Capitalism’s Ideal Healthcare: All Profit, No Care
U.S. capitalism gave us a special gift for the 2025 holiday season – a healthcare crisis for millions of workers.
The immediate issue is the bitterly named Affordable Care Act (ACA), which opened for business in 2014. Headlines warn, “Higher cost, worse coverage: Affordable Care Act enrollees say expiring subsidies will hit them hard.” The Trump administration wants to abolish the ACA. Congressional Republicans, flooded with angry calls from previously loyal voters, want to dismantle healthcare programs slice by slice. Democrats are eager to score “messaging” points while they protect capitalist profit in healthcare. Whatever the outcome of this catfight, workers, their families, and retirees will pay more for healthcare, and many will not get care when they need it.
The ACA, also called Obamacare, oversees a marketplace for health insurance corporations. It is mainly targeted at people who do not have a health plan through their job or Medicare. Several states (California, Massachusetts, New Jersey, and Rhode Island) require that you have health insurance, else you are liable for a tax penalty. But the corporations’ premiums are so high that the federal government has propped up the system with partial tax credits. The insurance corporations are moving to raise premiums by 18% in 2026. All in all, if the credits expire, someone with a $28,000 income will see her premium go from $325 to $1,562 a year. A 60-year-old couple with an income of $85,000 would pay $22,600 more than they pay now.
Why Isn’t Care Free and Equal for All?
Why isn’t health care guaranteed, free, and equal for everyone? Health care is a huge source of profit for capitalists. The various bloodsuckers are stacked like a pile of blocks ready to topple down:
The health insurance corporations: UnitedHealth, Humana, CVS/Aetna Health, and others shun people with known health problems. They require you and your physician to convince the corporation when you need a medical procedure. They charge extra if the medical professional you need to see is “not in our network.”
Pharmaceutical corporations: The drug companies make huge profits off medications crucial to your survival and health. One study, comparing three dozen pharmaceutical corporations versus the Standard and Poor’s 500 as a whole, found huge differences in gross profit margin (76% versus 37%) and in earnings before taxes, interest, and depreciation (29% versus 19%). A similar industry is the medical machine and device corporations.
Hospitals and clinics: Most hospitals are in chains like HCA Healthcare (184 hospitals), Ascension (140 hospitals), and Trinity Health (101 hospitals).
Some of them claim to be nonprofit, but that just means they are exempt from property and income taxes. “Nonprofits” are run to maximize financial surplus, accumulate capital, and give top executives princely salaries. The Kaiser Permanente system with its 40 hospitals paid CEO Gregory Adams $12,721,446 in 2023; another 36 executives got anywhere from one to five million dollars.
Medical practices: Physicians used to be independent small businessmen. Today, three out of four primary-care doctors and pediatricians are overworked employees of hospitals and clinics. Other physicians are in medical group practices in which they share ownership with insurers, hospitals, and private equity financiers. Profit rules here, too.
The Remedy Is Class Struggle
In a capitalist society, we only get healthcare through class struggle.
When workers negotiate a union contract, the bosses say, do you want to keep the health plan or would you “prefer” a wage increase? No, we want both, and we will strike to get them.
Starbucks boasts that its baristas have a health plan – if they work at least 20 hours a week. Baristas testify that at stores with active union organizing, the bosses reduced their schedules “from working 25 hours to 17 or 18 hours a week and some … only getting five to 10 hours.”
In New York, 250,000 city government retirees, especially the 70,000 retired teachers, fought the City, the school system bosses, and the bureaucrats of the United Federation of Teachers and AFSCME, all intent on pushing the retirees into Medicare Advantage. MA is a growing private kingdom inside Medicare that shovels money to health insurance corporations while they confine people to narrow networks of caregivers. The retired workers campaigned for several years and blocked transfer to Medicare Advantage – for now.
We can’t get good care when there are not enough healthcare workers and when their work suffers because they cannot pay the rent. In November, 40,000 workers at the campuses and medical centers of the University of California, including patient care assistants and hospital technicians, went on strike over these issues. A magazine for health care bosses counted 38 major strikes at hospitals and clinics across the country in 2025.
Improved Medicare for All
Healthcare activists’ programmatic demand is Improved Medicare for All, also called single payer. Everyone would be automatically enrolled at birth, and all care free. Since nearly all doctors, hospitals and other care providers would be in the system, your choice of physician and hospital is not limited to a network. Improved Medicare for All would replace the hated health insurance corporations. The single buyer of health care (the Medicare administration) would have bargaining power versus the pharmaceutical corporations, hospital chains, and other industries of the health care sector.
There were recurring drives to enact Medicare for All in the United States after World War Two, but the American Medical Association and allied capitalists defeated them. Union officials who practice business unionism instead of class struggle also resist Medicare for All. They embrace co-management of a company health plan as a selling point for joining a union.
A single payer plan or something close to it has worked well in Canada, France, Germany and many other countries. Britain after World War Two went one better, placing most doctors and other care providers in a National Health Service. Many physicians opposed single payer, but with experience in it they became supporters.
However, social democratic healthcare programs cannot escape capital’s incessant profit drive. In Britain, for example, the National Health Service was re-legislated in 2012 from a single institution into a collection of Clinical Commissioning Groups that in turn outsource healthcare to private firms dedicated to their “bottom line.” Care standards have weakened, physicians are fighting speedup and larger patient loads, and understaffing of clinics is pervasive.
The Socialist-Communist Path to the Fore
In the 1990s, big health insurance corporations arose and formed health maintenance organizations, each in business with selected hospitals and physicians. Their massive economic clout makes the struggle to win Improved Medicare for All much fiercer today. The campaign for single payer might result in some lesser relief measures, but it will take revolutionary anti-capitalist struggle to guarantee free and equal care for all.
Workers who want to advance the cause of our class will bring agitation for the socialist-communist path to every strike and every political battle where healthcare is an issue. We must overthrow capitalism. We can run society ourselves, including the hospitals, clinics, outpatient services, and pharmaceutical development and production. The purpose of economic activity shall not be profit for a few but rather the well-being of all.
U.S. capitalism is in terminal economic decay, and the capitalist republic is disintegrating. We need a communist party that agitates, educates, and organizes for the mission of our class. No matter how small our numbers are now, we need communist organization ready before the masses decide that enough is enough. The most visionary goal is the most practical one.
Charles Andrews is the author of The Hollow Colossus and other books.
A list of his occasional essays is at http://www.hollowcolossus.com/moreCA.htm