If you’re a Democratic party star who’s being talked about as a potential 2020 candidate for president, you probably recently announced your support for single-payer legislation.
Sen. Bernie Sanders will unveil his Medicare for All bill on Wednesday afternoon, flanked by high-profile co-sponsors including Sens. Kamala Harris (D-CA), Elizabeth Warren (D-MA), Cory Booker (D-NJ), Jeff Merkley (D-OR), Sheldon Whitehouse (D-RI), and Kirsten Gillibrand (D-NY).
It’s a sharp departure from the mainstream political conversation just a year ago, when Sanders was running against former Secretary of State Hillary Clinton for the Democratic nomination. During the campaign, Sanders’ advocacy for a single-payer system was popular among a large section of the progressive base but didn’t have this kind of full-throated support from other leaders of the Democratic Party.
Asked about Sanders’ Medicare for All platform last April, Clinton said she agreed with the goal of universal coverage but couldn’t support his single-payer bill.
“I do think when you make proposals and you’re running for president, you should be held accountable for whether or not the numbers add up and whether or not the plans are actually going to work,” she said. “If someone promises you something for free, read the fine print.”
Now, many of the party’s rising stars sound a lot more like Sanders.
“You should not be punished because you are working class or poor…. I think health care should be a right to all,” Booker said Monday. “This is something that’s got to happen. Obamacare was a first step in advancing this country, but I won’t rest until every American has a basic security that comes with having access to affordable health care.”
“I’m co-sponsoring @SenSanders’ #MedicareForAll bill,” Merkley tweeted an hour later. “Health care should be a right for all, not a privilege just for the healthy & wealthy.”
The single-payer platform seems to have swiftly found its way into the Democratic party’s good graces, but this political moment wasn’t created in a vacuum. Grassroots activism on the state level, contentious battles over the Affordable Care Act, and Sanders’ 2016 presidential campaign have all resulted in a political environment where it’s become easier for national lawmakers to lend their public support to the progressive policy.
“I do think historically this is an important moment,” Ben Palmquist, an activist with Healthcare Is a Human Right at National Economic and Social Rights Initiative (NESRI). “There’s no guarantee but I think that the door is open.”
“Health Care Is A Human Right”
Many activists on the state level have been pushing for a universal health care system for decades.
NESRI works closely with the Vermont Workers’ Center, a group that was founded in the late 1990s and has been advocating for a single-payer system in the state for years. The group fights for the rights of workers but found health care to be a “sticking point,” said Keith Brunner, the campaign co-director at Vermont Workers’ Center.
In 2008, the group kicked off the Health Care is a Human Right campaign.
“We are essentially trying to remove insurers from the game,” Brunner said. “Health care should not be a market commodity… it’s something that should be provided as a public good. It’s expending the idea of democracy into the economic sphere.”
Their campaign was successful in getting a bill through the legislature. In 2011, Vermont passed a law that paved the way for the state to establish the first single-payer health care system in the country; the effort stalled when the governor pulled his support in 2014. The small state failed to figure out how to finance the system, and Gov. Peter Shumlin, who had once championed the bill, decided it wasn’t “the right time” for Vermont.
Similar campaigns popped up around the country in places like Maine, California, and Pennsylvania, where activists in have been knocking on doors, canvasing, holding clinics with nurses, and putting on town halls where people can tell their health care stories.
In 2014, New York State Assembly Leader Dick Gottfried organized hearings around the state to discuss single-payer. Activists gathered at the hearings and organized people to tell their stories in support of a universal health care system.
Since then, the New York State Assembly passed single-payer legislation for the first time in 20 years, with the support of single-payer activist groups (though the legislation has not passed the State Senate).
“We are essentially trying to remove insurers from the game. Health care should not be a market commodity… it’s something that should be provided as a public good. It’s expending the idea of democracy into the economic sphere.”
A similar campaign has been underway in Pennsylvania for several years, and in California, Andrew McGuire, the executive director of a group called California OneCare, has been organizing for more than 44 years. Years ago, McGuire started bringing together organizations with an interest in single-payer.
Now, it looks increasingly likely that California could be perhaps the most serious testing ground for single-payer. Advocates recently rallied around SB 562, a single-payer bill that passed the California State Senate, although the Assembly Speaker stopped the bill from coming to the floor.
Single-payer versus Obamacare
Single-payer activists have had a complicated relationship with the Affordable Care Act. During the early years of the Obama administration, as the fight over the ACA took hold of Washington, many activists were sharply critical of the legislation — saying it didn’t go far enough to accomplish their goals.
“We were saying we see this as a false solution,” Brunner of Vermont Workers Center said. “Ultimately, it’s a structure where we’re taking public money to subsidize the insurance companies… We want it to be a public good.”
The activists who spoke to ThinkProgress said they were also concerned about some specific elements of the ACA, such as the lack of ability to negotiate with drug companies, the fact that undocumented immigrants were left out of the system, and the lack of meaningful cost controls.
And the ACA’s uneven implementation across the country revealed further gaps that some activists hope a single-payer system would be able to overcome. After the Supreme Court ruled that Obamacare’s Medicaid expansion should be optional, for instance, millions of low-income Americans have been locked out of health care reform altogether.
One activist, Tim Faust, said it was working to help enroll people in the ACA in Florida — where lawmakers rejected the Medicaid expansion — that ultimately led him to support a single-payer system.
“I had to go to work,and there was a bunch of folks I would talk to who didn’t qualify for Medicaid without the expansion,” Faust said. “They were left out, and I had to break my brain every single day, explaining to folks, ‘Hey, I’m sorry, you’ve been failed.”
In the Obama years, many activists hoped that pushing back against the ACA from a progressive perspective would result in steps toward universal care.
But after President Donald Trump was elected and the GOP-controlled Congress inched closer toward its longstanding goal of outright repealing the law, the terms of engagement changed.
“I had to go to work,and there was a bunch of folks I would talk to who didn’t qualify for Medicaid without the expansion. They were left out, and I had to break my brain every single day, explaining to folks, ‘Hey, I’m sorry, you’ve been failed.”
“Most of us assumed in the past that if we’re comfortable enough, at least we won’t slip farther than that. Future progress is uncertain but steps backward won’t happen,” Palmquist said. “But if they’re willing to dismantle the ACA, take health care away from people… what else are they willing to do?”
Now that health care reform is more vulnerable than ever before, single-payer activists have found themselves in a different position. They’re on the front lines making arguments for preserving Obamacare.
“For a long time single-payer supporters were very critical of the ACA,” Ursula Rozum, the upstate campaign coordinator for Campaign for New York, said. “It’s an interesting dynamic that attacks on the ACA have mobilized support.”
Sanders, Trump, and the new health care reality
Many activists point to Sanders’ passionate and high-profile support of a single-payer system as a major reason why the political winds have begun to shift toward single-payer.
After Sanders’ run, many activists were particularly excited by the fact that it was clear that Medicare for All was a popular policy among a large section of voters. Activists said they saw a tangible impact after the 2016 primary campaign. More people were showing up at organizing meetings, and the message was spreading into groups of people that hadn’t historically been engaged in the single-payer fight.
Drew Christopher Joy, the director of the Southern Maine Workers’ Center, said Sanders gave a voice to something he has seen on the ground for years.
“It really is true that the people are ahead of our legislators,” Joy said. “Folks on the ground experience the health care crisis.”
Activists’ message gained even more steam when health care reform came under attack in the Trump administration. Their arguments against repealing Obamacare mirror the points they have been making about universal health care for years: It boils down to the belief that health care is a right, not a privilege.
“Part of what we’ve done here in Pennsylvania is to absolutely get involved in the fight to defend against the repeal of the ACA without a replacement that’s better,” Nijmie Dzurinko, the co-founder of Put People First PA, said. “We’re not saying ‘Yeah, OK, just repeal it.’ We’re saying you have to replace it with something better and the only place to really go is universal health care.”
“It really is true that the people are ahead of our legislators. Folks on the ground experience the health care crisis.”
The renewed fight over the ACA has been a difficult line to walk for activists who are pushing for a state-based single-payer system, according to Rozum. But the attacks on Obamacare have opened up a moment for activists and legislators alike to have a policy conversation about more progressive reforms.
“We don’t want our success in New York to be on the backs of cutbacks around the country,” Rozum said. “There was more skepticism before, and now a lot of people in New York are seeing our statewide bill as a state-based defense of what might happen on the federal level.”
What comes next
This year, the political landscape is changing. A number of Democrats are running for Congress on single-payer platforms, including Jess King, who’s running for a House seat in Pennsylvania.
King, who’s running a conservative district, said she has had exciting conversations with people across the political spectrum about a single-payer system.
“Medicare for All and single-payer is just the right thing to do. It’s immoral that in the richest country in the world people still die from lack of access to health care,” King said. “And people we’re talking to are so excited about it.”
Activists agree there is renewed energy for the issue.
“I do feel that there is a shift,” Joy, of Maine, said. “It does feel like there is some new momentum.”
McGuire, who’s organizing in California, said there’s no question in his mind that a single-payer system is coming. In fact, he thinks that, at least in his state, it’s coming soon.
“I’m absolutely convinced we’re going to get single-payer,” McGuire said. “It will either happen with no major funding in five or ten years. With major funding we could have it in two or three years in California.”
And while many activists are excited by this moment, many of them are cautious about getting too far ahead of themselves, and they point to the stalled bill in Vermont as a warning about what could happen if the momentum dies down.
“Medicare for All and single-payer is just the right thing to do. It’s immoral that in the richest country in the world people still die from lack of access to health care.”
“It’s not something that we can just ask elected officials to do,” Palmquist said. “We have to change the politics and force them to support universal health care.”
Many activists echoed that refrain: Single-payer only happens if the grassroots movement overwhelms a donor class that benefits from the status quo.
“I think single payer is inevitable if we make it inevitable,” Faust said. “People have always wanted to be treated justly and humanely and fairly. This isn’t a radical proposition.”