This piece is a contribution to the Pre-Convention Discussion for our 32nd National Convention. During Pre-Convention Discussion, all aspects of the party’s program, strategy, and tactics are up for consideration and debate. The ideas presented here are those of the author or authors alone, and do not necessarily reflect the positions of the Communist Party USA, its membership, or their elected leadership bodies. — Editors

The drive to build a broad base of support for a single-payer, universal healthcare system is appropriate. Collin Kawan-Hemler’s The party must renew its engagement with the healthcare for all movement is spot-on. However, it is an insufficient reform for producing a truly just and equitable healthcare system. Achieving even a universal public health service would maintain private ownership of hospitals and health systems, for-profit pharmaceutical companies, and current funding mechanisms and incentives for medical research and publication, discovery of new therapeutics, as well as medical education and training.

The state of healthcare in the United States is precarious. In 2022 the Supreme Court reversed Roe v. Wade, eliminating the constitutional right to abortion and returning the decision to the states with devastating consequences. The Supreme Court followed this assault on public health by ending affirmative action in college admissions processes. This will corrode medical education and diversity in medicine and impede efforts to uproot structural racism. Additionally, legislators have passed criminal bans on life-saving, gender-affirming care in 24 states, with 22 states imposing professional or legal penalties on clinicians providing gender-affirming care.

Despite the promises of the Affordable Care Act, costs keep soaring. Americans have a lower life expectancy, a higher rate of avoidable deaths, and disgraceful rates of infant and maternal deaths. While the current administration has lowered prescription drug prices and standardized health plans and deductibles, our healthcare system remains disjointed and labyrinthine. Day-to-day administrative frustrations for doctors are compounded by the active denial of medically necessary care by insurance companies, tragically costing tens of thousands of lives each year.

Against this backdrop, labor is steeling itself. Strikes in the healthcare industry have increased and resident physician unionization continues. Healthcare workers are fighting against longer working hours without additional compensation, control over scheduling and operating decisions, staffing shortages, health and safety concerns, lack of childcare assistance, and for improved access to healthcare programs. Moreover, burnout (or more accurately moral injury) among doctors and other healthcare professionals, which accelerated over the course of the pandemic, is at crisis levels. Billing and maximizing revenue — rather than the pursuit of patient care — govern working conditions and underline administrative demands. This directly violates professional values. Patients are consumers to be sold services by providers.

Although many hospitals and health systems are nonprofit or not-for-profit, they are subject to the same market demands and stressors as for-profit entities. Corporate cost-cutting erodes the public’s access to healthcare. Consequently, hospitals and community practices continue to close and/or merge into ever larger health systems. Private equity firms circle like vultures. Increasing revenue is also achieved with the active deskilling of medical training and expertise. The growing dominance of hospitals subverts the autonomy and professional authority of healthcare workers.

The Party program currently provides no outline of a possible transition or series of reforms that could bridge a Medicare For All system to socialized medicine. Moreover, the Program fails to address interrelated challenges that would influence the building of any just and equitable healthcare system. Beyond demands to restructure medical institutions, our Party should underline the need for safe communities, adequate access to public spaces and leisurely physical activities, elimination of food and housing insecurity, and environmental justice among other demands throughout the Program as a means of advancing public health.

To that end, I submit the following for consideration at the National Convention:

• That our country’s healthcare crisis demands assembling a broad, progressive movement to achieve enactment of a public, universal, and comprehensive National Health Program/Service
• Creation of a Healthcare Commission or Committee to coordinate the Party’s activity in engaging with and organizing healthcare workers, as well as develop additional analysis and proposals
• A demand that all people deserve the highest level of quality healthcare, meaning care that is patient-centered, physician-led, multidisciplinary, and value- and evidence-based
• A demand for a national jobs program, with special attention to the education and training not just of the diverse workforce of physicians, nurses, and allied health professionals our country needs but also paraprofessional and vocational workers such as home health aides, nursing assistants, and technicians
• A demand to nationalize the for-profit pharmaceutical industry, with research, development, production, and distribution of therapeutics driven by public need and patient care demands

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