The Democratic establishment — deep in the pockets of the health industry — wanted to make sure any blue wave election in 2018 would help sink, rather than support, the growing movement for a single-payer health care system. The recent decline in co-sponsors of the House Medicare for All legislation is, in part, a byproduct of this strategy and a reminder of the great obstacles corporate Democrats have put in front of the single-payer movement.
In 2018, there were 124 cosponsors for the Medicare for All bill in the House (then H.R. 676), representing 66 percent of the Democratic Caucus. This was celebrated widely as a high-water mark for the legislation. So was the release of Bernie Sanders’s Medicare for All bill in the Senate, which also got a record 16 co-sponsors, including prominent Democrats who are running for president.
Given that the Democrats gained 35 seats in the 2018 midterm and Medicare for All has been polling extremely high among Democratic voters — a survey by Reuters from August 2018 showed around 85 percent of Democrats supported the policy — many were hopeful that the number of cosponsors would rise even higher in the current Congress.
Despite this hope, when Rep. Pramila Jayapal introduced the new flagship Medicare for All bill (H.R. 1384), the amount of co-sponsors decreased considerably to 106, down to 47 percent of the caucus. So why, if Democratic voters are moving left on health care, is this not reflected in Congress? Where did all the co-sponsors go?
A Truthout analysis shows the primary reasons for this decline are: 1) incumbents who once supported Medicare for All who have defected, and 2) a largely disappointing freshman class.
The most well-known faces of the freshman class are progressives, such as Alexandria Ocasio-Cortez, thanks to their ambitious proposals and popular support. This might give the impression to the public that this is reflective of the whole class. The majority of the newest House Democrats, however, were shaped strongly by the Democratic Congressional Campaign Committee and the New Democratic Coalition. About 71 percent (42 of 59) of freshman House members declined to co-sponsor the legislation. Some freshman candidates who ran on the issue during the campaign, like Harley Rouda of California, still declined to co-sponsor Jayapal’s bill.
In happier news for the movement, three incumbent Democrats decided to co-sponsor Medicare for All for the first time: Reps. Joseph Kennedy and William Keating of Massachusetts, and Susan Wild of Pennsylvania. However, 29 of the Democrats who were previously co-sponsors have defected this year. Why are Medicare for All’s congressional supporters backing out?
Incumbent Democrats Turning Away
It is much less courageous for members of Congress to co-sponsor legislation that has no chance of passing. So last year, as members of Congress quickly signed on to H.R. 676 some suspicious names appeared on the list (like Joseph Crowley, who had never hinted at support for the policy until he faced Alexandria Ocasio-Cortez in the primary). In the minority, they could add their names while, behind closed doors, giving viable explanations to donors: “Don’t worry, it has no chance of passing — I am just getting re-elected.”
Now that Democrats control the House, this calculus changes for many. Sure enough, 29 incumbents who previously co-sponsored H.R. 676 have failed to co-sponsor the newer bill, which recently was made stronger to include long-term care for elderly and disabled Americans. Among these defectors are Reps. Elijah Cummings, Hakeem Jeffries and Marcy Kaptur.
“It’s another painful but important lesson about the limits of politely pushing elected officials to the left,” writes Alex Panagiotopoulos, who analyzed the defections. “Just because they co-sponsor or promise to support legislation doesn’t mean [they will] expend any political capital to make it happen.”
Adam Gaffney, president of Physicians for a National Health Program, told Truthout that the most important thing is to keep pressuring candidates to support the legislation.
“The movement has been putting pressure on Democrats [that] don’t support it, this kind of work must continue,” he said. (Gaffney recently impressed many with his stirring defense of Medicare for All on Fox Business News.)
Why the Freshman Class Is Largely Unsupportive of Single-Payer
When people think of the freshman class of Democrats, the most recognizable names tend to be Reps. Ocasio-Cortez, Ilhan Omar and Rashida Tlaib. This makes sense, as they are pushing popular policies — and are constantly attacked by Republicans.
These strong voices of dissent, however, are in the minority in the new Congress. By and large, the freshman class of House Democrats has refused to support single-payer in practice. Of the 59 freshman Democrats elected to Congress this year, only 17 of them (a woeful 29 percent) co-sponsored H.R. 1834.
This was not by chance. It can be traced to the Democratic National Campaign Committee (DCCC) and the corporatist New Democratic Coalition in the House (and its affiliated NewDemPAC). Long before the 2018 midterms were underway, Democratic Party power brokers and fundraisers were militant in trying to keep prospective members of Congress in line going into the 2018 election. This included pleading with new candidates not to support single-payer or, as The Intercept reported with corroborating audio, trying to bully progressives out of the races altogether, depriving voters of a chance to weigh in. Establishment Democrats’ goal was, as Politico reported, to “neutralize the threat” of single-payer.
“Democratic voters want single payer health care. But don’t expect to hear Democratic candidates talk about it,” the report said. “To avoid divisive intraparty fights that drive candidates left — only to be attacked by Republicans for favoring socialized medicine — the Democratic Congressional Campaign Committee warned aspirants last year about the political liabilities of endorsing ‘single-payer.’”
Until the Bernie Sanders campaign in 2016, single-payer was not recognized by most media and politicians as a mainstream proposal (despite its popularity among the public). Sanders energized the movement, putting powerful Democrats and industry stakeholders on guard.
Surely, the leadership of the New Democratic Coalition and similarly minded organizations chalk this up to another victory for the “vital center.” They, like House Speaker Nancy Pelosi, argue the voters aren’t “ready” for single-payer, despite its massive popularity. This is a rather dubious interpretation, however, given that the DCCC deprived many voters of a chance to vote for a single-payer candidate in their district. Candidates were hand-picked by party officials in many instances, as the Hoyer tape proved.
When seeking candidates in 2018, the DCCC embraced the centrist/corporate Third Way agenda. The New Democratic Coalition, which preaches free markets and is funded largely by Wall Street, endorsed 27 candidates in the 2018 primary. The DCCC, the primary fundraising institution for the House, endorsed 25 of these 27 candidates via its Red to Blue list. This provided money, support, opposition research and more, giving these candidates a huge advantage in the primaries. As a result, candidates supporting single-payer found themselves being thwarted, attacked and outspent by their own party leaders, who were defying the wishes of most of their base.
“The Democratic Congressional Campaign Committee unleashed a scorched-earth campaign against [House candidate Laura Moser of Texas],” reported Vox, “releasing an opposition memo highlighting past statements Moser made seemingly denigrating her home state.”
Moser, a single-payer supporter, lost to the DCCC’s choice, Lizzy Fletcher, in the primary. Fletcher won the seat and failed to co-sponsor the new Medicare for All bill.
By contrast, the DCCC did not support any of the same House candidates endorsed by the Bernie Sanders-founded organization, Our Revolution, which endorses candidates with a range of progressive views on single-payer and beyond.
The New Democratic Coalition saw 16 of its endorsed candidates win in 2018. Of these 16 candidates, only three co-sponsored the Medicare for All bill in the House. Had the DCCC not gone so far out of its way to oppose single-payer supporters, the outcome may have been quite different. Had they embraced single-payer, the amount of co-sponsors could have risen considerably.
“The problem we have is actually with the Democrats,” said Jessica Early, a nurse practitioner and health care justice organizer, in a 2017 interview with Truthout. “We know how Republicans are going to vote on this issue. The obstacle we face is getting Democrats who will support us into office.”
Can New Democrats Derail Single-Payer?
The term “New Democrats” refers to an ideological and strategic movement that argues the U.S. is fundamentally a center-right country and the Democrats must embrace this — and corporate donors — to win elections. During the 1990s it was the most powerful wing of the party: Bill and Hillary Clinton, John Kerry, Joe Lieberman and most of the party’s top names were on board. The New Democrats boasted about helping pass the Welfare Reform Act of 1996, which added work requirements to cash and food assistance and was supported mostly by Republicans in Congress. The organization was also hostile to candidates who tried to run as progressives, such as Howard Dean and Ned Lamont in 2004 and 2006 respectively.
This kind of thinking has, for the most part, fallen out of favor: There is virtually no grassroots support for “centrist” moderation. It is a doctrinal assumption, however, made by much of the dominant media, that proposals like single-payer will hurt Democrats in the general election, or in districts that President Trump won in 2016. Third Way, which is run largely by hedge fund managers, advanced this theory in its Winning on Health Care memo in 2016.
“A national debate over single payer is what Republicans want since it would turn health care from a winning Democratic issue into a losing one,” Third Way pleaded.
Many advocates, however, say a national debate over single-payer is exactly what the Democrats – and the United States more generally – need to be having.
“This is a winning issue for the American people and for the Democrats,” Gaffney said. “Now we have to get it done.”
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