Single Payer Movement Has Transformed The Healthcare Fight

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Above photo: On Monday night, CNN hosted a healthcare debate between Sens. Lindsey Graham, Bill Cassidy, Bernie Sanders and Amy Klobuchar. (CNN/Screen Shot)

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The CNN Debate Was Proof.

During CNN’s Monday night debate about the Affordable Care Act, it became clear that progressives have set the terms of discussion.

NOTE: This article raises the important question about who we want to be as a country. A solid super-majority of progressives support a social insurance model for healthcare, and an increasing number of conservatives do too. That Sen. Sanders has to defend the Affordable Care Act (ACA) is consistent with his allegiance to the Democratic Party. Both Democrats and Republicans cannot deny the fact that the ACA was written by and for the benefit of the medical industrial complex. The smallest step we can take to change from a model that treats health care as a commodity, like the ACA, to a model that treats health care as a public good or right is a national single payer healthcare system such as National Improved Medicare for All. Sanders’ bill has significant weaknesses that continue to treat healthcare as a commodity, and that it why it has support in the Senate. We are gaining ground in the struggle for Improved Medicare for All, but we have work to do. Visit to learn more.   – Margaret Flowers

The grassroots fight for single payer, championed by Bernie Sanders, has thoroughly reframed the healthcare debate over the past year.

That became clear during CNN’s Monday night healthcare debate between Sens. Lindsey Graham (R-S.C.), Bill Cassidy (R-La.), Bernie Sanders (I-Vt.) and Amy Klobuchar (D-Minn.). The debate came as Republicans labor, Sisyphus-like, to “repeal and replace” the Affordable Care Act (ACA). Graham said in his opening remarks that the debate was about “who we want to be as a nation.” Cassidy said that it was about who has power.

Sanders, who dutifully defended the ACA on Monday but made it clear that his ultimate goal is a single-payer system, agrees with Graham and Cassidy that the healthcare debate isn’t really about healthcare. As he said to a Vox interviewer recently, “what this struggle is about really, honestly, is not a healthcare debate.”

What is it about then? Well, it’s about power. And it’s about who we want to be as a nation. Just like Graham and Cassidy said. In other words, the healthcare debate centers around the big-picture questions of our moral responsibilities to one another—and our distribution of resources within U.S. society.

It’s impossible to talk about single payer without talking about the inequalities of the current system, and the fact that 28 million people are still uninsured. Sanders does that all the time. He did so again Monday. But so did Graham and Cassidy. The Republicans’ point was just that the ACA’s failures had priced too many people out of the market, and state-based programs are a better path to truly universal coverage.

It’s impossible to talk about universal coverage without talking about the power and corrupting influence of corporations. Such talk is expected from Sanders. But it was a Republican, Graham, who said Monday that “the biggest winner under Obamacare is insurance companies, not patients.” It was Cassidy who said that the ACA is a huge giveaway to the pharmaceutical companies, the hospital sector, the health insurance industry—everyone but the American people.

Whether they actually believe these things doesn’t matter. What matters is that Republicans were talking about healthcare using a progressive framework that focuses on power and inequality. This moment, in some ways, is an inverse of what we saw in the 1980s, during the early stages of the neoliberal ascendancy, when Ronald Reagan and the GOP framed their push for tax cuts and deregulation as a matter of individual “freedom.” That framing still pervades our political discourse. You might wholly reject the neoliberal notion of freedom. But you can’t escape it.

That’s what single payer is doing for the progressive movement, for some elements of the Democratic Party, and for our political discourse generally. As with the GOP’s push for tax cuts, the progressive healthcare push forces people across the political spectrum to engage questions about “who we want to be as a nation.” It puts power and inequality front and center in a way that few other issues have the power to do. It reframes the debate.

Earlier this month, Sanders introduced a “Medicare-for-all” bill in the Senate. It has subsequently gained support from at least 21 Democratic senators, including several of the party’s potential presidential contenders in 2020, like Sen. Kamala Harris, of California, and Sen. Kirsten Gillibrand, of New York. A similar single-payer bill in the House has 119 supporters. Neither bill has any chance of immediate success, in strictly legislative terms.

In broadly political terms, however, the slow-building wave of support for these bills has the potential to be momentous. Transformative philosophy needs the engine of actual policy. Single payer, like the Right’s obsession with tax cutting and deregulating, is both a vision of how things should be and a plan to get there.

“This fight,” Graham said on Monday, “it’s just beginning.” He meant the fight to repeal and replace the ACA specifically. But the evidence from Monday evening suggests that there is a bigger fight brewing, with terms set by left and progressive forces. And it may well be more than Graham, Cassidy, and the GOP had bargained for.

Theo Anderson, an In These Times writing fellow, has contributed to the magazine since 2010. He has a Ph.D. in modern U.S. history from Yale and writes on the intellectual and religious history of conservatism and progressivism in the United States. Follow him on Twitter @Theoanderson7 and contact him at

  • DHFabian

    First, “single payer” doesn’t mean universal health care. From what we’ve been able to determine to date, Sen. Sanders’ “Medicare for All” (for example) ends — and does not replace — Medicaid. The elderly poor and the disabled currently rely on dual benefits, with Medicaid covering the Medicare premiums, prescription costs, etc., for the benefit of the better-off. The past year of trying to get some straight answers regarding this from Sen. Sanders, etc., hasn’t been successful.

    We need clear answers concerning how much worse conditions will become for our poor, the elderly, and the disabled.

  • kevinzeese

    You need to study up on an issue before you write comments that are not consistent with reality.

    Single payer, improved Medicare for all, does cover everyone and provides healthcare for all. The House bill, HR 676, is the better model and has much wider support. The Sanders bill has some major shortcomings. Among them is he needs to incorporate Medicaid including long term care in his bill. But, even the Sanders bill includes poor people.

    Things will get better for the poor, elderly and disabled even under the weaker bill, the senate bill introduced by Sanders but the Sanders bill needs to make some changes and we need to pressure him to do so. Among them, is that long term care provided now by Medicaid needs to be included in the bill like the House bill does. Done right, there will be no Medicaid because healthcare for the poor will be improved as they will be treated like those who have money.

    As to clear answers, we support the House bill over the Senate bill and long-term care is one of the reasons. This is still several years away and it is our job to pressure Sanders to improve his bill.

    Here is our healthcare campaign — get involved, sign up.

  • chetdude

    With a little bit of luck and massive Public Education and militant, constant pressure on congresscritters from the Popular Resistance (read Mainstream Opinion and Desire), HR676 may only be 2 to 3 years away!

  • kevinzeese

    We see our healthcare campaign building up to post-2021 but it could happen sooner. Trump had been a consistent supporter before he ran for office (Obama had been also) so he needs to be pushed.

  • chetdude

    Trump would sign it if he thought there was a buck in it for him… 🙂