This piece is part of Fighting for Our Lives: The Movement for Medicare for All, a Truthout original series.
"It's been the summer of single-payer" – RoseAnn DeMoro
The release of Bernie Sanders' Medicare for All Act has injected a remarkable jolt of energy into a movement for health care justice that was already on the ascent.
"The grassroots are more than ready to organize around this bill. It could not have come out at a better time, said Michael Lighty, public policy director of the California-based National Nurses United, in an interview with Truthout. "The growing momentum for the policy is really due to two things. First is that we have always known single-payer is the better policy. But now the politics are really changing. . . With the momentum on the ground, this cannot be stopped."
Just the anticipation of the bill sparked a wave of energy for advocates of Medicare for All, a policy that Sanders' presidential campaign helped elevate into the national discussion. As a result, Sanders' bill arrives at a time when the movement stands ready to organize around Medicare for All with vigor. In the days and weeks leading up to release of the bill, organizers and constituents were already working tirelessly to influence their senators. This grassroots pressure led to a stunning 15 co-sponsors already on board in the Senate, surpassing the most optimistic expectations of advocates. Organizers are aware that there are formidable opponents to deal with but say they are ready for the fight.
This momentum was apparent long before yesterday. A similar (not identical) bill in the House, HR 676, which has been in Congress since 2003 now has a record 117 cosponsors. The GOP efforts to destroy Medicaid and repeal Obamacare have united health care activists across the country, galvanizing the fight for single-payer.
Political campaigns, protests and civil disobedience have often centered around Medicare for All, reflecting the fact that 25 percent of the country views health care as, according to a Monmouth poll, the "top concern for American families."
The public sentiment is clear. Nearly 60 percent of Americans, 80 percent of Democrats and even a plurality of Republicans support Medicare for All, according to an Economist/YouGov poll, This is not an outlier; polls have consistently shown a majority of support for the policy for more than a decade. Not even the dominant corporate media – which for years have been dismissive of the policy – can ignore the issue anymore, as both the New York Times and Washington Post have run articles about the growing momentum for single-payer.
Trickle-Up Effect: How Grassroots Support Has Penetrated the Establishment
Leading up to the bill's release, there was much anticipation over who, if anyone, would co-sponsor the legislation. Sanders introduced a similar bill in 2013 but could not garner a single co-sponsor. But much has changed since then. Today, Sanders is the country's most popular politician whose large and loyal base of supporters cannot be taken lightly by Democrats. Senators Elizabeth Warren and Kamala Harris (both the subject of much speculation as possible presidential contenders in 2020) announced their intention to co-sponsor the legislation long before it was released. By Tuesday Al Franken, Tammy Baldwin, Cory Booker, Kirsten Gillibrand, Sheldon Whitehouse and Jeff Merkley were on board. The number escalated to 15 by Wednesday morning.
Even some senators who have not co-sponsored the bill have started to show a new, if guarded, interest in the policy. Senator Minority Leader Chuck Schumer has suggested the party should "be open" to the issue. Even red-state senators facing re-election have been considering the idea. Jon Tester of Montana suggested the policy should be discussed at a hearing on Monday. Joe Manchin of West Virginia played both sides, saying on Tuesday that he is "open" to the policy but later adding that he is also "skeptical." Even these tepid reactions are surprising given that both were among the four Democrats to oppose the GOP's Medicare for All amendment aimed at dividing Democrats during the ACA repeal session.
While 15 co-sponsors may not sound like a big number in a vacuum, given the single-payer blackout in Washington for the last 20 years, it is a considerable sign of progress. In 2009 Democrats could not even rally enough support to pass a small, mostly toothless public option, which the Congressional Budget Office (CBO) ruled would have "minimal effects" on access and cost. Now, the public option has become the default response of Democratic single-payer skeptics, like House Minority Leader Nancy Pelosi (who is increasingly frustrating progressives) and Tim Kaine, who may well be trying to carve out a Third Way, centrist path toward the Democratic presidential nomination in 2020. The most likely progressive presidential contenders (Harris, Warren, Booker, Sanders), however, are publicly on board.
"It's looking increasingly likely that supporting single-payer health care will be the standard for Democratic lawmakers who want to be considered serious 2020 candidates," wrote Addy Baird in a blog post for the Center for American Progress, which has received funding from the for-profit health industry. Such a statement would've been inconceivable just a couple of years ago.
"It seems every day a new, major voice is coming out in favor of single-payer: Jimmy Carter, Elizabeth Warren, Al Gore, Warren Buffet," said Ida Hellander, who spent 25 years at Physicians for a National Health Program (PNHP), in an interview with Truthout. "Bernie Sanders deserves a lot of credit. His campaign gave this issue a lot of attention."
Max Baucus's Flip Reflects ACA's Limited Utility
The most unlikely display of support for Medicare for All may have come from former Montana Senator Max Baucus, who retired from the body in 2014. In 2009, as chair of the powerful Senate Finance Committee, the Montana senator would not even discuss the merits of such a policy as he led the committee process for what would become the Affordable Care Act (ACA). His dismissal of single-payer sparked outrage among activists, notably the Baucus 8, who were arrested while protesting his decision.
On Thursday, however, Baucus stunned many when, according to the Bozeman Chronicle, he said "my personal view is we've got to start looking at single-payer. . . We're getting there. It's going to happen."
Baucus's change of heart is noteworthy for several reasons. First, it speaks to the limited utility of the ACA. Obamacare, as it is known, has improved access to health care considerably; the number of uninsured has gone down to about 28 million from nearly 50 million. The law, however, preserved the commodification of health care and does not control the exploding costs of care, according to data from the Centers for Medicare and Medicaid Services, which forecast health spending to grow to nearly 20 percent of GDP by 2020.
"I think what Baucus and others have come to see is that the Affordable Care Act has taken us as far as it can go," said former health insurance executive-turned whistleblower, Wendell Potter, in an interview with Truthout. "The trend of increased support is not like anything I can recall in the recent past."
Also of note are the circumstances under which Baucus announced his support of the policy. Baucus refused to even engage single-payer advocates in 2009, back when he was still in the Senate and – like most of his colleagues in both parties – received large donations from the drug and insurance industries. In fact, as the Montana Standard reported, just months before the ACA's passage, the industry accounted for 25 percent of Baucus's fundraising, "more than any other member of Congress." It is a telling indicator of the pervasive role of money in politics that now that Baucus is free from the need to fill his campaign coffers with corporate money, he is willing to speak out in favor of the policy.
Building Support for the Bill at the Grassroots Level
If the Medicare for All Act of 2017 became law, within four years all Americans would receive a "Universal Medicare card" that would be a ticket to comprehensive health care services: hospital stays, primary care, substance abuse and mental health treatment, dental and vision. Reproductive care would also be included, as the law would repeal the Hyde Amendment, which bans federal funding of abortion.
But in the lead-up to the bill's introduction, there were concerns about what would end up in the final legislation. Some reports suggested the Medicare for All bill would fall well short of expectations, while others argued that Sanders would abandon Medicare for All entirely and put all his energy behind a public option (he still speaks favorably of such incremental steps). Others expressed concern that the bill might include co-pays and cost sharing, which have been shown to cause even insured patients to defer much-needed care due to financial barriers.
Margaret Flowers, a board member for Physicians for a National Health Program, initially told Truthout that there were concerns that Sanders would "include co-payments for people who earn over 199 percent of the Federal Poverty Level," which would cause "greater administrative complexity" and "cause people to delay or avoid necessary care." Several organizers, however, told Truthout that Sanders' staff later informed advocates that cost sharing would not be in the final bill. After these assurances, these activists were more enthusiastic about the effort.
"After meeting with Senator Sanders' staff, we felt more reassured that his intention is to ultimately create a strong National Improved Medicare for All system," wrote Flowers and fellow advocate Kevin Zeese on Health Over Profit about their meeting, which took place about a week ago. "[Sanders] is seriously trying to figure out how to transform health care from being a profit center for big business to being a public good that serves the people.''
Indeed, the bill includes no co-pays or deductibles, although the bill does give the Health and Human Services secretary the ability to impose co-pays for prescription drugs to incentivize the use of generic drugs. "PNHP applauds Sen. Sanders and the thousands of grassroots advocates whose tireless advocacy has pushed single payer to the forefront of the national debate on health care," said Claudia Fegan, PNHP's national coordinator, in a statement. "We look forward to working with Sen. Sanders to strengthen and advocate for this bill."
Now there appears to be a wide consensus in support of the bill from the single-payer community. The national advocacy organization Healthcare-NOW has rallied the public to pressure senators all week. Medical providers are also playing a central role. Physicians for a National Health Program has been organizing for 30 years and has produced some of the field's seminal research. Nurses, who are the most trusted workers in the country, are also among the most enthusiastic supporters of Sanders's plan. Groups like the California Nurses Association, the Massachusetts Nurses Association and National Nurses United, for instance, are pouring considerable time and, often, resources into the reforms on both the state and federal level.
Jessica Early, a nurse practitioner and health care justice organizer for the Vermont-based group Rights and Democracy, told Truthout the "Medicare-for-All Act of 2017 puts forward an alternative vision [and] will have a profound positive impact on the lives of my patients."
Early emphasized that single-payer health care is a positive step that is absolutely necessary for her patients and others across the country.
"The health care fight is not over until we finally build a publicly funded universal health care system that puts patients ahead of private profits," she said.
Preparing for the Illusion of Grassroots Opposition
Meanwhile, the for-profit health industry is watching the push to make it irrelevant (save for possible supplemental insurance). "A single-payer reform would end insurers' role in the health care system, essentially wiping out their entire business," said David Himmelstein, a lecturer at Harvard and co-founder of PNHP, in an interview with Truthout.
The industry will respond in kind, predicts Potter, who has firsthand knowledge of the industry's methods. Chief among its strategies, he tells Truthout, is to create the illusion that the opposition to such reforms is not coming from the industry itself but from so-called patient-centered groups that it funds, as well as through allies like the Chamber of Commerce.
One popular trick is the creation of "Astroturf groups," often administered by public relations firms, which are designed to appear as organic groups devoted to patients, when in fact, they are directly funded by the industry. Potter helped to engineer this type of Astroturf initiative in 2007, when Michael Moore released the film Sicko, which made a strong critique against the US health system, in favor of a public health system. Potter later apologized to Moore for his role in this process.
This is just one of many techniques the industry and right-wing groups deploy to resist progressive measures. The industry and their allies have a vast network of think tanks and organizations that are well-funded and aggressive in their opposition to single-payer.
One such group is the Koch-funded State Policy Network, which the Center for Media and Democracy describes as an "$83 million right-wing empire." The State Policy Network has organizations in nearly every state that can react quickly – and with resources – to counter any policy they don't like across the country. Other opponents, such as the American Medical Association, Third Way Democrats and right-wing think tanks and media, will also be militant in their opposition to the single-payer bill.
Opponents' main talking points will include the tax increases that are required to finance a Medicare for All system; they argue it is therefore unaffordable. But, experts point out, this is misleading; one of the biggest benefits of single-payer is its cost efficiency. For instance, in Canada, which has a system very much like the Sanders plan, per capita health-care spending is $4,445, while the country spends 11.4 percent of its GDP on health care and insures everyone. Meanwhile, the United States spends $8,223 per person on health care annually, spends 18 percent of its GDP on health care and leaves nearly 30 million uninsured.
Similar disparities exist between the United States and every other nation in the Organization for Economic Cooperation and Development (OECD) – all 33 of which have public, universal health care systems. The United States is the lone member of the OECD without universal coverage. As of 2012, the average OECD country spends $3,268 per capita on health care and 9.5 percent of its GDP on health expenses, or about half of what the US spends.
Among the chief culprits for the misleading claim about costs was Hillary Clinton, who repeatedly used her air time to spread this right-wing falsehood when facing Sanders in the presidential primary. "It is really tragic. She had billions in free air time that our organizations could never afford to pay for, and instead of using it to speak out in favor of single-payer, she lied about it and smeared it," Hellander told Truthout.
Medicare for All's Moment
Given the bottomless pockets of the industry and its sophisticated misinformation techniques, there is a tough fight ahead for Medicare for All. Nonetheless, this has been one of the most important weeks in the history of the universal health care struggle.
Indeed, one must go back to 1971 to see a single-payer bill with any momentum proposed in the Senate. This was when Ted Kennedy introduced the National Health Security Act, which proposed a "straight national health system," as a CBS new broadcast reported at the time. To counter this, Richard Nixon proposed a system – almost identical to the Affordable Care Act – that would rely on the private sector and fail to provide universal care.
With 15 co-sponsors, Sanders' bill cannot be labeled as just an organizing tool. It is also a potential template for a transition to a humane health care system that leaves nobody behind. To accomplish this, of course, the public must stay engaged, pressure existing members of Congress and elect advocates of single-payer to Congress and to the presidency. But the fight is no longer just a conceptual one. Things are getting real for the health care justice movement.
Sanders clearly played an important role in this major step. But it is crucial to note that the resurgence of a single-payer movement is, at its root, the product of the tireless work of activists, organizers and educators who never ceased their efforts, even when the Democratic Party would only shun them.
"Yes, the lead taken by Sen. Bernie Sanders certainly has helped to spark the movement. But it is not Bernie Sanders alone who is bringing other politicians on board," said PNHP's Don McCanne. "The people lead, politicians follow, and that is not a phenomenon limited to the Democratic Party. So, gather the grassroots together and lead. Be there, bring others, and do it."
This is the strategy organizers are employing, trusting that this work – and Sanders's bill – is the product of a movement whose time has finally come.