of the Comcast Towers that had construction costs of $2.6 billion. So, with all these expensive buildings in the city, we might think that the public educational system would be adequately funded. 

Today per student funding for education in Philadelphia is about $10,000. When we walk across the street on City Line Avenue, we enter the Lower Merion School District. There per student funding is about $26,000. Lower Merion is a suburban community and lacks the billion dollar buildings housed in Philadelphia. 

If you think this disparity in funding for education isn't fair, you aren't alone. Commonwealth Court Judge Renée Cohn Jubelirer wrote a 780 page decision arguing that the gross disparity in funding for education in Pennsylvania is illegal. However, since the Pennsylvania state government says that this decision is non-binding, it hasn't been enforced.

However, in New Jersey the courts of that state ruled in their Abbott v. Burke decision that the inequality in educational funding in the state was also illegal. However, that decision was binding.

Instead of taking the money from the most affluent New Jersey residents to correct this problem, the state had other ideas. They increased property taxes making New Jersey the state with some of the highest property taxes in the nation.

Conclusion  

In order to put all this information in perspective, I believe we need to look at the nation of Cuba. Today Cuba is having a difficult time largely because of the economic embargo enforced by the United States government.

However, Cuban citizens have no debts for education or health care. In fact, both education and health care are lifetime rights to citizens on the island. In fact, Cuba has twice the number of doctors as the United States per capita. Cuba has trained doctors from around the world free of charge. Cuban doctors have also gone all over the world to treat patients in need.

All of this is possible when there is a government that makes human needs the priority over profits. As the capitalist system continues to demand that workers give up more and more just to sustain ourselves, we need to understand that there is another way.    

   

We have always lived under a ruthless dictatorship

Art by Kathe Kollwitz

By Steve Halpern

Donald Trump will be the President of the United States again. Trump says he wants to deport 12 million immigrants who live in this country. He says that they are "illegal." 

These are the words of a convicted felon. We might also consider that President Joe Biden didn't hesitate to flagrantly violate the law when he gave Israel arms to murder civilians. In order to put our current reality in perspective, I believe we need to look at the founding of the nation known as the United States of America.

The revolution of the thirteen colonies

The Declaration of Independence consists of a list of grievances the settlers of the thirteen colonies had against the British royal government. They argued that the British instituted a "long train of abuses" that resulted in "despotism." They felt they had a "right and a duty" to throw off that power and establish new "guards for their security."

Unlike the democrats and republicans today, these colonists opposed the British measures aimed at limiting immigration. They also used the racist word "savages" to describe the first nations who lived on this land for thousands of years.

So, the Declaration of Independence begins to give us an outline of the contradictory character of the government that was established in this country. On the one hand, people began to have rights of free speech, separation of church and state, as well as some voting rights.

There was another aspect to the revolution of the thirteen colonies that few people talk about. In the late 1700s most people were farmers who usually worked outdoors. They could not have imagined the world we are living in today with cars, cell phones, educational and health care systems, as well as refrigerators, stoves, washing machines, and dryers. These monumental changes happened because the revolution began to unleash the productive forces of capitalism. One of the laws of capitalism is that the economy needs to continuously grow.

However, we can also say that from the beginning the United States government has been a ruthless, diabolical, and tenacious dictatorship. After the revolution, veterans were starving and they engaged in an armed uprising led by Daniel Shays. The new revolutionary government dealt with the starving veterans by repressing them with armed force. The government also continued the genocidal wars against Native Americans. 

The new revolutionary government supported the unimaginable horrors of chattel slavery. Then capitalists, workers, and farmers formed a coalition to destroy chattel slavery in the Civil War. 

The government continued the war against the working class

After a brief period of reconstruction, the government used its dictatorial powers to violate the Constitution and strip African Americans of their rights with the Jim Crow laws. Today there is a memorial museum in Montgomery, Alabama of over 4,000 human beings who were illegally lynched. The government adamantly refused to prosecute the murderers.

The revolution of the thirteen colonies as well as the Civil War did expand the rights of people living in this country. However, those rights were extremely limited and needed to be defended through struggle.

Workers were brutalized and murdered when they went on strike. Civil rights activists were also brutalized and murdered in the struggle to give Black people the rights they were supposed to have in the Constitution.

The government arrested Alice Paul and the suffragettes for demanding that women have the right to vote. In prison the suffragettes went on a hunger strike protesting their incarceration. Prison guards then inserted a tube into the throat of Alice Paul to force-feed her.

The genocidal wars against Native Americans lasted for over a century. These wars spanned over the entire area of this country. Why was the government so tenacious in their attempt to steal Native American land and strip them of their culture?

Clearly Native Americans had many problems before their contact with Europeans. The First Nations needed to migrate to find the means to live. At times they came into conflict with other native nations. However, they lived in an environment where everyone worked together to share what they had. During these years Native Americans made outstanding advances with respect to the sciences of agronomy, medicine, and astronomy. 

The United States government advanced their hundred years genocidal war to strip Native Americans of their homeland. They also replaced the Native American communal environment with the capitalist mode of production. Capitalism always requires a gross inequality between the super rich and those who can barely afford to live

However, Presidents place their hands on the bible and take an oath to defend the Constitution. The 14th Amendment to the Constitution says that everyone is supposed to have "equal protection under the law." 

President Franklyn Delano Roosevelt didn't hesitate to violate his oath of office when he ordered 125,000 Japanese to be placed in concentration camps. For decades Presidents didn't hesitate to violate their oath of office when they allowed states to strip African Americans of their rights with the Jim Crow laws. 

President Joe Biden didn't hesitate to violate his oath of office when he gave massive amounts of arms to Israel. They used those arms to murder thousands of civilians. Members of Biden's Administration have resigned because of the President's support of genocide. President Elect Donald Trump promises to continue to violate his oath of office by supplying arms to Israel that will be used to murder babies.

The politics of Donald Trump and Kamala Harris are essentially the same   

Donald Trump and Kamala Harris had basically the same message in their Presidential campaigns. Trump says he wants to make America great again. Harris said she wants to strengthen the middle class. What are they talking about? 

About 80 million people died in World Wars One and Two. After those international slaughters the United States became the world’s superpower. Then the U.S. economy dominated the world until the 1970s. 

During those years the economy in this country grew by leaps and bounds. The labor, civil rights, and women’s movements also erupted. For all those reasons the standard of living improved for most workers and corporations grew astronomically. 

Donald Trump and Kamala Harris imagine that their policies can bring us back to the time when the U.S. economy dominated the world. Because of the reality of capitalism, this is a truly impossible dream. Since the dreams of Trump and Harris are impossible, I believe it is worth thinking about what is possible.

The so-called news media will not report these facts

First, there are about eight things we need and want. These include food, clothing, a place to live, transportation, communication, health care, education, and exposure to cultural activities that include music, art, dancing, theater, film etc. 

When we purchase any of these commodities we are, in effect, required to contribute to enterprises that add little or no value. These include, profits for manufacture, transport, and sales. Then there is interest to banks, insurance, advertising, corporate law, landlords, and let's not forget maintenance for thousands of atomic bombs.

When we look at all those expensive skyscrapers in the cities, most are office buildings. Few of the enterprises housed in those skyscrapers add value to the commodities we need and want.

So, when we look at this reality, we see how much of the work done in the capitalist world is not necessary to provide for the things we need. This means that if we had a different political economic system, there would be a lot less work to do in order to provide for the things we need and want.

Understanding these possibilities, we might ask a few questions. Why are there about 44 million people in this country who do not have adequate access to food? This, while the shelves of supermarkets are overflowing. Why are there huge numbers of empty office buildings, while hundreds of thousands of people are homeless? 

The answers to these questions are clear. Under the capitalist system the top priority is the drive to maximize profits. This explains why corporations gave over two billion dollars to the Presidential campaigns of Donald Trump and Kamala Harris.

However, the problem is much deeper than the inequities of campaign financing. All the mainstream news outlets routinely give next to no coverage of third party candidates. The educational system routinely ignores the Marxist analysis of politics, economics, and history.

Then we can think about what happens when we go to work every day. Employers control the work environment. When we leave work corporations control the prices we pay. Then they advertise how wonderful overpriced commodities are. So, someone please explain to me how this is a democracy. 

Now I have another question. How can this system ever change?

First, we can say that the economy of the United States has been deteriorating for the past fifty years. There are economic downturns every four to seven years. There were downturns in the years 2000, 2008, and 2020. in each of these downturns the government literally gave away huge amounts of money to prevent an all out depression. The Chinese economy experienced huge growth and this also kept international capitalism relatively stable.

However, it is extremely likely that during the next four years, there will be another economic downturn. We don't know how deep this will be. One possibility is that banks will close and the cash machines we use to get money won't be working. If this happens, we can rest assured that working people from around the world will demand fundamental change. This would be in spite of the fact that Donald Trump just won the Presidential so-called election. 

A new vision for the future

There is no law in this country that makes it illegal to imagine a world where human needs and not profits are the fundamental priority. I believe that most people would like it if everyone in the world had the means to live. Yet, very few people talk about how it is possible to achieve these goals. 

We have all been raised to think that politics is about the elections and who holds positions of power in the government. The reality that I pointed to in this blog is how working people won the rights we have because of sustained struggle and not because of elections.

I believe that as the economy continues to fall apart rank and file working people will be open for arguments calling for fundamental change. Many of these people voted for Donald Trump or Kamala Harris. What would that change look like?

We might look at the numbers of people in the working class in the world. We might also look at the amount of work that is, in effect, wasted in enterprises that add no value to the goods and services we all want and need. 

Thinking about all of that, if the government and the economy made human needs and not profits the priority, there would be a fundamental change. Workers would only need to work for a few years before retiring. We would all have lifetime rights to all the things we need and many of the things we want. There could be more teachers so class sizes would never exceed ten students to one teacher. The number of doctors could grow astronomically. This would mean that we could all actually talk to a doctor when we need to. There could be an efficient mass transit system that would take us to anywhere we want to go in the world.

While capitalist stability is becoming an impossible dream. a socialist future world is indeed possible. I encourage everyone to take part in the national demonstration on January 20 to coincide with the inauguration of President Donald Trump.