Single Payer: Which Way Forward?
To say that there’s a political disconnect in the fight for a national single payer health care delivery system is to state the obvious. The struggle for M4ALL has grown due to decades of grassroots organizing alongside the gradual worsening of Americans’ health insurance coverage, with support now reaching 70% in the general public as reported by FOX News after the November elections.
Yet now in the middle of a pandemic, where the USA accounts for a quarter of the world’s infections, and a third of the deaths, the USA’s for-profit healthcare system has no national plan or coordinated response. Instead, since so few Americans are going to the doctor this year, there is resounding joy in the industry as profits mount simultaneously with the despair of millions. The NYT reported an “embarrassment of profits” for some of the largest health insurance companies, a doubling of profits in the second quarter of 2020 compared to 2019. These obscene profits are coupled with staggering increases in wealth for billionaires in the healthcare sector. Their wealth has increased by 36.3% from 402.3 billion to $548 billion between April 7 and July 31, 2020. All this stands in sharp contrast to failing rural and inner city hospitals, smaller medical practices and the hundreds of thousands of unnecessary COVID deaths.
For journalists and talking heads in the mainstream media, this dysfunctional monstrosity is just the acceptable reality of our healthcare system. Discussing any responsibility or alternatives are disregarded.
With millions losing their job-based health coverage, millions more stuck with high insurance costs and lower benefits, Medicare for All is once again deemed off-the-table by all major politicians, including even its biggest proponents.
This disconnect comes on top of a worsening economic crisis threatening to push millions out of their homes while half the population is living paycheck to paycheck, poverty rising and food insecurity is growing. On the other side of the class divide, trillions of dollars have been showered on the wealthy and corporations via the misnamed CARES ACT, and the world’s billionaires have increased their wealth 10.2 trillion during the COVID pandemic. If there’s ever a perfect storm of economic, social, and public health crises, it is now.
The Republican leadership has taken advantage of this crisis and assigned blame to the largely unpopular ACA and fixated on its destruction. It has spent its political energy focusing on the high costs and other weaknesses of the ACA while never offering anything as a credible replacement.
On the other end of the aisle, President Biden has clearly stated his opposition to M4ALL, promising to veto the bill if passed. Democrat House leader Nancy Pelosi is equally opposed, making the chances of a vote remote under the current leadership. The current Democrat platform focuses on “strengthening” the ACA, an easy attack vector for Republicans who are able to exploit the real failures of the ACA and continue to disorient the public.
With these pitiful responses, disillusionment with the system is prevalent, and Americans are looking for alternatives.
Controlled Opposition or Bottom Up Independent Movement?
Which brings us to the nub of the issue. The M4ALL movement has grown, support is high and the need greater than ever. Grassroots organizing, the COVID-19 death spiral, combined with the continued deterioration of coverages and rising insurance costs has moved public support to a higher level despite a blizzard of attacks by opponents ranging from the insurance industry, media talking heads, politicians of both parties, unions, and liberals.
As it currently stands, the public overwhelmingly favors M4ALL, and the main legislation, HR 1384, has over 100 cosponsors. Yet there’s no clear strategy or energy emerging to push the bill forward in Congress or mobilize public support at this crucial time.
Despite an even deeper crisis than the 2008 recession, we are headed for a repeat of 2009, when the late John Conyers sponsored SP bill had more co-signers than any other healthcare legislation at the time, but was ditched by Democrats in favor of the ACA, a bill written by the insurance industry.
Once again, Democrats are poised to join with Republicans to scuttle the immensely popular bill in favor of the insurance industry again, all under the meek disguise of “getting something accomplished”.
Clearly, the M4All movement needs to rise to the occasion — or else risk jeopardizing its own credibility. Not only has public opinion overwhelmingly shifted in favor of M4All, but large numbers of Americans are ready to fight for it as well. The Bernie Sanders 2020 campaign drew huge amounts of activists out week after week for canvassing racked up a record number of donations.
Now with the Sanders movement gone, and the pandemic exposing the injustices within the healthcare system, M4All supporters are looking for answers.
The recent proposal by Jimmy Dore, YouTube political comedian, to force a vote on M4ALL in the House galvanized supporters, drawing tens of thousands to virtual town halls, but was overwhelmingly refuted by the officaldom of the Medicare for All movement. This has brought light on all the weaknesses of the present approach — an insider strategy that gives Congressional Democrats and the organizations that align with them too much power to unilaterally determine the direction of the struggle, while stifling voices in the grassroots. At this crucial moment, the strengthening of a popular movement is pushed aside for the sake of maintaining favorability within subsets of the Democratic party. In reality, grassroots energy is the real source of power. Rather than hitch their horses to insiders, movement leaders must drive the car, act and work in a non-partisan fashion to actually build real power.
Where some critics of Dore agree with building a mass organizing force, they scoff at his proposal and instead say work must be confined within select electoral races tied to the Democratic party and insist congressional supporters like Jayapal and Ocasio Cortez are “allies” and should not be subject to criticism. Besides the “Squad”, there are already over 100 co-signers of HB1384. What is their role in strengthening the grassroots movement? Will they hold town hall meetings and build public coalitions in their district?
Movement leaders must realize that the members of Congress must be dealt with from positions of principle and independence. Otherwise, the insider compromises progressive reps are subject to trickle down to the movement. If AOC says Medicare for All is off the table, the movement is weakened if there’s not leadership elsewhere standing up and pushing it forward. Public support is strong but we are up against an industry that is prepared to spend whatever is necessary to fight us at every turn — leadership is crucial.
In the period ahead, the peoples expectations will grow and the need for M4ALL will become clearer but so will the power of corporate Democrats who now control all branches of government. They will muzzle any grassroots mass actions and push the insider strategy and demand obedience.
Movement leaders should be wise to exploit a house vote, which would help many to understand the huge disconnect between Congress and the public. Actions like this can aid in forming a diverse coalition of labor, racial justice, and public health organizations to push for large demonstrations, public hearings, and petition drives. This is what we need to build towards: a united bloc of grassroots organizations and unions to push legislators to act.
Labor Needs to Step Up and Fight
However, labor and other organizations that should rise to the occasion and provide resources and independent leadership at this critical juncture are simply not capable, largely due to their deep ties to the Democratic party.
Organized labor has been in a steady state of decline for the past few decades. Rather than use popular struggles such as M4A to try to gain back some ground, it has largely doubled down on the business union model of operation, which treats employers as “partners”, abandons the role of membership education, mobilization, and community outreach to increase union strength and the labor movement at-large.
The lack of an organized independent current inside labor challenging the dead-end strategy of cooperation holds labor back. Witness labor’s silence over the past months on demanding wages be paid and healthcare for all workers during the pandemic, something almost all other developed countries have done. Despite hundreds of resolutions over the past decade supporting M4ALL at all levels of labor, real support is weak and ultimately folds when the Democrats give the orders. It has no real life or energy outside of a small handful of unions, and much of labor officialdom is indifferent or simply hostile to M4A, seeing brokered insurance plans as one of their last few selling points of a union to many workers, despite the share of unionized workers dropping yearly. This puts most of the top labor leadership at odds with both the growing mass of unorganized workers without unions and public opinion who are sympathetic to M4ALL and need real healthcare.
In order to win M4A, other popular programs, and stave off its own decline, labor needs a mass upsurge against the corporate domination of society and its political allies. History shows that when labor engages its rank and file into popular action, it can sweep away major hurdles that seemed impossible to overcome. The passage of Social Security in the 1930’s is one such example.
It needs an internal revitalization that advocates a fighting alternative program that mobilizes and puts people first instead of taking cues from “corporate partners” and Democratic politicians as to what is on and off the table. Building this necessary independent movement will ultimately clash with the party, and this is why Dore’s proposal has struck such a nerve. The multiple unfolding crises have put the need for a fundamental change in plain sight and progressives need to rise to the occasion.
If our only hope for Medicare for All is phone banking for intermediate legislation deemed “on the table” by the progressive caucus and working to elect more progressive Democrats to Congress, the movement will never actually move forward. With an independent movement that doesn’t take cues from “allies” in Congress, but instead uses them to help move the agenda forward, we can reach a stage where it isn’t an isolated YouTube personality making such a suggestion but membership-led organizations, backed with the participation of ordinary people, who see themselves playing a real role in this fight.
Ed Grystar is Chair of the Western Pennsylvania Coalition for Single Payer Healthcare. He has over thirty years experience in labor and health justice movements. Served as President of Butler County (PA) United Labor Council, AFL-CIO from 1987-2002, Western PA Labor coordinator for Jesse Jackson for President in 1988, PA coordinator for Dennis Kucinich for President in 2004. He has worked for a number of healthcare unions.