Centrists want to co-opt the phrase and apply it to something weaker than a single-payer system.
Alexandria Ocasio-Cortez beat 10-term House Democrat Joe Crowley in New York’s 14th District — the political upset of the year — in part because she championed Medicare-for-all (in addition to free college tuition and a jobs guarantee, among other progressive policies).
Immediately, some pundits began to try their best to explain her victory in a light most favorable to moderate liberals.
Part of their agenda involved watering down what “Medicare-for-all” means. It is very important that Medicare-for-all advocates resist these efforts and clarify exactly what we’re fighting for.
Vox’s Dylan Scott recently quoted one activist (Adam Green, co-founder of the Progressive Change Campaign Committee), describing the “pleasant ambiguity of Medicare-for-all.” Green suggested that there was no downside to letting voters hold different definitions of the phrase in their minds, at least during campaign season. Meanwhile, Paul Krugman described Medicare-for-all, in his New York Times column, as a “deliberately ambiguous phrase.”
“In practice,” Krugman wrote, presumably to reassure centrist readers, “[Medicare-for-all] probably wouldn’t mean pushing everyone into a single-payer system. Instead, it would mean allowing individuals and employers to buy into Medicare — basically a big public option. That’s really not radical at all.”
It’s correct that Democrats diverge on the issue of health care. Yet despite the musings of Krugman and others, there’s nothing ambiguous about the Medicare-for-all legislation Ocasio-Cortez supports and that appealed to the people who voted for her. She was referring to two specific bills, Rep. Keith Ellison’s H.R. 676 and its companion, Sen. Bernie Sanders’s S. 1804, both of which would create a single-payer health care system and both of which share clear principles.
Yet as public support for Medicare-for-all rises, establishment think tanks and lobbyists are floating proposals designed to capitalize on its momentum while diluting its content.
In February, the Center for American Progress released a plan called “Medicare Extra for All,” a particularly shameless attempt to co-opt Medicare-for-all’s popularity. It would create a public option similar to what Krugman describes — it would allow people to buy into a public “Medicare Extra” plan while leaving in place the privatized, multi-payer system that drives our health care struggles.
Obama administration alumnus Andy Slavitt’s United States of Care initiative, on the other hand, promises to “put health care over politics” — an obvious impossibility — with three extremely vague “principles”: giving Americans “an affordable regular source of health care”; protecting them from “financial devastation” as a result of medical bills; and, the giveaway that Slavitt’s organization will settle for less than what voters are demanding, requiring legislation to be “economically responsible” to “win … political support.”
Benchmarks as vague as that prevent any accountability, ensuring that, whatever inadequate plan might be passed, these experts will be able to congratulate themselves.
In contrast to such vagueness, Democratic Socialists for Medicare for All (for whom we work) — a campaign organized and paid for by Democratic Socialists of America, working in coalition with National Nurses United and Labor Campaign for Single Payer — has defined its five core demands as follows. They dovetail with the Sanders and Ellison bills.
There should be a single, federal program
We need a true single-payer system, not a patchwork. Unlike our current fragmented mess of a health care system, Medicare-for-all would ensure that Americans no longer have their health outcomes determined by the free market’s whims.
It would expand Medicare to everyone as a single, public program and prohibit private insurers from offering competing services, effectively abolishing the private health insurance industry altogether and democratizing approximately one-sixth of the US economy.
Health insurance CEOs currently make an average of over $20 million per year by profiting off the sick; Medicare-for-all will redirect the money that currently goes to them toward its intended purpose: providing health care.
With all Americans on the same program, every doctor and hospital will be in-network, giving patients complete freedom to choose from whom and from where they receive care. Unlike tiered systems in which the wealthy are able to purchase a higher standard of care — the kind that CAP and United States of Care advocate for — Medicare-for-all will extend high-quality care to everyone.
As Nye Bevan, architect of Britain’s National Health Service, argued in 1958, “you can’t have different treatment in order of contribution. You can’t perform a second-class operation on a patient if they aren’t paid up.”
Coverage should be comprehensive
The program will provide comprehensive coverage that exceeds the services currently covered by Medicare. Dental, vision, and mental care will be covered, as will inpatient care, outpatient care, primary care, preventative care, palliative care, ambulatory care, emergency care, maternal care, and newborn care.
It will eliminate the need for supplemental insurance, expanding the benefits of expensive “Medigap” plans to everyone. Sanders’s bill will also cover contraceptives and abortion, as well as repeal the Hyde Amendment, which largely bars the use of federal funds to pay for abortion; that would make it one of the strongest reproductive rights bills in US history.
Health care should be free at the point of use
Everything covered under Medicare-for-all will be provided without cost, meaning no fees, no copays, and no deductibles. Medicare-for-all isn’t “affordable access” or the opportunity to pay for care; it’s care without any financial hurdles at the doctor’s office, clinic, or hospital.
The program will be funded by progressive taxation — in other words, by primarily taxing corporations and the rich. American residents and employers would pay a tax that would effectively replace their current health care expenses; it would be modest for most and rise according to ability to pay.
Sanders projects that his bill will mean substantial savings for 95 percent of Americans. The average working-class family currently pays nearly $6,300 a year in premiums — not to mention unpredictable out-of-pocket spending. Under Medicare-for-all, such a family would pay less than $500 in taxes, saving well more than $5,000 per year.
Medicare-for-all will be a program by and for the people, one based on neither charity nor sacrifice. It will benefit everyone, guaranteeing that none of us ever has to worry about affording a medical emergency. Such a program will eliminate the number one cause of bankruptcy in the country and remove the unnecessary stress of dealing with the insurance market, decommodifying one of our most basic human needs.
The program would be universal
Medicare-for-all will cover all American residents, regardless of income, age, employment, medical history, or immigration status.
“Health care is a right” has become such a common catchphrase that proponents of all kinds of health care plans have adopted it. Yet any health care proposal that maintains unequal coverage and cost-sharing — the requirement that patients foot part of the bill — can never be truly universal. Even meager copays deter patients from receiving care. And forcing people to choose between competing insurance plans, even with a robust public option on the table, will inevitably leave many underinsured.
If we are truly committed to the idea of health care as a right, then we will eliminate the profit motive and guarantee that all patients receive the same standard of treatment and breadth of coverage. Real universal programs foster solidarity by bringing people together under equal treatment for the benefit of the common good. Medicare-for-all will be the first program of its kind in the United States, and will change Americans’ understanding of what they can and should demand from their government.
It would provide a just transition for workers currently employed by the private insurance industry
Both the Sanders and Ellison bills include severance, placement assistance, and job training for those affected by the abolition of the private insurance industry. Many people will still be needed to administer Medicare-for-all, but it will result in a massive reduction in administration work, eliminating the need for many insurance workers and administrative staff in hospitals.
More health care providers will be needed, and health care professionals currently working for insurance companies can find work in the field. But a training and placement program is absolutely necessary to protect the incomes of insurance and administrative workers for whom the transition proves more challenging. Our Medicare-for-all proposal will provide this.
A mass movement for Medicare-for-all is emerging around these five principles, with groups like the Democratic Socialists of America and National Nurses United running nationwide campaigns built on door-knocking and public advocacy. In April, the Democratic Socialists of America hosted its first Weekend of Action, during which dozens of chapters in more than 20 states canvassed and organized town halls or rallies; an even bigger weekend event is planned for August 11-12.
Last month, Healthcare NOW and Labor Campaign for Single Payer held a single-payer strategy conference in Minneapolis, attended by dozens of unions and single-payer advocacy groups from around the country.
These campaigns are working. A recent Morning Consult/Politico poll shows that 63 percent of American voters support a “Medicare-for-all health care system, where all Americans would get their health insurance from the government.” Just 26 percent were opposed.
Clear, honest messaging will help us build on this popularity and prevent lookalike proposals from sowing confusion.
Let there be no doubt — Medicare-for-all is a universal, public program that would provide comprehensive medical care to all American residents, totally free at the point of use. Any attempt by pundits or lobbyists to muddy the waters around this proposal is an obvious attempt to co-opt the campaign’s momentum with an eye toward weakening future legislation and protecting the interests of health-industry profiteers.
Ocasio-Cortez’s moral clarity on the campaign trail worked to great effect with New York City voters. Medicare-for-all reflects that resolute vision, one in which our common well-being and dignity take obvious precedence over the profits of a few. For millions of American voters, there’s nothing ambiguous about it.
Tim Higginbotham and Chris Middleman are organizers with the Democratic Socialists for Medicare for All campaign. Find them on Twitter @singlepayertom and @_Middleman
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