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Medicare For All Reaches The Crossroads

Above photo: A 2018 rally at the Baltimore Convention Center demanding Medicare for All. Elvert Barnes/CC BY-SA 2.0.

In 2021 the U.S. healthcare crisis has, again, reached a boiling point. It was already simmering in 2019 when the number of uninsured grew to 33 million. Covid then triggered a job crisis that added anywhere from 15 to 27 million to the ranks of the uninsured. The still-growing job crisis has pushed the number of uninsured near or beyond the 49 million uninsured that existed prior to Obamacare, whose goal was “universal healthcare.”

It’s no surprise then that Medicare For All emerged, pre-Covid, as the most popular policy during the Presidential Democratic primaries. But after the Democratic Party organized, once again, to crush Bernie Sanders’ campaign, Biden tried to push discourse away from Medicare For All with plans to “improve Obamacare” a goal as ambitious as “patching up the Hindenburg.”

The failures of Obamacare — the Affordable Care Act (ACA) — are many, though among the biggest is the ever-rising unaffordability of healthcare, which is the main reason people surveyed said they were uninsured (the average family premium has risen 54% since 2009, a number that continues to rise quickly). The universal healthcare that the ACA was to create has fallen short by tens of millions while an additional tens of millions of insured people are “under-insured,” meaning they can’t afford to use their insurance during a pandemic that’s pushing masses of people into hospitals.

The ACA cannot be fixed because it left in place the giant regional monopolies in every sector of the healthcare system that keeps costs high — the same monopolies that crushed the “co-ops” that sprang into existence with the ACA and disappeared after realizing the industry was cinched up by the healthcare oligarchy. In 2021 huge swaths of the country consist of a “healthcare market” dominated by a single insurer, with the rest in the hands of a small, colluding oligarchy that poisons healthcare in tandem with the increasingly-merged hospital chains.

The ACA was further crippled by some of its key funding mechanisms being overturned, such as the individual mandate, “Cadillac tax” and medical device tax, which together represent a crucial pillar of the ACA — though especially the mandate, which was intended to force healthier people into the insurance pool to help drive down costs.

The Supreme Court has yet to rule on the overall legality of the ACA (due sometime in spring), but even a favorable ruling won’t correct the individual mandate, whose “penalty” Congress changed to $0. Thus the younger, healthier, and poorer people who couldn’t afford the premiums or outrageous deductibles of the ACA’s “bronze” plan opted out, driving a stake into the heart of the cancer-ridden program.

The ACA that lingers on, zombie-like, cannot be “fixed,” it needs to be cremated. It’s often much cheaper to raze dilapidated structures and build new ones. Every estimate suggests that Medicare For All will be profoundly cheaper than the current system over the next ten years, which is twice as expensive, per capita, as any other country in the world while delivering worse outcomes. The monopolies causing the cost crisis need to be crushed, not pandered to.

The Covid crisis has profoundly exposed the foundational failures of the ACA, while also wrecking any final illusions in the employer-based health insurance system that fails the employed with expensive plans while abandoning those who lose their jobs. The ACA and the employer-based system are both collapsing under the economic duress of Covid, and need barely a shove to topple completely in favor of Medicare For All.

Obamacare Has Failed, Long Live Obamacare?

The failures of Obamacare get glossed over by apologists who focus on the periphery of the program — distracting from the market-centered core. The ACA did contain several positive non-market appendages, most notably the expansion of Medicaid for those states that opted in. This and other progressive elements of Obamacare can be easily kept by Congress while the capitalist center is flushed.

Unfortunately many progressives fell into the trap of defending Obamacare from Trumpism, not realizing that the ACA gave Trump a genuine populist demand: millions of people hated being “individually mandated” to buy healthcare they couldn’t afford, while realizing afterwards that high deductibles kept them from using their new ACA insurance. A Left demand was thus gift-wrapped to the far-right. While Trump was rallying against the mandate some unions and progressive groups foolishly defended it.

Yes, it was necessary to defend the Medicaid expansion and other progressive parts, but these should be amputated from the failed heart of the ACA while the Left declared “the ACA is dead, long live Medicare For All.”

Biden recognizes the ACA has flatlined and something must be done. He’s pledged to “improve” the corpse using two main proposals: the expansion of ACA subsidies and the addition of a public option, both an attempt to prop-up the health industry oligarchy.

Biden’s plan aims to take healthcare activists on a long voyage, in the opposite direction of Medicare For All, with the intention of reinforcing the market-driven system that has failed catastrophically for decades.

Many will follow Biden down this profitable path: some Democrats, health care executives and even self-styled “progressives” will dedicate their time and resources. But other Leftists are in danger of permitting the trip to take place when they have the power to stop it.

The moment contains a historic organizing opportunity, where Biden’s shaky plans can be torpedoed in favor of real solutions, moving the conversation in the direction of Medicare For All that will be supported by the majority of Americans.

The lessons of Obama’s tenure cannot be forgotten: he was elected with a supermajority in Congress and proceeded to waste his mandate creating the ACA. Several big unions and community groups dedicated vast resources to the ACA, at their own expense. For several years this writer was a small voice in a choir warning about the ACA, concluding in 2014:

“Obamacare was always more barrier than progress: we’ve wasted the last several years planning, debating, and reconstructing the national health care system, all the while going in the wrong direction — into the pockets of the insurance corporations. A couple progressive patches on the sails won’t keep her afloat.”

Re-living that nightmare in 2021 can be avoided if this special moment is seized, which is rife with opportunity around Medicare For All. Deep change is possible because the pandemic has radically shifted the political ground; the passing of stimulus checks is a key example of political expectations being raised, which is a key ingredient to organizing success.

Killing Obamacare with Medicare For All

The hardest part of an organizing campaign is often the education component: making the public aware of your demand and then convincing them it’s actually a good idea. Groups like Labor For Single Payer and others have effectively recruited hundreds of unions to endorse Medicare For All, though much broader education skyrocketed last year, pre-pandemic, triggered by the discussion in the Democratic primaries.

Nearly all media outlets spent months discussing and debating Medicare For All, forcing the ideas upon the public consciousness. The results of the debate were a crucial and decisive victory for Medicare For All, whose popularity has risen dramatically in the last two years among Democrats and Republicans alike. Vast political fields were fertilized and seeded.

It’s true that public opinion polls can bounce around based on the specific questions posed, though it’s also true that 99% of people despise Big Pharma, Big Insurance and Big Hospital who constitute the backbone of the current, disintegrating system. Continuing and expanding the public debate on Medicare For All must remain at the center of the organizing strategy, since the opposition shrivels under the bright lights of the debate stage, because their position is indefensible.

Keeping the conversation on Medicare For All means preventing it from being derailed into other directions, by Biden, while constructing new debate venues: media-catching events that engage the public and focus attention on the issue. Historically this has been done by mass rallies, strikes and other creative mass direct actions, as well as elections and other moments related to legislation such as Supreme Court decisions or legislative votes — all of which give the campaign opportunities to educate, agitate and organize around.

The Democrats know that Medicare For All is still on the tip of the public’s tongue. There is no other viable solution — as far as the public knows — beyond Medicare For All, i.e., it’s the most popular solution to the current healthcare crisis.

Biden knows that the movement’s base has grown dramatically, and that a call to action is capable of getting a mass response. Thus the Biden administration’s strategy is one of distraction and sowing division, by pushing the Left to focus on “improving Obamacare” while getting lost in an endless debate about ACA subsidies and “what a public option might look like.”

Biden’s Obamacare revival must be denounced loudly and via action, by rallying around the positive demand for Medicare For All. Doing this can expose the lack of support for saving Obamacare while showing the broad support for Medicare For All, in effect derailing Biden’s plans while building tracks towards universal health care.

The opponents of Medicare For All — Big Pharma, Big Insurance and Big Hospital — want only to survive the current political crisis. They know their system is tottering and will promise anything to save time and avoid structural change at this critical moment.

Some activists will fall for this trap, believing that new reforms will “lay the foundation for Medicare For All,” when in fact such reforms will be strengthening the foundation of the current system in order to survive the growing healthcare crisis connected to the ACA.

The pandemic has called the question for healthcare, and the Left must have a readymade answer that includes a timeline. When we say Medicare For All and a potential supporter asks “when”? — the answer cannot be a vague “sometime in the future when we’ve accumulated enough power,” as many organizers have answered lately.

How the Left Might Miss the Moment

Longstanding movements often have built-in barriers to seizing new moments. Sometimes those who organized in the political wilderness get stuck in yesterday’s reality, believing victory to be beyond the visible horizon when it’s around the next bend. They thus stick to old tactics after the ground has shifted beneath them, which requires a final push instead of a 5-yr plan.

An example of this thinking occurred recently during the Medicare For All Strategy Conference, organized by Healthcare Now. Many of the workshops were excellent sources of information, though several hyper-focused on the legislative calculus in Congress, where “strategy” discussions walked attendees through exhaustive details of legislative districts and other long term electoral tactics.

One of the stated key goals for 2021 involves getting the same amount of co-sponsors for the new Medicare For All legislation which existed for the previous session’s legislation, with a longer term goal of getting a hundred additional co-sponsors. This could take years, if it happens at all. No goal was articulated about when the campaign hoped that the law would actually be passed. To a new activist activated by the current moment, such an approach feels like a strategy of surrender.

On some level the strategy makes sense: when you’re counting votes — and you need a majority to pass a law — a co-sponsor implies a strong “Yes” vote. However most bills get passed with far fewer co-sponsors, and when an issue is politically charged many legislators will, under the public spotlight, grudgingly vote “Yes” even if they staunchly opposed co-sponsorship. This is how we got stimulus checks. The co-sponsorship strategy may have been solid in 2011, pre-Covid. The world has since changed, radically. Covid is transforming Medicare For All from popular demand to a bulletproof one.

Traditional tactics can and must still be used — education events that include telling personal experiences with the healthcare system, getting unions or local governments to support resolutions in favor of Medicare For All, etc. — but when a demand becomes bulletproof the organizers should feel more confident going on the offensive.

Medicare For All is bulletproof because the broader population has become what organizers call “agitated” about healthcare, i.e., they feel passionate to the point they’re willing to take action. The pandemic has forced millions of people into the realm of the uninsured, joining the already tens of millions of uninsured and under-insured.

If these people are mobilized — giving them an opportunity to express their agitation — politicians will feel the heat of urgency to the point they could vote “yes” on Medicare For All in the same way they succumbed to stimulus checks. By giving opportunities to mobilize an organizer assesses the level of existing agitation, so they know if there’s enough energy to take the next step.

We’ve entered a historic economic crisis not seen since the Great Depression — which should factor prominently in re-orienting tactics. All social movements begin slowly but are eventually punctuated by a mass influx of attention and energy, where what seemed impossible yesterday begins to feel inevitable.

A struggling working class desperate for answers won’t join a movement with a goal distant enough to feel unreal. If organizers believe that “forcing the vote” for Medicare For All is a bad tactic now, they must say “when” such a vote should take place, so that activists have a stable pathway to victory instead of clinging to an improbable dream.

It’s fine for organizers to say “we intend to have a vote in one year after displaying the demand’s power,” while in the meantime rejecting Biden’s plan to stabilize the current broken system. But offering no specific plan during a historic crisis is unacceptable. The Left can’t take a painstakingly slow approach that allows Biden to quickly build pro-market firewalls against Medicare For All.

Exploit The Crisis, Or Else…

The demand for Medicare For All cannot be disconnected from the rest of the social-economic crisis triggered by Covid, especially since mass unemployment exacerbated the healthcare crisis. The housing and climate crisis are themselves intimately connected to the employment and healthcare crises.

Medicare For All organizers thus have a self-interest in organizing united front mass rallies with these movements, as well as Black Lives Matter — who’ve proven their issue has an agitated, mass base. Of course race matters when it comes to healthcare, since for decades healthcare has been a pillar of the Black liberation movement while discrimination continues to deny adequate treatment across the country.

A small list of mass demands could be rallied around on the local and national level that would focus the public conversation — putting us down the road — of winnable demands. National Nurses United and Democratic Socialists of America could reach out to other nurses unions, teachers, and others at the center of the Covid crisis, while Labor For Single Payer could return to the unions who’ve expressed support for Medicare For All to ask for their support for a spring (or summer?) mass mobilization.

Such an action would give groups time to educate and mobilize for the effort, while helping prevent some unions from piling on to the Biden gravy train, where union-specific crumbs are being prepared to steer them away from Medicare For All (just like Obama seduced several large unions to commit huge resources to promote and defend the ACA).

Such an ongoing mobilization would cut through Trumpism like warm butter, since rural America is suffering disproportionately from the healthcare crisis, with hospitals closing and fewer insurance options available at higher prices. Working class people in “red states” can support Medicare For All as easily as they clamoured for stimulus checks and as forcefully as they denounced the individual mandate.

Because of its populist nature, Medicare For All is a demand that can be stolen by the far-right if the Left fails to act. The middle-class base of the far-right also suffers under the weight of the healthcare oligarchy, where small businesses stand to benefit from Medicare For All by removing healthcare costs from their books (though there is already a trend of employers ditching their employee healthcare coverage).

We’ve entered a moment in history where everybody’s politics are being tested, and judged by the broader population now engaged in politics for the first time in decades. They will decide for themselves who is serious about fighting for the working class.

Expectations are rising, and those who seize the moment will be rewarded while inaction can lead to irrelevancy. The millions of new people demanding change are doing so out of impatience and urgency, which any successful movement must reflect.

A couple expecting a baby can still be caught off guard by a premature birth. The Covid crisis has unexpectedly delivered the demand of Medicare For All, though who raises the child may still be in question.

Shamus Cooke is a member of the Portland branch of Democratic Socialists of America. He can be reached at

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