The State of Medicare for All

The State of Medicare for All

The people of the United States remain at the mercy of a corrupt political class to legislate a correction to the dysfunctional health care system. More than a third of the nearly 200 countries on Earth, including many poor countries, provide access to health care for all of their people as a human right. The U.S., the only wealthy nation that doesn’t, is also the richest in the history of the world.

While the media stayed focused on the personality of Donald Trump in the run-up to last year’s presidential election, one issue ruled them all to an electorate in need: health care. The reasons why are self-evident. Sickness is an inevitable part of the human condition. Virtually everyone knows someone that has suffered from rapacious health care infrastructure that places private profits over public needs.

Tens of thousands of lives are lost every year from inadequate health care insurance coverage. Two-thirds of all personal bankruptcies in the U.S. are related to medical expenses. A study released in late July in the Journal of the American Medical Association, not exactly a radical source, found that 18% of all Americans have medical debt in collections. If the raison d’être of a health care system is to provide care, it is perverse for that system to operate on a for-profit basis that relies on the denial of care to maximize profits.

History has shown that begging politicians to lead on this issue isn’t going to bring about that change.

I. History of Healthcare Reform

Franklin Roosevelt pledged to provide universal health care in the Economic Bill of Rights that he spoke about in his final State of the Union speech. His successor, Harry Truman, failed later that year in an attempt to get his plan for government-sponsored health care insurance passed over a full-court press of American Medical Association opposition.

John Kennedy told a packed Madison Square Garden crowd in May 1962 that, “We are behind every country, pretty nearly, in Europe in this matter of medical care for our citizens.” It was the penultimate of 33 rallies held across the country by the AFL-CIO in support of an effort to introduce what became known as Medicare when signed into law by Lyndon Johnson three years later.

A dozen years later, in tough economic times, Jimmy Carter proposed an incremental plan that preserved the role of private for-profit insurers that was opposed by his Democratic rival Ted Kennedy who favored a more ambitious plan. Another decade and a half passed and Bill Clinton’s health care reform efforts, led by Hillary in the boom 1990s, which also sought to protect the financial sector’s insurers, likewise crashed and burned.

II. Obamacare and Its Discontents

Another decade and a half saw Barack Obama, with a Democratic supermajority in both houses of Congress, finally make a degree of incremental progress with the passage of the Affordable Care Act AKA “Obamacare.” Obama never allowed advocates for the sensible single-payer solution to be taken seriously in negotiations and dropped his centerpiece “public option” once elected. Essentially, in exchange for a ban on denial of coverage due to pre-existing conditions, the public option was dropped and coverage was made mandatory, with subsidies given to help pay their private insurance premiums.

What kind of health outcomes does all that money buy? The U.S. now ranks 36th in the world in life expectancy at birth.

This progress was gained by ratcheting up the government’s protection racket for the insurance industry. Since Obamacare became law, the cost of health insurance premiums has risen more than twice as fast as earnings, while deductibles rose more than six times as fast. And about 30,000,000 people remain completely uninsured. In a nod to Big Pharma, no effort was made to rein in out-of-control drug costs. Medicare remains banned from negotiating drug prices. On average, prescriptions cost 50% to 80% less to fill in Canadian pharmacies than in the U.S.

Because of this extortion, health consumption expenditures per capita on average are about $11,000 annually in the U.S., more than double what they are for Canadians. And what kind of health outcomes does all that money buy? The U.S. now ranks 36th in the world in life expectancy at birth. It isn’t just pretty nearly every country in Europe that we are now behind. And all of the health care inequities have been intensified by a global pandemic.

III. Opportunities and Obstacles

Proponents of single-payer health care insurance have long been a voice crying in the political wilderness, consigned to irrelevancy by the ruling class and its mass media that, when it mentioned them at all, decried them as unserious extremists. That began to change in the 2016 presidential campaign when Bernie Sanders ran hard against Hillary Clinton on “Medicare for All.” His success in the Democratic primaries legitimized his position on health care, making it more mainstream than ever before.

Medicare for All was a lightning rod in the 2020 campaign as well. Exit polls taken at virtually every primary stop in 2020 showed supermajority support for Medicare for All, even in states where Sanders trailed Joe Biden by large margins, including “deep red” states like Mississippi. Nationally, nearly 70% of those polled, both overall and among independents, approve of Medicare for All. Among self-identified Democrats, it’s nearly 90%. Even about 50% of Republicans see it as the answer to our health care crisis.

But like his Democratic establishment predecessors, Joe Biden is not among them. Just like his 2008 running mate Obama, Biden campaigned on a public option. Unlike him, he dropped it from his rhetoric even before his election, as soon as he wrapped up the party’s nomination.

Now even Sanders has also seemingly backed off from his signature issue. Although he sponsored a Medicare For All bill in the Senate in the last Congress, he hasn’t reintroduced it this year despite a slim majority in that chamber and that has 90% support among Democrats. As Chairman of the Senate Budget Committee, where he largely controls the reconciliation process to get things passed around the filibuster, he has opted instead for an attempt to lower Medicare eligibility to age 60 and expand coverage to include dental, vision, and hearing. Those would not be insignificant improvements, but now it appears they are off the table too.

Even worse, Rep. Pramila Jayapal’s Medicare for All bill, reintroduced as HR1976 in 2021, which has 117 co-sponsors in the House, is vehemently opposed by the Democratic Party leadership and does not appear to have a path forward with no committee hearings scheduled and no prospects for a floor vote. Of those House co-sponsors, only one attended one of the March for Medicare for All events on July 24. Many of them were vociferous supporters of Medicare for All on the campaign trail just last year, but only MO freshman Cori Bush dared to utter one word of support for those getting out in the streets to demand health care equity. She’s new.

Nationally, nearly 70% of those polled, both overall and among independents, approve of Medicare for All. Among self-identified Democrats, it’s nearly 90%. Even about 50% of Republicans see it as the answer to our health care crisis.

IV. The March for Medicare for All Movement

As a volunteer organizer for one of those, the July 24 March for Medicare for All in Louisville, I was heartened by that day’s events in more than 50 cities in 30 states. Here in Kentucky, we built a broad coalition of 21 non-profit organizations advocating for Medicare for All including groups from the racial justice and labor movements, healthcare providers, the disabled, Lexington DSA, and the Movement for a People’s Party (MPP).

The organically-grown, grassroots effort on July 24 may be a harbinger of things to come. It was thrown together in a hurry by inexperienced people and inevitably missteps were taken. Coalition building is fraught with peril, especially it seems on the Left and the digital age makes things more hazardous. But what made it so appealing to me initially was just how many disparate groups all rushed to join, desperate to move the needle on such a vital issue, despite some past rivalries that made sometimes strange bedfellows. Not every group was involved with marches in every city, but in one place or another the DSA, MPP, the Green Party, National Progressive Party, Black Lives Matter, the Sunrise Movement, Our Revolution, Physicians for a National Health Program, the AFL-CIO, Progressive Democrats of America, Americans for Democratic Action, Real Progressives, NAACP, Move to Amend, Occupy, Act Up, Fight For $15, SURJ, and many, many others all came together on the same day to loudly demand health care justice.

Some were notable by their absence. Although I observed people wearing Poor People’s Campaign shirts at the Louisville event, I did not see that they had formally endorsed any of the marches. National Nurses United begged off early, claiming that it was too soon for in-person events during the pandemic.

There were disputes in several cities regarding DSA participation. The Louisville chapter voted against co-sponsoring the Louisville March (despite heroic efforts to stage it by some of their membership) and our Lexington chapter elected to endorse it – by just a one-vote margin. The Portland and Asheville events were disowned by the national organizers because of alleged pilfering of registrants’ data by DSA members, as was the Ft. Lauderdale event for the same reason by MPP.

Where it goes from here remains to be seen. I know that at the hugely successful Louisville event many rivers were crossed and a lot of networking took place among people that want to work for change. We have to loudly demand that politicians, even the progressive ones, follow our lead on this issue. They must be made to fear for their political lives. Life is a struggle.