The 2019-model Bernie Sanders
has aged well, looking as spry as he did four years ago. His speeches are the
same, too. But where they were once dismissed as too radical, they are now
mainstream, clearly focusing on the ills of an America that has grown more
inequitable since he last ran for president.
Those were my impressions when
I joined about 12,000 others last week and heard him speak at Grand Park, a big
grassy space across from Los Angeles City Hall.
The ability of his
organization to build such a crowd in a city accused—wrongly—of political
apathy was impressive. Almost a year shy of the California presidential
primary, Sanders’ team had assembled an email network and social media
connections, recruited and deployed dozens of volunteers, relentlessly
contacted lists of potential supporters, and moved them into long lines,
patiently waiting to enter the park.
“Not only are we going to win
California, we are going to win the Democratic nomination,” Sanders shouted.
But one rally does not make a campaign.
Beyond the park, as well as
beyond the city limits, are the millions of victims of an economy and society
growing progressively more unequal. Draw a circle around Grand Park on a map of
metropolitan Los Angeles and it will encompass all the ills of an inequitable
America. To the east is skid row, with streets crowded with homeless people.
Farther east and south and west are crowded neighborhoods where immigrants and
native-born share poverty and send their children to public schools unable to
equip them to earn a living wage in a cutthroat, competitive, technically oriented
world. Bad health, inadequate diets, a shortage of physicians and nurses and
the need to work two or three jobs to survive add up to insurmountable
barriers.
Extend the imaginary circle to
the entire country, and it will include urban centers and the unemployed and
underemployed residents of rural counties in the grips of the epidemic of drug
deaths and suicide.
The coming election is about
these people. Some are Trump voters, some are not. Among them are the many
victims of the huge gap between the rich elite on top and the growing number of
poor people.
I’ve always thought that
health care is the issue that encompasses every aspect of this inequality, a
belief that has been strengthened each time I visited a county hospital or a
clinic. Without the certainty of care, millions are a step away from financial
ruin and death. “For the third straight year, life expectancy in America is in
decline,” Sanders said at the rally. “We are going to change that.”
During the event, I talked to
people about health care. I approached two women, Sandy Reding and Rebecca
Prediletto, who were wearing the red shirts of the California Nurses
Association. Their union was a major force behind Sanders four years ago,
embracing a concept then ridiculed by cautious Democratic mainstreamers:
Medicare-for-all. Earlier in the week, Sanders had spoken at a nurses union
rally at UCLA, where the nurses had staged a one-day walkout in support of
members in other parts of the state.
This particular Saturday was
the day before the revelation of the report giving President Trump so-called
exoneration in the Russian investigation. But, as the Democratic victories in
last year’s House elections showed, health care means more to voters than the
president’s relations with the Russians. The following week, Trump, scorning
the election results, moved to kill Obamacare.
“We’ve been on the ground
canvassing for Medicare-for-all,” Reding said. Their reception, both nurses
said, was much different than it was four years ago. “It’s the difference between
night and day, ” she said. “These are people who come out after they have done
their research. Medicare-for-all is the fire-starter, the catalyst.”
It is a catalyst because
guaranteed medical care, as represented by Medicare-for-all, would bring about
a great improvement in American life on many levels. Obamacare, or the
Affordable Care Act, has already made life better. I saw that when community
health care clinics for the poor began to expand immediately after President
Obama signed the law that will always be identified with him. Just a few weeks
before, these clinics had feared closure or sharp reductions.
The Center on Budget Policy
and Priorities estimates that 20 million Americans have gained coverage by
receiving Affordable Care Act subsidies since Obamacare became law. That’s in
addition to young people who have been added to the rolls, the new eligibility
of those with pre-existing conditions and recipients of Medicaid.
Obama made major compromises
to win approval for his proposal. This left defects in the program. His efforts
to remedy them failed because of Republican opposition and Democratic inability
to agree on a fix.
Improvements have been
proposed by congressional Democrats. A simple cure would be to increase the
subsidy, leaving in place Obamacare’s complex system of private insurance,
public “marketplaces” and a variety of plans with different costs and benefits.
Even simpler would be to eliminate private insurance, including employer plans,
and provide health insurance through a single government plan. That’s
Medicare-for-all.
It would be a federal
government-administered program providing coverage to all U.S. residents.
“Medicare-for-all would result in a major shift in the way in which health care
is financed in the U.S.—away from households, employers and states to the
federal government and taxpayers,” the Kaiser Family Foundation says.
This would be a revolution,
now impossible to accomplish with Republicans in control of the presidency and
the Senate. In addition, those with employer-provided insurance might be
reluctant to give it up. Rep. Pramila Jayapal of Washington, presidential candidate
Sen. Elizabeth Warren and other Democrats favor a two-track approach, making
fixes in Obamacare while fighting for Medicare-for-all. Sanders wants to go all
the way as soon as possible.
Trump’s alternative is brutal.
It’s hard to imagine the harm it would do the country if he succeeds in killing
Obamacare. “More than eight years after enactment, ACA changes to the nation’s
health system have become embedded and affect nearly everyone in some way,”
according to the Kaiser Family Foundation.
The numbers of people who
could lose coverage if Trump succeeds are staggering. It would return control
of health insurance to the insurance business, famous in pre-Obamacare days for
whom it would not cover.
The Kaiser Family Foundation
says 17 million poor Americans could lose Medicaid coverage and 15 million
others could lose ACA subsidies that now help pay for policies. The foundation
says 52 million people have pre-existing conditions that are now covered by
Obamacare but would not be included if it is repealed. Higher rates for women
could return. Preventative services mandated by the ACA could be lost,
including screening for breast, colon and cervical cancer and pregnancy-related
services, such as contraception. The requirement for insurance companies to pay
for essential services could be lost. Among these are mental health and
substance abuse treatment. Such illnesses, experts say, are largely responsible
for Americans’ decreasing life expectancy.
Think of all these numbers as
human beings. It’s easy to forget about them with the news media transfixed on
finding out whether Trump and his shady team tried to cover up electoral and
business wrongdoings. But these potential victims of Obamacare repeal were
heard during last year’s election, when they helped the Democrats win the
House.
Four years ago, even two years
ago, these concerns were not a major part of the political debate. Growing
income equality changed that. The poor, as well as members of the working class
and middle-class, white-collar sectors, find themselves in the same boat, too
many of them in the gig economy, working part-time, one illness or injury away
from disaster.
“The ideas we talked about
were considered by mainstream politicians as much too radical,” Sanders said at
the Grand Park rally. “Well, brothers and sisters, a funny thing happened in
the last two years. … Now it is our job to complete the revolution.”
I don’t know whether Sanders
can win. With so many Democratic candidates floating around, it’s too early to
talk about that. But in a Los Angeles park, filled with supporters, Sanders no
longer looked too radical—and his victory didn’t seem so improbable.
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