With Primaries Over, Advocates Fight to Keep Single-Payer in Spotlight

The 2018 primary was a historic election for the movement for Medicare for All, which continues to ascend into heights that seemed unimaginable just a few years ago. Advocates of the policy face a challenge as they pivot to the general election: How to keep the issue central to the midterms.

In the last few years the momentum for Medicare for All, a “single-payer,” publicly financed plan for universal coverage, has been undeniable. In 2016, the Bernie Sanders presidential campaign helped bring the policy into the national debate. In 2017, RoseAnn DeMoro of National Nurses United said 2017 was “the summer for single-payer.” She was pointing to the record-setting support for the House version of Medicare for All (H.R.676) and the introduction of Sanders’s Medicare for All bill (S.1804) in the Senate.

As important as those two years were, however, the 2018 primary has also been a pivotal moment in the fight for single-payer. More candidates who supported single-payer ran (and won) for office — up and down the ballots — than they have in at least a generation.

“This has been an unprecedented election season for the single-payer movement, and it definitely shows that the ground has shifted on this issue,” said Benjamin Day, director of the single-payer advocacy group Healthcare-NOW, in an interview with Truthout. “The country is already there … the role of grassroots organizations like ours is just to close the democracy gap at this point and get Congress moving.”

The momentum is serious enough for the major industry stakeholders (pharma, the insurance industry, medical associations, hospitals, device manufacturers) to create an entire organization, the Partnership for America’s Health Care Future, devoted to keeping the issue from becoming the consensus among Democrats.

But a consensus appears to be forming — at least in the House, where 123 of 194 Democrats support Medicare for All, as well as among voters of all ideological stripes. As the primary season was winding down, a Reuters/Ipsos poll was released showing record support for Medicare for All: 70 percent of the public, 85 percent of Democrats and a stunning 52 percent of Republicans. Even 60 percent of industry executives think single-payer would have a positive effect.

Other events have also galvanized the movement. Advocates hope that the Medicare for All Caucus, a coalition of House members whose purpose is to pursue and study the policy that was formed this summer, can be a vehicle to move H.R.676 through the House. The new caucus, Day says, is “already one of the largest caucuses in the House, is a major development, and will be the group bringing pressure from the inside.”

There are also important new leaders who have yet to get national attention in the campaign, Day said. “To me, the more emblematic (but less publicized) primary campaign was Michigan’s 9th Congressional district,” said Day. In this race Andy Levin is expected to win the general election on a campaign supporting single-payer. His father, Rep. Sandy Levin, who has a powerful perch on the Ways and Means committee, has never supported this kind of reform in more than 30 years in Congress. Young people are far more supportive of Medicare for All than their elders, so this reflects a generational shift in more ways than one.

Indeed, Levin’s likely victory in the general election (his district is extremely blue) counters a flawed media narrative that single-payer can only win on the coasts. “I feel like we’re really trying to launch a whole response to 2016, a new politics of solidarity,” Levin said, after winning his primary on August 6. “People are so sick of all the fussing, and they want a strong vision of America where we have health care for everybody.”

Down-Ballot Shakeup in New York Is a Boon for Single-Payer

The dominant media in the United States have long been hostile to single-payer, treating it as a pipe dream and often citing its costs and not its savings. This has not changed since the issue has penetrated mainstream debate. For instance, media outlets would highlight supporters of single-payer who lost state-wide races — such as Cynthia Nixon in New York, or Abdul El-Sayed in Michigan — and portray their losses as evidence that Medicare for All is a losing issue.

These reports overlooked many successes further down the ballot. In fact, the New York Primary may turn out to be an extremely important development for single-payer. In New York, the chair of the health committee in the Democratic-controlled State Assembly, Richard Gottfried, has passed a single-payer bill many times in the Assembly over the years (the New York Health Act, or A05062).

The problem for advocates is that in the State Senate, a group of conservative Democrats, calling themselves the Independent Democratic Caucus (IDC), created a majority government by caucusing with Republicans. As a result, the Republicans have not put the issue up for a vote, even though a majority of the Senate has cosponsored the senate version of Gottfried’s bill.

But due to pressure from the left, the Independent Democratic Caucus dissolved in April. Six of their eight incumbents lost last week to progressive challengers and Democrats are widely expected to control both chambers after the election. If they do, and if current supporters don’t back out, the math suggests the bill should be able to pass both houses and at least make it to Cuomo’s desk.

“Support is growing with the public. In the State Senate, we now have 31 cosponsors – one vote shy of a majority. The Democratic Primary results will raise the energy level, and I expect even more support after the November election,” Assemblyman Gottfried told Truthout. “I look forward to working with a progressive, Democratic Senate majority – including bill sponsor Senator Gustavo Rivera, ranking member on the Senate Health Committee – to pass the bill in both Houses.”

Senator Rivera tells Truthout he is excited at the possibility of a Democratic-controlled State House, so they can pass the NY Health Act. He said he would meet with Gottfried to update and improve the bill prior to the next session.

“If we do the work, there is a good chance we can control the Senate and I will be chair of the health committee. It being my bill, you can bet I would work with [Gottfried] to pass a bill and get it signed by the governor,” Senator Rivera told Truthout in an interview.

Meanwhile this year, a much-anticipated RAND study was released on the law and found it to be viable — as did a 2015 study from liberal economist Gerald Friedman, which showed it would result in considerable savings in overall health spending in New York, especially those with lower incomes.

“The authors estimate that total health care spending under the New York Health Act (NYHA) could be slightly lower than spending under the status quo,” the RAND study, titled “An Assessment of the New York Health Act,” concluded. “Spending would be similar in 2022 and 3 percent lower by 2031, with the ten-year cumulative net savings being about 2 percent, if administrative costs and growth in provider payment rates are reduced,” the report found.

Cuomo only grudgingly offered qualified support for single-payer for the first time in 2017. He supports the concept on the federal level but has not given a public statement on the NY Health Act.

The prospect of the Senate changing hands, as well as the release of the RAND study, has led to a flurry of activity by opponents of single-payer in the state, in both the health and finance industries. These interests formed a coalition and a website called “Realities of Single-Payer.” devoted to trying to counter the NY Health Act and spin the RAND study, organizers tell Truthout.

“The insurance industry seems to know that it is possible to flip the Senate, and that’s why they have launched an opposition group spouting lies and misinformation about the impact of single-payer health care in New York,” Robbins said.

This is not unlike the approach of the Partnership for America’s Health Care Future, but it differs in that it is aimed at stopping single-payer at the state level.

“Until political power shifts in D.C., New York has the opportunity to lead the way by pursuing universal, public health care, which will protect residents from the assault on health care from the Trump administration,” Robbins said.

Single-Payer as a Referendum on Trump and GOP

Robbins’s framing of single-payer as an antidote to GOP attacks is one that could help keep the single-payer discussion alive in the coming months. Trumpcare scared America to its core. At one point, a Senate version of Trumpcare that would throw 23 million off insurance polled at 12 percent support. Further, Trump’s director of the Center for Medicare and Medicaid Services, has said the Trump administration won’t approve any state single-payer plans.

Contempt for Trump is, like support for the single-payer movement itself, moving to new heights, and single-payer is the kind of policy that would most protect the public from GOP ideologues and industry power brokers who are constantly trying to put their hands in the public’s pocket. If advocates can successfully portray the policy as a direct antidote to Trump’s attacks on the public’s health care, it could intensify or widen its level of support.

Many have cited the Trumpcare efforts as a potential watershed moment in the push for a national health system. As Sarah Jones wrote in The New Republic:

This latest example of its resilience represents a turning point, if Democrats choose to seize the opportunity…. Now is the time for the Democratic Party to begin building a proposal for a single-payer health care system.

GOP Attacks on Single-Payer

Jones is right to qualify her assessment with “If Democrats choose to seize the opportunity.” Democrats have a long history of squandering, not seizing, opportunities. But while some Democrats are wary of running on single-payer, Republicans are raising the issue to try and portray the party as being in favor of socialized medicine. For instance, Ohio gubernatorial candidate Richard Cordray refused to support single-payer in his successful campaign against Dennis Kucinich, a long-time supporter of the policy. This has not stopped Cordray’s GOP opponents, however, from being attacked for it. “He owes voters a clear answer: does he support imposing a Single-Payer healthcare system on Ohio?” asks an attack ad from the Republican Governors Association.

This is where the party is very much divided. Cordray is following the Third Way/DCCC playbook and avoiding the issue. Others want to have this debate — and this includes several gubernatorial candidates who are seeking reform at the state level as well.

“Governors who enthusiastically support single-payer health care are the key for Medicare for All legislation to ever advance at the state level, but they’ve been like unicorns in recent decades — more rumor than reality,” Day said. “This year we saw high-profile gubernatorial candidates running on Medicare for All across the country, and quite a few of them winning their primaries in California, Colorado, Maryland and Massachusetts. There is no question that the window for state single-payer legislation is opening wider, just as momentum is building in Congress.”

It is all part of a stunning revival of a policy that could save thousands of lives and incalculable suffering each year. Organizers are acting with purpose, sensing this could be an early stage of the fight for health care as a human right.

“I believe we have a duty to create a world in which health care [is] accessible to everyone, and with the political will created by a grassroots movement making the demand, it is immensely possible,” Robbins said.