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The Democratic Party platform now states clearly that “we fundamentally believe health care is a right for all, not a privilege for the few.” And following the Senate races in Georgia, Democrats will now take control of both houses of Congress along with the presidency. So the question is, now that they will hold power, how will the party reform healthcare? In 2009, Barack Obama assumed the presidency as Democrats held a supermajority in the Senate, with a majority in the House, yet the party failed to pass the full-fledged reform they sought, instead landing on a compromise bill, the Affordable Care Act (ACA), which expanded healthcare access but did not make coverage universal.
Now, the Covid-19 pandemic has fully revealed the structural flaws of the healthcare industry model: profit-driven, just-in-time staffing and supply chains have produced unsafe work environments, a lack of regular testing, and too little personal protective equipment for healthcare workers. The defunding of public health systems and long-standing health inequities can no longer be ignored. Instead, this crisis requires a fundamental systemic response, and a single-payer system is the only comprehensive, cost-saving option that eliminates barriers to care while addressing the multi-faceted Covid-19 public health crisis.
That solution is rooted in the savings, universality, comprehensive benefits, public health, and cost control generated by single-payer healthcare financing.
Advocates for Medicare for All have won the policy debate — a recent study from the Congressional Budget Office shows again that single-payer saves money, controls costs, and covers everybody, including for long-term care. There is tremendous popular support for Medicare for All. But we lack the backing among enough elected officials to win politically, including from the newly inaugurated President Joe Biden.
Our task is not to simply convince Biden to change his views on Medicare for All, but to change the political waters in which that view holds sway. Our task is to create the political will to topple the for-profit healthcare industry, which means building a popular movement that can vilify its business model, expose its corruption of policymaking and shine a light on its financial influence over elected officials, who should similarly be exposed and challenged electorally for protecting an inhumane system.
Fixing the ACA is on the table, if it can be done in the Senate through a majority vote in the “budget reconciliation” process, or if the Democrats eliminate the 60-vote filibuster rule. As consumer advocate Wendell Potter writes, “Biden has proposed lowering the age of Medicare eligibility to 60 and establishing a public health insurance option to compete with private insurers. He also campaigned on improving the Affordable Care Act to make federal subsidies available to more people.”
With an evenly divided Senate, there will likely be a push from mainstream Democrats to add a “public option” to the health plan. But even a genuinely public program with no out of pocket costs that provides comprehensive benefits, like the “public option” proposed by the Biden-Sanders Unity Task Force, doesn’t contain costs system-wide, leaves 10 million people uninsured, burdens taxpayers with a bailout of insurers to keep their product “affordable,” and adds further complexity to a costly insurance plan-based payer system.
When a federal ACA fix bill moves through committee, there will be a strategic opportunity to demand a “mark-up” of the single-payer bill and the inclusion of key policy priorities — such as lowering prescription drug prices and eliminating out of pocket expenses — in whatever bill emerges. This process could bring media and political attention to the policy advantages of Medicare for All.
But the task is larger than working to improve the ACA. We must organize to solve the healthcare crisis, not just to “fix” the bill.
There’s a set of administrative actions the Biden administration could take to immediately expand healthcare coverage, including enrolling everybody in Medicare for the duration of the pandemic, as incoming Senate Budget Committee Chairman Bernie Sanders has proposed. Passing additional pandemic-related healthcare legislation will be essential, so pressing for that package to include coverage of all out-of-pocket costs for everybody while covering the uninsured is both good politics and good policy.
Many advocates believe the political road to a national healthcare program is through a successful state model. Biden’s Health and Human Services Department, under the leadership of Medicare for All supporter and California Attorney General Xavier Beccera, can administratively grant state innovation waivers to establish single payer in states such as California, where support is strong. Gov. Gavin Newsom campaigned in favor of single payer. Initiating a waiver would change the argument from whether to implement a single-payer system to how. And it’s arguably the fastest way to move the issue politically while demonstrating the policy advantages of such a model. Other states could also follow course.
Still, there is no shortcut to winning guaranteed healthcare for all residents of the United States. Doing so will require a mass movement allied with, and incorporating the demands of, broader social movements for justice. We must continue to loudly protest and challenge the inequities highlighted by the pandemic, the public health crisis of racial injustice, anti-immigrant attacks, and state-sanctioned violence — which includes the denial of healthcare itself — propelled by economic inequality. At the heart of overcoming these injustices, Medicare for All stands as a policy solution that would intimately affect and improve our lives.
Fighting for a universal, guaranteed healthcare system embodies solidarity — the acts of kindness and caregiving that show we are all in this together, taking care of each other. It’s a task worth taking up in 2021.
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Michael Lighty, a Sanders Institute Fellow and DSA activist, is a consultant for the National Union of Healthcare Workers.