The Cross-Partisan Appeal of
Single-Payer Healthcare
In early April, a public radio
program in the Rust Belt city of Rochester, N.Y., spent an hour discussing
healthcare—but not, as you might expect, the GOP’s attempt to repeal and
replace Obamacare. It focused instead on the brightening prospects for a
single-payer healthcare system. The guests included a Trump voter and
small-business owner, Tim Schiefen, and the co-chair of the Rochester chapter
of the Democratic Socialists of America (DSA), Karen Vitale. What was
remarkable was how little they disagreed.
Asked his opinion of
single-payer, Schiefen responded that it was worth exploring. “The problem is
putting the foxes in charge of the henhouse,” he said. “Why are we allowing these
gross, overspending health insurance companies … to administer this
stuff?”
Increasingly, the single-payer
solution is generating that sort of consensus across ideological and party
affiliations. In early April, an Economist/ YouGov poll showed that 60 percent
of respondents supported a “Medicare for all” system, including 43 percent of
people who identified as conservative and 40 percent of Trump voters.
The energy behind single payer
is partly a result of the GOP’s success in pointing out the flaws in Obamacare,
then failing to offer a workable alternative. Vitale believes that, in a
paradoxical way, it’s also driven by Trump.
“I think Trump broke open a
lot of things,” says Vitale, who grew up in a rural small town an hour south of
Rochester. She says that the Trump voters she knows trusted his populist pitch—
and “now they’re activated, and they’re acting from a place of self-interest.
You can’t put them back in the box.” When Trump breaks campaign promises, she
predicts, “They’re going to notice really quickly. They noticed with
Trumpcare.”
That doesn’t mean they’re
ready to abandon Trump. On the radio program, Schiefen said he appreciates
Trump’s “moxie” and has no regrets. But he also said he would be willing to
vote for Democrats with better ideas. “The whole system is built too much on us
[versus] them,” he said. “Let’s put aside the differences. Let’s get to the
root of the concern.”
A healthy interest
Vitale and other members of
the Rochester DSA are part of a coalition pushing for single-payer reform in
New York State. In early April, they traveled to Albany to lobby state
legislators. They also regularly canvass the city, educating people about
single payer and urging them to call their representatives.
“It’s not difficult to talk
about healthcare with people from across the spectrum,” Vitale says. “People
want to pit rural Trump voters against the educated, progressive people in the
cities, and that’s not where the tension is. The tension is with suburban Trump
voters who are wealthy and doing very well in our current healthcare system,
and have no interest in reform.”
The power of single payer as
an organizing tool seems to hold true across the nation. As with many DSA
chapters, the East Bay DSA has seen a spike in membership since the election,
and much of the new energy is being channeled into the push for single payer.
The chapter sends hundreds of volunteers each month to canvass on behalf of the
Healthy California Act, which would create a state single-payer system.
“It’s strategic because it’s
something that’s going to profoundly benefit the vast majority of people,” says
Ari Marcantonio, East Bay DSA’s lead organizer for the campaign. “So this is an
issue we can mobilize tens of millions around. But single mothers, people of color,
poor people and immigrants will benefit the most. ”
Among some conservatives, the
shift in thinking on healthcare is being driven by the idea that, as Schiefen
said, the insurance companies are profiting at the expense of people’s health.
That critique allows them to pin the problems on Obamacare while embracing the
idea of universal healthcare.
Consider Christopher Ruddy, a
Trump supporter and CEO of the influential conservative website Newsmax. In a
recent editorial, he urged Trump to “reject the phony private health insurance
market as the panacea” and lamented that Paul Ryan’s second plan “accepts key
parts of the Obamacare law that benefit the insurance industry, but it ends the
Medicaid expansion program that benefits the poor and keeps costs down.”
Ruddy didn’t embrace a full
single-payer system. But he did argue that Trump should honor his campaign
pledge to provide universal healthcare. It could be achieved, he wrote, by
expanding the Medicaid system “to become the country’s blanket insurer for the
uninsured.”
When a dramatic expansion of
the Medicaid program is a prominent conservative’s solution to our healthcare
crisis, we’ve entered uncharted waters.
A bigger boat
As recently as last year, the
push for a single-payer system seemed virtually dead among the Democratic
establishment. Hillary Clinton ran on the promise of tweaking Obamacare. The
liberal economist Paul Krugman wrote that Bernie Sanders’ “Medicare for all”
proposal was “just not going to happen anytime soon.”
Now, the goal seems a lot
closer. In January, Rep. John Conyers (D-Mich.) reintroduced a bill—originally
put forth in 2003—that would create a publicly financed universal healthcare
system funded largely by a payroll tax, tax hikes on the rich and a financial
transactions tax. Conyers’ bill, The Expanded and Improved Medicare for All
Act, has widespread backing from unions, medical organizations and progressive
groups, and had 104 co-sponsors as of late April.
Bernie Sanders has promised to
introduce a single-payer bill in the Senate, leading CNN to predict that
“Democrats eyeing the 2020 presidential contest could soon face a
‘Medicare-for-all’ litmus test from the party’s progressive base.” At a rally
in March, Sanders said, “Every major country on earth guarantees healthcare to
all people … don’t tell me that in the United States of America, we cannot do
that.”
This abrupt turnabout is
partly a result of the Republican failure to replace Obamacare. The GOP’s
flailing has energized and focused the resistance to Trumpism while undermining
the party’s legitimacy on the issue. The videos and headlines from raucous town
halls have been particularly devastating. A Pew Research poll released in
mid-April found a 19-point gap regarding which party is trustworthy on
healthcare, with 54 percent saying that Democrats would do a better job.
At the same time, progressive
energy has expanded the horizon of possibilities. Groups devoted to pushing the
Democratic Party in a progressive direction—like Justice Democrats, Brand New
Congress and Progressive Change Campaign Committee (PCCC)—are making healthcare
reform central to their work, and they’ve moved well beyond Obamacare. Brand
New Congress, which recruits and supports progressive candidates for office,
cites “making Medicare available to anyone who wants it” among its highest
priorities. PCCC has collected more than 40,000 signatures on a petition that
asserts, “All Democrats running for office in 2018 should publicly support and
run on passing Medicare for All.” The goal is “to create a push for Democrats
to go bold,” says Kaitlin Sweeney of PCCC.
These federal reform
initiatives are working in synergy with state-level proposals. In Minnesota,
state Sen. John Marty introduced legislation in January to create a
single-payer system with universal coverage. More than 250,000 Minnesotans are
currently uninsured.
“The Affordable Care Act was a
half-baked solution,” says Marty, a member of the Democratic Farmer Labor
Party. “I don’t want to minimize for a minute the difference it makes. It covered
many millions more people. But … the system is dysfunctional, and it’s getting
worse.”
Drop by drop
Marty compares the healthcare
fight with the struggle for marriage equality, in which state laws created a
domino effect. In 2008, he introduced a marriage equality bill in the Minnesota
Senate and said it could pass in five years—which it did, in 2013. “This is
doable stuff,” he says. “Times are changing and [single payer] could
happen.”
None of the state-level
campaigns are a sure thing. The November election turned the Minnesota
legislature considerably “redder,” meaning Marty’s bill has no chance in the
near term. The Healthy California Act, introduced in February, appears to have
broad support in the legislature, but Democratic Gov. Jerry Brown has been
skeptical. In New York, single-payer legislation is stuck in the GOP-controlled
Senate.
But if and when one state
adopts a single-payer system, it could quickly alter the national political
landscape, with implications far beyond the fight for healthcare reform. For
DSA, the fight for single payer is intended to be the first stage of a
revolutionary program.
“The single-payer campaign is
really about training hundreds of young people who have never been involved in
activism or politics to get brass tacks organizing skills, which are door-to-door
outreach,” says Ari Marcantonio of East Bay DSA. “We’re using it to build a
mass socialist organization, city by city, and the power and the infrastructure
we need to win all kinds of things—like a living wage for all workers and
housing as a human right.”
Fundamentally, he says, the
aim is to “challenge the very deeply ingrained notion that markets are our
friend.”
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