A unusual opportunity to adopt a single payer healthcare in a US territory: The case of Puerto Rico's junk bonds

The specter of the fiscal crisis of Puerto Rico and the consequent fear that the government bonds could be downgraded to "junk" status, justified an unprecedented attack on the living conditions of the working class (e.g., implementation of a sales-tax, across the board lay offs of public employees, cut-offs in the teachers' pension system, increased public university tuition, raise in utilities' costs) and privatization of state assets such as toll gate roads and the international airport. But organized labor did very little to oppose these unprecedented State measures, and indeed, Puerto Rico's bonds were classified as "junk" by the rating agencies Moddy's, Standard and Poor's, and Fitch, by February 2014. Meanwhile, the top 400 list of locally owned business was led by a managed care company (Triple-S Management) that reported a net income of 108 million for the past two years. Following a neo-Marxist theory of the State, the working hypothesis of this analysis is that at times of a severe economic crisis, it is possible for state managers to adopt policies that may hurt the interests of individual capitalists in order to assure the conditions for continuous capital accumulation. The case of Puerto Rico is analyzed from the perspective of political economy, based on arguments that support proposals under consideration by the Commonwealth's Legislature for the adoption of a single payer. It is concluded that current fiscal crises provides an unusual opportunity to promote a single payer healthcare system, even among conservative policy makers.