Employment-Based Health Care vs. Democracy: Hidden Dimensions of Business Rule

It is characteristic of the narrow, business-dominated nature of U.S. political culture that the current American health policy debate includes no meaningful discussion of the critical roles the nation’s employment-based health insurance system play in deepening the power of bosses over workers and closing off democratic space.


Think about it. It’s bad enough that working people have to calculate the risks of going without paychecks before daring to challenge their workplace masters to any significant degree. In the U.S., uniquely among modern "capitalist democracies," employees also have to factor in the chances of losing health coverage for themselves and their families along with their jobs. The common 19th century American understanding of the employer-employee relationship as a form of slavery ("wage slavery") takes on new meaning in light of workers’ dependence on employers for affordable health care.


The bosses own their underlings in more ways than one.  And they know it. It’s not for nothing that you can’t generally receive Food Stamps while engaged in a labor strike. The capitalists used their influence to prohibit state assistance to striking workers long ago.  They know that working peoples’ marketplace and workplace bargaining power is enhanced by the existence of a strong social safety net, which reduces the hazards involved in challenging capitalist authority by providing working class people alternative sources of income and protection to those provisionally extended by capitalists. The powerful business lobby has been pushing through the dismantlement and de-legitimization of the welfare state for decades because capitalists-as-employers want, in Frances Fox Piven’s words, "to make long hours of low-wage work the only available option for many." [1]


Employment-based health insurance is a curiously underestimated underpinning of business-class rule. So is the endemic problem of overwork in the U.S., home to the longest working hours in the industrialized world. As the pioneers of the American labor movement knew quite well, meaningful popular democracy depends critically on time – on the possession by the populace of leisure time to study, understand, and communicate and organize on the issues of the day. Overworked citizens lack the leisure required not just to keep their bodies, souls, and relationships together but also to participate in politics in an adequately informed, organized, and effective manner. The much-bemoaned American "time squeeze" is a critical part of the nation’s dangerous "democracy deficit." [2]


It happens to be intimately related back to the nation’s employment-based health insurance system in an important but rarely noted way. Health care costs amount to very sizeable portion of total employee "compensation" [3] in the U.S. Of critical significance, these costs are paid per full-time worker employed, not per hour worked.  And this, as the left-progressive economist Juliet Schor pointed out seventeen years ago in her brilliant, eye-opening study The Overworked American: The Unexpected Decline of Leisure in America (New York: Basic, 1992) is a major underlying "structural incentive" pushing capitalist employers to get as much work from as few workers as possible. [4]


Disconnecting medical insurance from employment by introducing universal government-provided health coverage under a single-payer system would democratize and de-commodify access to medical goods and services.  It would also significantly reduce the costs of health care, increase labor demand (and hence workers’ bargaining power), and create more of the leisure time working people require to be meaningfully engaged in their nation’s supposedly democratic political culture. It would help working people develop more capacity to resist employer domination – a capacity that sorely needs enhancement in a nation where workers’ wages and salaries lag far behind their productivity, where commonly parasitic CEOs receive grotesque salaries more than 500 times the income of average workers, and where (contrary to working people’s expressed preferences) less than 7 percent of the nation’s private-sector workers are enrolled in unions.


Today, as under President Clinton and previous administrations, there’s more than the profits of the big health-insurance companies and their financial backers at stake in the corporate defeat and dilution of health reform.  Beneath the standard recurrent business-class wolf-crying about "government take-over" and "socialized medicine" lurks the business establishment’s timeworn fear and loathing of democracy and worker power within and beyond the workplace. We the working class majority need to remove the employer class, not just the financial-insurance complex, from its position of control over our health care.


Is it no wonder that these critical issues are banished from meaningful health-policy discussion in the United States’ "corporate-managed democracy," the "best that money can [and did] buy." Honest discussion of capitalist class power relations is naturally forbidden in the nation’s reigning "mainstream," business-coordinated political and media culture, itself the single greatest totalitarian threat of the 21st century.[5]


It is long past (all-too short) time for a profound, many-sided popular rebellion against this fake democracy and its faux free press, which provide deceptive cover for business class rule.



Paul Street ([email protected]) is the author of many articles, chapters, speeches, and books, including Empire and Inequality: America and the World Since 9/11 (Boulder, CO: Paradigm, 2008);  Racial Oppression in the Global Metropolis (New York: Rowman & Littlefield, 2007), Empire and Inequality: America and the World Since 9/11 (Boulder, CO: Paradigm, 2004), Segregated School: Educational Apartheid in the Post-Civil Rights Era (New York: Routledge, 2005); and Barack Obama and the Future of American Politics. (BoulderCO: Paradigm, 2008): http://www.paradigmpublishers.com/books/BookDetail.aspx?productID=186987





1. Frances Fox Piven, The War at Home: The Domestic Costs of Bush’s Militarism (New York: New Press, 2004), p. 75.  See also Frances Fox Piven and Richard A. Cloward, The New Class War: Reagan’s Attack on the Welfare State (New York: Pantheon, 1985), p. 31 and various sources (including important essays by Samuel Bowles, Herb Gintis, and Juliet Schor) cited therein.                                                                        


2. On the democracy deficit, see, among many possible cite, Noam Chomsky, Failed States: The Abuse of Power and the Assault on Democracy (New York: Metropolitan, 2006). 205-250; Paul Street, "The Resistance Gap: On Media, Time, and the Curious Absence of Riots," ZNet (February 10, 2009), read at http://www.zcomm.org/znet/viewArticle/20528

3. I put quotation marks around this standard corporate term for wages and salaries because it would be absurd under capitalism for workers to be fully compensated for the labor they provide employers. The profits system makes hiring and continued employment contingent on the existence of a disparity between what employers pay and what they get from employees.  The transfer of surplus value from worker to boss is a condition for work. Executive "compensation" levels, another topic, are often absurdly high and commonly reward activities that put decent human existence at ever-more grave risk.


4. Something that helps explain the seeming absurdity of mass unemployment and under-employment alongside chronic overwork in the U.S. Juliet Schor, The Overworked American: The Unexpected Decline of Leisure (New York: Basic, 1992), 39-40, 66-67, and passim. Interestingly enough, Schor had nothing direct to say about the decline of leisure as a critical democracy issue.



5. See Alex Carey, Taking the Risk Out of Democracy: Corporate Propaganda Versus Freedom and Liberty (Urbana, IL: University of Illinois Press, 1997), 133-139; Sheldon Wolin, Democracy Incorporated: Managed Democracy and the Specter of Inverted Totalitarianism (Princeton, NJ: Princeton University Press, 2008); Street, "The Resistance Gap."

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