The proposal for a national
Medicare-for-all demonstration could be a first step toward turning growing
sentiment for a single-payer system into action and organization.
July 21, 2017
DONALD TRUMP and the
Republican Party suffered another setback in their drive to wreck an already
ailing health care system and loot the rubble for more tax cuts for the
super-rich.
Earlier this week, Senate
Majority Leader Mitch McConnell's second attempt at a "wealth care, not
health care" bill stalled due to opposition within the narrow Republican
majority. This was followed quickly by the breakdown of a Plan B proposal to
repeal Barack Obama's Affordable Care Act (ACA), but not bother replacing it.
With Trump blustering about
canceling the Senate's August recess until it acts, McConnell and the
Republicans will keep trying. They could succeed--perhaps with help from the
spineless Democratic Party. But for now, Trump-McConnell-Ryan-care is stuck in
a ditch.
That's good news: All the
versions of the Republican legislation are a disaster. The allegedly more
"moderate" Senate proposal, for example, would slash
more money over the long term from the Medicaid program for the poor than
the House bill passed in May.
But there's bad news, too: The
Republicans' failure to pass a destructive law doesn't change the fact the
health care system under the ACA is sinking deeper into crisis.
Obamacare contained some
important advances that should be defended against the Republicans. But by
establishing a framework that leaves tens of millions of people at the mercy of
profit-hungry private insurers, it set the stage for chaos and crisis among the
people who were supposed to be helped by the ACA.
If the Republicans are in a
position to try to saw off the limbs of the health care system, it's because
they were able to exploit mass dissatisfaction with the ACA status quo.
The only way out of the health
care hunger games is a radical alternative to both Trumpcare and Obamacare: a
single-payer system covering everyone under an expanded and strengthened
Medicare-for-all system.
The real good news is that
there is a groundswell of support for this alternative--a
Pew Research Center survey last month found that support for a single-payer
system has grown by half in three years to 33 percent--along with new left-wing
initiatives to organize this sentiment into protest and political action.
There's a long way to go
before Medicare-for-all is achieved. But more and more people are refusing to
let the length of the journey discourage them from taking the first steps.
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WHEN McCONNELL admitted defeat
for a second time, support for his health care bill had
sunk as low as 12 percent, according to a USA Today poll.
The legislation is so
obviously disruptive--the gutting of the Medicaid system alone will cause chaos
in a sector of the economy that accounts for one in every six dollars of U.S.
gross domestic product--that much of the health care industry itself is
opposed. Yet it was just a vote or two away from being rammed through and
signed into law.
With the margin so close, the
wave of protests that put the GOP on the spot in Washington and around the
country was incredibly important.
On Capitol Hill, for example, the
disability rights organization ADAPT organized a "die-in" at McConnell's
office in June. Police pulled some protesters out of their wheelchairs in
arresting 43 people.
Other actions upped the
pressure on Republicans while they were still in Washington, but there was no
relief when they headed home for appearances at town hall meetings. Since the
beginning of the year, GOP lawmakers have faced the kind of dissent once
mobilized against Democratic members of Congress during the Obama years.
Republicans got the message--many cancelled
appearances in their home districts.
Democratic Party-leaning
organizations may have called for these protests, but the grassroots organizing
that made them flashpoints of dissent is a stark contrast to the attitude of
the party establishment--which has been to keep their heads down.
The party's strategy is to
stay out of the way while Republicans shoot themselves in the foot--and wait
for gains in the next election. This cynicism was crystallized after the House
Republicans voted through their health care bill--and a
group of smug Democrats started singing in premature celebration of election
victories to come.
The Democrats can't be trusted
to put up a fight, even against the destruction of Obamacare. In fact, it's
just as plausible to envision McConnell getting some Senate Democrats to go
along with an altered version of Trump-McConnell-Ryan-care as it is to imagine
Republicans getting their act together.
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THE LEFT should remember this
fact in the months to come: It took a protest movement to challenge Trump and
the Republicans on health care. This fits with the overriding lesson of the
Trump era, both during the campaign last year and in the opening months of
Trump's presidency.
That lesson: You can't fight
the right from the center.
Trump and the Republicans have
one thing going for them: The health care system is still a mess for millions
of people because of the failures of Obamacare. The positive measures in the
ACA are outweighed by its toxic core, which leaves
insurance companies free to prey on millions of people who are required by
law to buy their defective, overpriced product.
Since the ACA passed in 2010,
the insurance giants have gotten federal agencies to loosen the new regulations
on them, while they figured out how to game the Obamacare system to maximize
profits. Premiums are rising, along with out-of-pocket costs passed onto
policyholders--and the ACA's "exchanges," where individuals are
supposed to purchase insurance, are in
danger of breaking down altogether as insurers pull out of different states.
That's not Trump lies or
Republican propaganda--it's the truth.
The cure, of course, isn't the
GOP's poison that would make the system sicker. It's the radical break that the
Obama administration never considered in 2009: A single-payer system providing
universal health care, like exists in almost every industrialized country in
the world except the U.S.
The urgent need for that
alternative has broken through to a wider number of people than ever before.
Despite the slanders of the health care industry, one-third of people told
the pollsters from Pew that they support single-payer right now. Fully 60
percent say the federal government should be responsible for ensuring health
care coverage for all Americans--which is only possible under a single-payer
system.
The time is ripe for
supporters of Medicare for all to take the movement to the next level. But that
requires a clear understanding of what's in our way: The for-profit health care
industry and the Republican reactionaries, obviously--but also the Democratic
Party.
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THROWN OUT of power in
Washington by the 2016 election, leading Democrats are feeling freer to give
rhetorical support to single-payer. For the first time, a majority of House
Democrats has signed up in support of a Medicare-for-all proposal. Not only
Bernie Sanders, but Sens. Elizabeth Warren, Kirsten Gillibrand and Kamala
Harris have voiced varying degrees of backing.
But when it gets close to
actually achieving a single-payer system, the Democrats' enthusiasm grows cold.
In California this year, health
care activists pressed for the state legislature--which is wholly
controlled by the Democrats, along with the governor's mansion--to take up a
bill that would have begun work on a single-payer system.
The popular legislation passed
the state Senate easily. But in June, as the bill was due to be taken up by the
State Assembly, Speaker Anthony Rendon announced it would remain in committee
indefinitely--a legislative death sentence.
Rendon's excuse? He claimed
the postponement was to make fighting Trumpcare in Washington "the top
health care priority."
This is laughable, of course.
Passing single-payer legislation for the first time--and in the most populous
state in the country, no less--would be a stirring challenge to the Republican
reactionaries in Washington and galvanize the struggle against Trumpcare across
the country.
The real reason Rendon killed
the bill is because Democrats may see political advantage in saying they
support single-payer--but they don't want to incur the wrath of the health care
industry by doing something about it if they don't have to.
By contrast, the health-care
activists who mobilized in California and New York state--where similar
legislation advanced through one house of the legislature, but was stopped in
the other--showed that you can fight Trumpcare and champion single-payer.
In fact, the two battles need
to be linked--because protests against the Republican health-care disaster will
be much more effective if we have something better than Obamacare to put
forward as an alternative.
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MOMENTUM IS building on the
left to take up single-payer. When the Democratic Socialists of America
(DSA)--which has quadrupled in size over the past year--surveyed its members on
what campaigns to prioritize, Medicare for all came out on top by a wide
margin.
DSA members around Jacobin
magazine, among others, are proposing that their organization, in coalition
with other left groups, call a national demonstration for single-payer in
Washington, D.C. As
Dustin Guastella wrote at Jacobin:
[A] march would give
socialists the opportunity to vocally and aggressively lead on a major
working-class demand. It would help us build organization, forge political
consensus, and reintegrate the socialist movement with a key sector of the
workers' movement. That same level of unity and clarity of focus could not be
achieved by lobbying-style tactics like phone-banking senators or through
hyper-local campaigns.
Health-care activists need a
way to build momentum at a time when local and state campaigns have run into
obstacles, as with California. And a nationwide action could provide a focus
for galvanizing the broad sentiment for single-payer, which is far bigger than
existing organization.
But some on the left have
opposed the national march initiative, including within DSA. A document
circulating on the Internet from DSA members in Washington, D.C., argues a
demonstration would eat up resources that could be used on local organizing,
while having no real impact.
Unfortunately, the document
includes some common caricatures of the left that are often
used to discredit the idea of protesting at all. But even setting that
aside, the criticism that a national march would take attention away from local
organizing is mistaken. Past
experience shows that mobilizing for a national march is an excellent way
to bring together people who might not meet otherwise.
In addition to shining a
spotlight on an issue that the media, like the political establishment, prefer
to ignore, a Medicare-for-all march could help turn a general mood into
tangible organization--which could then move on to next steps, whether local,
national or both.
The Republican onslaught won't
be stopped in its tracks by a single demonstration anywhere--nor is a
nationwide victory for single-payer in the cards in the near term. But if we
hope to win at any time, our side needs to get organized, and we need to take
every opportunity to do so.
Right now, the spotlight is on
health care, and the Republican train wreck is exposing not only the misery
they want to inflict on us, but also the crying need for something better than
Obamacare as an alternative. Socialists have something to say about that
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