Donald Trump’s exit from office — and the Republicans’ demotion to minority party — bodes well for patients in the United States, as the number of uninsured rose from twenty-seven million to nearly thirty million from 2016 to 2019. His administration’s willful sabotage of the already inadequate Affordable Care Act proved effective, with bottomed-out insurance navigator budgets, narrowed enrollment windows, and a so-called “public charge rule” that intimidated eligible immigrants from gaining health care benefits.
Add to that the yearlong pandemic, and the case for Medicare for All has rarely been more obvious. Millions have been thrown off their job-based health insurance at the same time insurance companies rake in record profits. The newly uninsured lucky enough to be absorbed by their state Medicaid program will likely experience the instability of insurance “churn” as they drift under and over the income threshold. The rapid expansion of rolls will strain state budgets and administrative capacities.
Meanwhile, hospitals relying on reimbursement are dangerously cash-strapped even as they’re slammed with COVID-19 cases. And millions of us are waiting for a largely publicly financed vaccine whose production was curtailed by a profit-driven intellectual property regime and whose rollout has been slow largely because years of austerity have starved public health departments.
Medicare for All — and the commitment to robust investment in healthy communities that comes with it — has something to say about all of these problems.
And yet, as the early Biden era unfolds, it’s unclear what exactly the new president intends to do about them. Joe Biden has heralded bipartisanship and vowed that “nothing will fundamentally change.” Though he initially ran on a so-called “public option,” the concept has vanished from his lexicon in recent months. The Democratic majority-by-a-hair seems unlikely to nuke the filibuster to pass sweeping reforms.
Nonetheless, socialists and progressives should continue to make Medicare for All one of our central demands. As Democrats gear up to pass a new COVID stimulus bill and legislate through budget reconciliation — a work-around for approving certain measures in the absence of a sixty-vote veto-proof majority — advancing a robust single-payer vision will serve a vital political education function, make inroads with legislators, and help keep the movement alive without a major presidential campaign to carry it.
Democrats seem likely to push for various tweaks to the ACA that, while improving upon the status quo, still leave the health care industry’s power — and mechanisms for harming patients — completely intact. We shouldn’t be timid about pointing this out: for example, Democrats’ plan to max out marketplace exchange premiums at 8.5 percent of income rather than 9.86 percent, as well as to eliminate the subsidy threshold so it no longer vanishes if a family’s income surpasses $100,000 per year, still preserves cost-sharing so high that many patients struggle to afford care when they need it — and leaves patients stuck with often tiny provider networks, vulnerable to bill collectors and lawsuits from providers, and saddled with the administrative burden of navigating byzantine insurance companies.
Similarly, fixing the so-called “family glitch,” which previously left certain dependents unsubsidized, does too little to alter the fact that families are financially penalized simply for having sick children. Perhaps most gravely, these changes wouldn’t upend the private insurance system or end employment-based insurance — two central problems of the US health care system. We desperately need Medicare for All.
Short of that, the Left can rally around a new bill from Bernie Sanders and Pramila Jayapal, the Health Care Emergency Guarantee Act, which would cover all necessary care for the duration of the COVID-19 pandemic. While the measure would sunset benefits once the country is fully vaccinated, offering patients a taste of single-payer could build a passionate constituency for it. It’s hard to take something good away from people — and that could build momentum for Medicare for All.
It would also provide a concrete campaign for Bernie supporters to get behind in the early days of the Biden presidency. The Sanders campaign activated thousands of newly politicized volunteers, many of whom are itching to get involved in transformative movement building. Organizing around Sanders’s signature demand is a natural next step, embedding them with other organizers and potentially filtering them into state-level single payer fights, insurgent electoral campaigns, and other local political initiatives.
Class consciousness is borne out of the realization that the power of health insurance executives, landlords, banks, and bosses all control enough resources to capture the political system to serve their own ends. Class struggle is how we wrest it back.