Yoshie wrote:
> I believe that the ruling class would rather not have a single-payer
> universal health care system and, if they have to have one at all, forced
> by the working class, they try to make it as meager as they can. Canada
> is a good example of countries that do have a single- payer universal
> health care system that the ruling class have underfunded and are
> threatening to privatize <http:// www.healthcoalition.ca/>. Attacks on
> the welfare state, from eduction to health care to old age pension, have
> been universal, only differing in degrees, depending on relative
> strengths of the ruling and working classes of countries.
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No one in Canada is calling for an end to medicare, including the capitalist
class.
They are calling for the supplementary formation of private clinics, mostly for elective and diagnostic procedures, which higher-income Canadians can afford through private insurance and would do so to avoid waiting in line. At the same time, they want lower-income Canadians to assume more of the cost of medicare through higher co-payments and deductibles and narrowing the scope of available services.
This is a major problem because these pressures are accompanied by underfunding of the public system in an effort, as you say, to "make (the single payer system) as meager as they can". But it is not wholesale "privatization". Actually, the benchmark seems to be the European systems, which are also mixed - I think Cuba is the only case where medicine is fully socialized - but where the mix is considered to be more favourable to private providers than in Canada. As a minimum, that is what the Canadian corporate and political leadership is aiming at.
Similarly, public health care is the result of converging corporate and popular interests, and also not a case of one or the other. It would be mistaken, I think, to see ruling class expressions of its continuing commitment to a public system providing basic medical services as simply a ploy. The financial sector, it is true, is pushing hard, especially in the US, for private health savings accounts along the lines of IRA's and Canadian RSP's which are designed to supplement private pensions. But the bourgeoisie as a whole understands that most people can no more easily save for the full cost of their own health care as for their own pensions, and that some form and degree of state support is necessary.
Particulary, with respect to health care, it is not a matter of altruism. Lost time due to illness has a major impact on productivity, and the corporate sector cannot ignore it or fund the treatment of illness on its own. This was recognized early on by the bourgeoisie, and was the foundation for a public health care system, quite apart from public pressure, which has continued to expand to the present day. I think the powerful US bourgeoisie, now faced with increased competition, is coming around to the recognition that this applies in its case as well, and that it is not realistic to assume that the costs of insurance can be offloaded to individuals or charities. If they were going to let their workers simply die in the streets for want of medical care, you could not explain the present system of medicaid and medicare for the largely powerless welfare poor and elderly.
The quality of the public system is the issue, not its existence.