The US is in a deep political crisis just as workers’ struggle hits new levels—including the biggest health strike in the country’s history.

On Tuesday evening the most reactionary elements of the right wing Republicans voted out Kevin McCarthy as speaker of the House of Representatives. It is the first time it has ever happened, and the first time there has even been a vote to remove the speaker since 1910.

McCarthy lost the vote 216-210 with eight Republicans and 208 Democrats backing the “motion to vacate”.

McCarthy peddles anti-abortion, anti-migrant views and backed Donald Trump’s lie that Joe Biden stole the 2020 presidential election. But he is not right wing enough for some Republicans.

Recently he did a deal with the Democrats to pass a temporary funding extension that avoided a partial government shutdown. And McCarthy wants to secure extra money for the war in Ukraine. His critics, following Donald Trump, are against additional war funds on the basis of “America first” nationalism.

The House speaker is more than just a ceremonial title. It’s a top position in US politics and second in line to the presidency behind the vice president. 

The chaos is a symptom of the deeper crisis facing US political institutions—once held up as models of liberal democracy. The last three years saw the far right assault on the Capitol, Trump’s denials of the presidential election result and many Republicans’ continued belief in a “stolen election”.

The Democrats cannot find a better candidate for the next presidential election than Biden. He looks increasingly politically shaky and is lagging behind Trump in many recent opinion polls.

And the US is embroiled in the Ukraine war and a growing confrontation with China. As his supporters were detonating a crisis in the House, Trump was involved in yet another court case.

Trump, his two adult sons and the wider Trump Organisation are accused of massively inflating the value of their properties by over £1.65 billion to secure favourable loans. None of the defendants will face jail time if convicted, because this is a civil case not a criminal one.

As the splits and clashes at the top accelerate, workers are fighting back. As well as the auto workers’ strike, on Wednesday morning 75,000 Kaiser Permanente health workers began the largest health strike in US history. Those out include some nurses, dietary workers, receptionists, optometrists, and pharmacists.

The strikers are members of a coalition of eight unions that cover 40 percent of Kaiser Permanente’s total workforce. They are concentrated in western US, including California, Colorado, Washington and Oregon.

Workers are demanding higher pay, action to tackle chronic staff shortages and protection against outsourcing. And they want earlier notice when management calls remote workers back to in-person work.

Unions are calling for a 6.5 percent wage increase for the next two years. “Workers are really being squeezed right now,” said Renee Saldana, a spokesperson for the SEIU-UHW union.

“They went through the worst global health crisis in a generation and then they come out and they’re worried about paying rent. They’re worried about losing their house. They’re worried about living in their cars.” 

Kaiser Permanente is a “non-profit”. But it has reported more than £2.5 billion profits in the first half of 2023 and has paid at least 49 corporate executives a salary of over £820,000 a year.

This strike is part of a bigger picture. The number of strikes with 100 or more strikers that have lasted a week or more has risen to 56 in the first nine months of this year. That’s according to a database by the Cornell University School of Industrial and Labor Relations. The figures are up 65 percent from the same period of 2022.

Other smaller strikes include one-day strikes at Starbucks locations that voted to unionise but haven’t yet reached an initial contract. When including those smaller strikes, there were 396 strikes over the course of the last 12 months—or more than one a day.

But, just as in Britain, the trade union leaders are holding back the full struggle. The UAW union has so far called out only 15 percent of the auto workers it could mobilise, and the health strike is for only three days.

Shifting the balance of class forces, and making the most of the ruling class crisis, means intensified struggle and socialist organisation.