Rep. Pramila Jayapal (D-WA) reintroduced the Medicare for All Act into Congress in March. The bill netted a record 112 cosponsors, which amounts to more than half the House Democratic caucus. Thanks to a surprise endorsement by Rep. Frank Pallone of New Jersey, the Medicare for All Act now seems destined to pass another historic marker, with its first hearing in the powerful House Committee on Energy and Commerce sometime in the current legislative term.
Meanwhile, outside of the DC Beltway, Medicare for All enjoys widespread support among the public with 72 percent of Americans in favor of making the switch to a publicly funded national health program.
Just how long support will remain at these current levels, however, is unclear. One barrier to advocates’ ability to maintain momentum are the persistent misconceptions spread about Medicare for All by its enemies.
A poll conducted by the Kaiser Family Foundation in 2020, for example, found that nearly 50 percent of Americans mistakenly believed that they could maintain their employer-sponsored health insurance under the health reform. That should alarm Medicare for All supporters, since one of their main selling points to the public is that it will eliminate increasingly exorbitant private health insurance plans.
It’s vitally important that we know and clarify exactly what we are fighting for. Drs Abdul El-Sayed and Micah Johnson understand this. Which is why they packed useful information into their book Medicare for All: A Citizen’s Guide to help anyone who needs a better understanding of the often misunderstood “policy-in-waiting.”
The book is a useful tool for even the most seasoned organizers looking to build the mass movement necessary to take on the medical profiteers who have prevented us from achieving national health insurance for more than a century.
The biggest lesson that readers ought to walk away with is this: Medicare for All is a reform with massive implications that reach far beyond health. As El-Sayed told Current Affairs in 2019, “Why single payer is so beneficial isn’t just that it would provide everybody healthcare. That’s really important, and it should be a primary goal, but it’s not the only goal.”
Medicare for All also has the potential to serve as a massive wealth redistribution program to middle- and low-income families, a jobs creator, a promoter of unionization, a check on hospital expansion and consolidation for profit, and a way to connect other human rights struggles together. Medicare for All would put tremendous constraints on private interests that, as the history of universal social programs show, will prove difficult to dismantle.
Hospitals, El-Sayed and Johnson tell us, exemplify the human cost of getting the policy details wrong, as well as the way that Medicare for All’s potential to improve health care delivery can be used by organizers to grow the movement in their states and local communities.
Medical centers have become the dominant employers and economic drivers in former industrial centers of the United States thanks to a tremendous influx of federal money. Currently, a third of all health spending goes to hospitals. But instead of using their economic leverage to decrease the financial burden on patients and to deliver higher-quality care, for-profit and not-for-profit hospitals dominate a region, then use their market power to coerce patients and insurers into paying exorbitant prices.
Giant hospital corporations, nonprofit or for-profit, are virulently opposed to Medicare for All precisely because their ability to increase revenue through monopoly power is diametrically opposed to the interests of health care workers and patients. Tenet and the Hospital Corporation of America (HCA), two of the largest for-profit hospital operators in the world, understand their shared interest, so they funneled hundreds of thousands of dollars into an anti-single-payer front group called the Partnership for America’s Health Care Future.
HR 676, the first national health insurance legislation introduced in Congress back in 2003, called for participating for-profit hospitals to convert to not-for-profit. Unfortunately, that provision is not included in the previous House bill (HR 1384) or Sen. Bernie Sanders’s signature Medicare for All Act. This omission will hopefully be corrected during the legislative process. As long as ravenous hospital corporations continue to rule the health care “jungle,” whatever Medicare for All bill that Congress churns out will likely be unpalatable to both patients and health care workers.
Thankfully, as El-Sayed and Johnson explain, the Medicare for All Act of 2021 maintained the use of global operating budgets as called for under HR676 as the mechanism for allocating funds to the envisaged national health program. They may sound technical, but global operating budgets are used every day to pay for our police and firefighting departments, libraries, and other institutions designed to meet universal, social goals.
Much of our health care right now is fee-for-service. The more procedures that are done on a patient, the more revenue is collected by the provider. The money is then laundered through a myriad of payers and financial transactions that make up our broken health care system.
Global budgets, on the other hand, cut through the unfathomable complexity by replacing per-patient billing with lump-sum payments that would be disbursed to hospitals based on what their operating costs were the previous year. That means hospitals will no longer have to waste time fighting over each patient’s payment. It will also be easier to identify where public dollars are going, so the money is spent on services that produce healthy outcomes.
El-Sayed and Johnson also remind us that Medicare or All would give a boost to health care workers looking to unionize, since hospitals would be prohibited from using public money to bankroll union-busting campaigns. The very groups that have linked rights in the workplace with the right to health of their patients have been nurses and health care unions, most notably National Nurses United.
For all their power and influence, hospitals are extremely vulnerable, since the interests of patients and health care workers are often aligned. Connecting those common interests is the key to winning Medicare for All. Medicare for All advocates should use this fact under coronavirus to mobilize community support around health care workers at their local hospitals.
“The battle for public opinion is not just a contest of ideas,” the authors remind us. “It’s also a contest of power, with supporters and opponents deploying all the resources at their disposal to get their message in front of people and change hearts and minds.”
While El-Sayed’s unsuccessful 2018 Michigan gubernatorial campaign is never mentioned in Medicare for All, the experience clearly gave him insight into how corporate interests use their money and influence to change the conversation around health reform in their favor. Before becoming a prominent spokesperson for national health insurance, El-Sayed championed a state-based single-payer plan dubbed “MichCare” during his campaign. Like Medicare for All, MichCare also called for the expansion of health coverage to every Michigander under age sixty-five through a single, publicly funded program. Dr Micah Johnson, El-Sayed’s Medicare for All coauthor, was one of the principal architects behind MichCare.
Establishment Democrats who refused to support health care reform beyond protecting and strengthening the Affordable Care Act stood in sharp contrast to El-Sayed. The young physician endeared himself to progressives by daring to speak out against Democratic primary rival Gretchen Whitmer’s close personal and financial ties with Blue Cross Blue Shield of Michigan, including a fundraiser to boost her campaign. Not surprisingly, Whitmer dodged El-Sayed’s attempts to put single payer at the forefront of the debate and cast doubt on MichCare as an unrealistic policy proposal. Despite winning the endorsement of Sanders and Rep. Alexandria Ocasio-Cortez, El-Sayed’s antiestablishment insurgency proved no match against the powerful forces united against him.
El-Sayed’s struggle to rally public support for MichCare, like numerous other attempts to pass comprehensive health reform in the United States, proved once again that the obvious merits of single-payer policy will not be enough to win Medicare for All.
“What would it take to strengthen the consensus on M4A and build the political will for reform?” ask El-Sayed and Johnson. “There is only one foreseeable possibility: a popular national movement pushing for M4A. Quite simply, there is no other force strong enough to overcome the partisan attacks and the deep-pocketed opposition from industry.”
The difficult work of building political power in support of Medicare for All will continue to rest on supporters’ ability to effectively communicate the inordinate ways that Medicare for All directly addresses people’s material needs, with the goal of inspiring more people to join such a movement. If organizers incorporate Medicare for All: A Citizen’s Guide’s insights to guide their actions, they might yet achieve single payer in the United States in our lifetime.