Summary: Tuesday’s midterm elections pitted Dem efforts to build social welfare and protect abortion rights and democracy against GOP blaming Biden for inflation and crime, and advocating for limits on abortion. The Dems performed strongly, but threats to democracy loom. We explore how the fights for democracy and single payer align.
By Jim Kahn, M.D., M.P.H. and Kenneth Colón
What the midterm election told us:
The nation averted the “red wave” endorsement of MAGA politics, with the best first midterm result for a Democratic president in decades. Voters responded to appeals to protect abortion rights and democracy, and largely didn’t blame Biden for post-COVID inflation. Yet it’s not time for complacency: American democracy remains in danger.
CNN reports that of the 34 Republican candidates for Secretary of State or Governor who rejected, questioned, or tried to overturn the results of the 2020 election, 11 are projected to win their races. The Republican National Committee has supported 70+ “election integrity” lawsuits, intending to suppress votes and systematically deprice Dems of full representation, as in the case of hyper-aggressive gerrymandering. A GOP Senate, if that happens, will obstruct Dem appointments to courts and agency oversight boards. The US House of Representatives will likely be GOP-controlled. This will likely lead to nearly nonstop hearings attacking Biden and other favorite targets of the Right to build support for a 2024 GOP presidential win. With a GOP president, traditional norms on stability of domestic and foreign policies will be jettisoned via bureaucratic subterfuge (a reclassification of civil servants as “policy making” thus depriving them of job protection, affording the president massive power to enforce loyalty over law). Meanwhile, the US Supreme Court will consider a case next month that may put control of federal elections solely in the hands of state legislatures — some of which, as a byproduct of extreme gerrymandering, deviate sharply from the views of their constituents. A Dem presidential candidate may win more votes, yet the state electors go to the GOP.
To be sure, there are encouraging signs in the mid-terms. Support was high among young Americans, who leaned very Democratic due to progressive values and favoring student debt relief – helping achieve impressive Dem overall and progressive results. We also elected our first Gen Z member of Congress. More and more, it appears that voters are recognizing and reacting to the threats to democracy. This offers hope of further broadening of resistance to GOP efforts to undermine majority rule.
Where does health reform fit in?
Small changes nudge us in a good direction, e.g. in the Inflation Reduction Act: more subsidies for the ACA, and Medicare drug price negotiations, constraints, and out-of-pocket spending limit. Yet single payer would do much better at controlling overall health care costs and save families thousands of dollars.
Beyond that, single payer is the health reform that most faithfully embodies the democratic values we’re fighting for. Equality would jump as universal, high-quality insurance replaces being uninsured, under-insured, or insured by under-funded programs for the poor. Liberty would rise by delinking work and insurance coverage, and offering real, unfettered choice of providers — not false choice among over-priced insurance plans. Small businesses and entrepreneurship could flourish as a result. Community would blossom by fostering the shared experience of access to care and elimination of medical debt. Americans could live longer, healthier, more fulfilling lives.
Is there a viable link between promoting single payer and saving democracy?
Single payer proposals engender massive attacks as “socialism” and “government takeover”. It isn’t, of course — it’s public financing of private care. Notably, even modest and inadequate reform ideas like a public option are similarly attacked, so we might as well think big, aiming for an approach that would really solve health care financing problems. Fortunately, people are increasingly recognizing the fundamental failings of our fractured insurance mess and thus the need for real reform.
So, how can we link the fight for single payer with the fight for democracy? Here are some ideas:
- Understand the links – where do the values overlap? We started above and are exploring other shared values. But we’d like to broaden the discussion and disseminate this idea.
- Explore alliances – convene organizations working on single payer and democracy preservation for structured discussion and mission coordination.
- Scrutinize the idea that the Dems should focus on small-bore incremental health reforms rather than single payer, which generates vigorous attacks from the GOP interests vested in our current health system. One potential counterargument is that only comprehensive health care financing reform broadly and powerfully advances democratic values. It’s the only way to control costs globally and for families. Another is that all healthcare reforms proposed by Dems will be condemned by the GOP anyway, so Dems should not let the GOP guide their healthcare strategy.
- Broaden political involvement. For people excited about these issues and energized by midterm results, and perhaps thinking about working with the local political party, or volunteering in elections – now is a great time to start.
- Encourage discussion. With friends, family, neighbors, anyone who will engage. Spread the word, but also listen well to their thoughts, beliefs, and concerns.
Let’s make meaningful progress on the parallel and aligned fronts of democracy and health care justice!