The following motion was adopted unanimously by Conference delegates.

Bernie Sanders’s 2020 presidential campaign slogan for “Medicare for All” drew a huge following among petty-bourgeois youth and in the working class, channeling anger over the disastrous state of American health care into the dead end of Democratic Party politics. This posed two related tasks for socialists. One was upholding the principle of class independence—which meant showing that winning better health care requires breaking with the liberals because the road to any real improvements is barred by the interests of the capitalist class. The other was advancing a revolutionary solution—showing how the pressing needs of the working class can only be met by overthrowing capitalist class rule and establishing a workers government. These tasks could only be carried out by fighting for revolutionary leadership against Sanders and the misleaders of the working class and the self-proclaimed socialists who were busy building this bourgeois roadblock.

The article “For Socialized Medicine!” (WV No. 1170, 21 February 2020) was published at the height of the Democratic Party primary elections, when there were massive illusions in Sanders’s promises of “Medicare for All.” This article crossed the class line by building Sanders’s campaign, helping subordinate the struggle to meet the health needs of working people to a liberal who was guaranteed to betray them. Instead of counterposing the struggle for free, quality health care to the Sanders campaign, the headline gave the lame advice: “No Illusions in Sanders’ ‘Medicare for All’.” This was such a craven capitulation that people on sales told us they were buying the paper because they supported Sanders, too. The only way to break the popular front is to directly confront and expose the illusions its supporters have that their interests can be advanced by uniting behind the liberal bourgeoisie. But WV did not fight against the liberals for communist leadership or make a single argument to show that supporting a liberal Democrat was an obstacle to advancing the fight for quality health care. Without this, WV’s call to break with the Democrats and rhetoric about the need to fight for socialism just made us a left tail on the Sanders campaign.

In the dispute in the union bureaucracy over which Democrat to support in the primaries, WV took a side with Sanders’s supporters. “For Socialized Medicine!” denounced the leaders of the Nevada Culinary Union and AFL-CIO head Richard Trumka for dividing the working class because they opposed “Medicare for All,” i.e., because they didn’t support Sanders in the primary. While the Culinary Union tops and Trumka argued that Sanders’s plan would undermine their unions’ medical benefits, unions on the other side of this dispute, including the AFT and SEIU, supported Sanders and argued that electing him would mean the unions would no longer have to fight for health care for their members but could rely on the capitalist government. Revolutionaries needed to oppose both sides in this dispute, cutting against both Sanders’s promises of “Medicare for All” and Biden’s defense of the status quo, and expose the union bureaucrats’ support to the Democrats as an obstacle to the struggle for decent health care.

The health care industry in the U.S. is dominated by a handful of giant insurance companies, Big Pharma and private care providers. The total social parasitism of the insurance companies, the pharmaceutical companies’ control over drug patents and production and private care providers’ price gouging are a gigantic drain on the country’s economy, producing record profits and making up 20 percent of the GDP. The U.S. health care system is the most expensive in the world, while the health care available to the majority of the population is among the world’s worst. Providing real access to good health care for the whole population requires defeating one of the wealthiest and most powerful sectors of the American bourgeoisie. The capitalists won’t simply give up their control over health care markets and their profits. A colossal struggle is needed to break the stranglehold of the capitalist titans over the health care system. The prerequisite for this is splitting from all representatives of the capitalist class.

The dire state of the U.S. health care system has created a huge pile of social tinder. Bourgeois reformers like Sanders are seeking to prevent any explosion by cleaning up the worst excesses of corporate medicine while defending the underlying property relations that caused the problem in the first place. Sanders promised a “revolution against the billionaire class,” but he wasn’t even willing to fight for health care reform in his own party. His liberal program necessarily meant that he would only put forward the most pathetic and ineffective measures—and abandon them at the slightest challenge. When Biden won the primary, Sanders immediately began to back-pedal and told his supporters to subordinate their need for health care reform to getting the Democrats in office.

The Democratic Party has been campaigning on health care reform for over a century, using the issue to win elections while the health care system has decayed and become increasingly parasitic. Sanders’s campaign just repeated the same strategy one more time. It did nothing to make health care better for the population. What it did achieve was to channel the deep anger over the U.S. medical system into the dead end of bourgeois electoral politics.

WV often made the point that the U.S. doesn’t have any kind of national health system because the bourgeoisie has been so successful at using racial oppression to divide the working class and weaken it. But what’s the conclusion? Black and white workers can’t be united on the basis of a reformist program, which either pits white workers against black people in competition over a few crumbs from the bourgeoisie or has nothing special to offer black people except remaining at the bottom of society. To unite the multiracial working class in the struggle for quality health care means fighting to address the particular needs of black people—construction of quality hospitals and clinics in the inner cities and rural South; good and well-maintained integrated housing, with heat, hot water and electricity; union-run job training and hiring programs to combat unemployment and the long hours, low pay and dangerous work of a population concentrated at the bottom of the working class. These demands all require making massive inroads into capitalist property; the first step to winning them is to struggle against the leadership of the liberals.

Health care is not just a question of the medical system. It touches every aspect of society, from ghettoized, rat-infested housing to dangerous working conditions to sleep deprivation and stress. To improve the health conditions of the working population requires a struggle against the capitalist class’s interests at every point, including for union control over safety and a reduced workweek at no loss in pay; taking over the bourgeoisie’s luxury apartments and upscale buildings; and expropriation of the hospitals, medical labs and pharmaceutical factories. Tying the struggle for better health care to the liberals means limiting it to what is acceptable to the bourgeoisie, agreeing in advance that the needs of working people and black people won’t be met. Only a leadership committed to the overthrow of bourgeois rule can advance this struggle.