If you are among the majority of Americans who want the government to guarantee health care to all, the current political moment raises a question: What can you realistically hope for, considering that the incoming Democratic president opposes the idea?
Over the weekend, there has been a debate raging on social media, in which some progressive critics began demanding that lawmakers like Representative Alexandria Ocasio-Cortez use their votes in the upcoming House speaker election as leverage to get a commitment for a floor vote on Medicare for All legislation. The idea is that, because the House is so narrowly divided, a handful of progressive icons in Congress could torpedo Nancy Pelosi’s bid to get reelected speaker, unless she agrees to schedule such a vote.
A floor vote on existing Medicare for All legislation could absolutely be a useful organizing tool — it could clarify which Democratic lawmakers actually support the idea, which Democrats are merely feigning support by just cosponsoring the bill but not voting for it, and which Democrats actively oppose it. That would provide a helpful road map for future primaries and pressure against its opponents.
However, only asking for that performative vote — rather than also asking for things that might change the structural power dynamic — would be a waste, and yet another instance of progressives reverting to a feckless tradition of prioritizing spectacles rather than the wielding of actual power.
If members of the Congressional Progressive Caucus were serious about championing Medicare for All — and about using their momentary power in the Speaker race as leverage — they could do much more than merely push for a ceremonial Medicare for All vote that might be helpfully clarifying but also would very likely fail.
They could additionally condition their vote for Pelosi on a commitment that she do the following.
1. Remove the Medicare for All opponent who chairs the key committee.
The current chairman of the Ways and Means Committee — which is one of the key panels overseeing Medicare for All proposals — is Representative Richard Neal, who has played a singularly destructive role on behalf of his health care industry and Wall Street donors. He opposes Medicare for All, and recently, he has tried to water down surprise billing legislation in the middle of the pandemic. Pelosi can remove Neal as the panel’s chairman, and next in line in seniority is representative Lloyd Doggett, who is a much more progressive lawmaker. In terms of changing the actual power dynamic, changing the leadership of this committee would do as much or more in one fell swoop than securing a doomed floor vote.
2. Schedule a vote on existing legislation to let states create single-payer health care systems.
Representative Ro Khanna has authored legislation empowering the Health and Human Services (HHS) secretary to approve waivers to states that want to create their own Medicare for All programs. As we previously reported, incoming HHS secretary Xavier Becerra has been an outspoken supporter of Medicare for All and has said he supports efforts to pass such programs in states — including in his home state of California, which recently considered such legislation. Unlike Medicare for All legislation — which is unfortunately probably still doomed to defeat right now — Khanna’s bill may actually have a shot at immediately passing the House and putting Becerra on the spot to deliver on his past rhetoric. An additional bonus: his bill could also humiliate Republican opponents who so often claim to support devolving power to states but whose votes against the proposal will expose their hypocrisy.
3. Schedule a vote on a resolution demanding Biden use executive authority to expand Medicare.
The American Prospect has reported that, thanks to provisions in the Affordable Care Act, President Joe Biden will have the unilateral executive authority to expand Medicare coverage during the pandemic. The House can pass a resolution demanding that he immediately take this action. A resolution like this should be a no-brainer.
4. Include provisions in year-end spending bills that create a presidential commission charged with crafting a Medicare for All program.
President Barack Obama created a commission to cut Social Security. Progressives can flip the script and create a commission charged with evaluating other countries’ universal health care systems and coming up with proposals to guarantee health care to all Americans. Granted, this is what Congress exists to do — but forcing a Democratic administration to come up with proposals could also advance the cause by pushing the executive branch to take the concept seriously.
5. Author a discharge petition to force a vote on Medicare for All.
A discharge petition is designed to let rank-and-file members of the House circumvent normal rules and committee procedures to force a floor vote on an issue. Creating a discharge petition on Medicare for All would help clarify who actually supports the program and who is merely cosponsoring Medicare for All legislation as a performative but empty gesture.
These are just five actions of many that could be taken in the context of the House Speaker’s race — and they can be taken in addition to a demand for a Medicare for All floor vote. Indeed, asking for all of these items means the final negotiated compromise position could be the Medicare for All floor vote.
But here’s the thing to understand: merely asking only for that vote — and not taking actions or making demands to substantively change the power equation — would start such a negotiation in a position of weakness, asking for the bare minimum from the beginning rather than asking for the whole loaf in hopes of at least getting half the loaf. It would also be a huge missed opportunity, and typical for a progressive movement that so often values spectacle over power.
In some sense, that proclivity is understandable — our short-attention-span social media culture disproportionately rewards spectacles rather than the unglamorous wielding of power. For instance, it is easier to do YouTube rants and get retweets about a high-profile floor vote than it is to get everyone excited about the much harder organizing work of getting esoteric HHS waivers or removing a relatively obscure committee chairman who is blocking progress.
Of course, the spectacles can be important — they can be critical organizing tools. But the performative gestures on their own are not enough. Ultimately, passing something like Medicare for All is going to require the actual wielding of power — and progressive lawmakers are in a position to wield some power right now by making an entire series of concrete demands.