COVID-19 has exposed the long-standing disparities and inefficiency of the U.S. healthcare system to a degree never imagined, and opened up major avenues for change.
The human and social costs of flaws in the system have brought unnecessary death and suffering, global economic devastation, and historic levels of government debt. Our public health infrastructure has been hollowed out, and our healthcare workforce has been sent into battle without the armor and weapons it needed to fight the virus.
The crisis has accelerated a decades-long transformation of the U.S. healthcare system from one centered on patient care and social responsibility to a business model driven by the profit motive and dominated by corporate values. The slow train wreck of U.S. healthcare has become a runaway disaster.
There is some good news. The training and altruism of our frontline healthcare workers have been highly effective. Solidarity with CDC (Centers for Disease Control) public health directives has beaten back the pandemic and saved lives, and there is determined global cooperation to find treatments and a vaccine.
So, where do we go from here?
Three extremely difficult and complex things must happen to vanquish COVID-19. First, we need an effective vaccine. Second, we need effective treatments for all phases of the disease. Third, we need to reverse four decades of radical libertarian control and determined destruction of our government. The only path to that goal is through a Democratic presidential victory, Democratic control of the Senate, and retention of Democratic control of the House.
Where does this place democratic socialists? Antonio Gramsci said that revolution in western democracies is not a convulsive event but a long complex process; that the Left in these countries has always fought for the expansion and defense of democracy; and that respect for democratic process is essential. André Gorz wrote of “non-reformist reforms” that simultaneously change the rules of the political game while playing it and expand the political power of the working class.
In this context, the 2020 presidential campaign opens prospects for healthcare system reform. Gramsci reminds us that class struggle runs through all the institutions of civil society and the state apparatus itself, and that socialists must never abandon any political terrain. For Gramscians, including this author, the DSA convention’s refusal to endorse anyone but a democratic socialist for president was a misreading of the situation. A Democratic presidency along with Democratic control of both houses of Congress would not be the enemy. Rather, it would be an arena of struggle to advance “non-reformist” reforms. Such reforms might include “Medicare Extra” and a robust public option. These could lead to Medicare For All and certainly would be central to the long process of repairing the devastation caused by the pandemic.
In this arena of struggle, democratic socialists must keep in mind four strategic considerations:
Make healthcare a public good, not a commodity. It must be managed as a public good, moving first, as Ezra Klein has written, from a private system with fractured public options to a public system with highly regulated private options. This is a “non-reformist” reform, and presumptive Democratic candidate Joe Biden must be pushed to support a program such as Medicare Extra, which would be far beyond the tinkering he currently proposes.
Move quickly to universal coverage and unlink health insurance from employment. There are only two ways to do this: (1) sell healthcare on the open market or (2) set up a unified system of public financing such as Medicare for All.
Increase system capacity by increasing international cooperation and coordination among governments.
Channel the anger of the younger generation of physicians and other healthcare workers emerging from their COVID-19 experience. They’ve seen the failures. Now they must see the alternatives.
Democratic socialists working within a broad coalition for meaningful reform have their work cut out for them. We would never have chosen this pandemic as a means to create a different history, but we can use it. Let us start now.