By Jonathan Michels
Jacobin, December 30, 2020
As 2020 comes to a close, we are no closer to winning a national health program in the United States than we were before COVID-19 struck, even amidst so much physical and financial suffering. But it would be a mistake to discount the entire year as a total loss.
Despite immense challenges and setbacks, there were moments during 2020 that offered hope in the movement for Medicare for All. Here are some of the highlights of both.
Much has been written about how the coronavirus pandemic laid bare the fact that everyone, even those fortunate enough to have health insurance, is vulnerable to sickness and death under our cruel and disjointed health care system. But Medicare for All supporters know, America has been in a perpetual public health crisis for more than a hundred years.
Even before the pandemic, as many as 250,000 Americans died each year from medical errors alone. As horrific as it is for 14.6 million people to lose their health insurance as a result of widespread job loss, that statistic is dwarfed by the 87 million Americans who already lacked insurance or were underinsured before 2020. Meanwhile, racial health inequalities were exacerbated by COVID-19.
A more important lesson to draw from the pandemic is that public health crises are not inevitable. In contrast to our multitiered system, Medicare for All would provide a single tier of coverage to everyone in the United States, regardless of income, employment status, disability, gender, or immigration status.
Single payer would eliminate financial barriers like exorbitant deductibles and copays, and strengthen our ability to respond to current and future public health crises by ensuring our tax dollars go toward meeting human needs.
The reasons that so many Americans are desperate for Medicare for All are clear. How we win transformative health reform comes down to our ability to build on the momentum fomented, in part, by Bernie Sanders’s 2020 presidential campaign to broaden the appeal for Medicare for All and mobilize a mass movement around it.
Workers Claim Their Essential Status
While many people have continued on selflessly as “essential” workers, the designation has been a death sentence for some. The coronavirus doesn’t care if you are a prisoner transporting dead bodies for $2 an hour, a meat packer at a poultry plant, a stocking clerk at a grocery store or a worker at a long-term care facility.
As the pandemic has shown, when workers don’t get the things they need to do their jobs safely, people die. That realization is what prompted workers like Chris Smalls and thousands of others to walk off their jobs or stage protests throughout 2020 — many of them without the protection of organized labor. Smalls and his coworkers organized a strike in March over lack of safety precautions at an Amazon warehouse in Staten Island.
“How essential are we if we’re spreading this virus to customers?” Smalls told VICE News in March. “Amazon is a breeding ground for the coronavirus. We’re going to be the second wave. Right now, I’m trying to prevent that.”
Amazon allegedly fired Smalls for taking a stand, but his protest inspired other workers around the country, like Tre Kwon, an ICU nurse, to organize a protest outside her workplace demanding better personal protective equipment (PPE).
Frontline health care workers are particularly vulnerable to contracting the virus because they work so closely with COVID-19 patients. Over fourteen hundred frontline medical workers are estimated to have died from COVID-19 as a result of unsafe working conditions, including a lack of PPE and testing.
In the face of mounting health risks and unbearable workloads, frontline health care workers not only earned the deserving admiration from the public, they have used the attention to speak out.
“We are afraid for our patients,” Kwon said at a demonstration outside of Mount Sinai hospital. “We are afraid for our families. We are afraid for our lives.”
The words and, more importantly, the actions of workers like Smalls and Kwon underscore the connection between workers’ safety and the public at large. Those links will have spread long after the pandemic is over if we ever hope to win a national health program.
Physician Groups Buck the Status Quo
The year started off on a promising note with the release in January of a position paper in support of single-payer health care published by the American College of Physicians (ACP), the country’s largest specialty society with 159,000 members.
“For a century, most U.S. medical organizations opposed national health insurance,” wrote Dr Steffie Woolhandler and Dr David Himmelstein, cofounders of Physicians for a National Health Program. “The endorsement of the American College of Physicians of single payer reform marks a sea change from this unfortunate tradition.”
Later in August, amid the worsening coronavirus pandemic, the 3,300-member Society of General Internal Medicine (SGIM) endorsed the ACP’s policy prescription.
The ACP is the second-largest physician group in the United States after the American Medical Association (AMA), the country’s most prominent and powerful physician group and the third largest lobbying group, behind only the National Association of Realtors and the US Chamber of Commerce.
In 2018, the AMA joined with organizations representing private health insurers, medical device manufacturers, and pharmaceutical and hospital executives to form a benign-sounding corporate front group called the Partnership for America’s Health Care Future whose goal is to “change the conversation around Medicare for All” — in other words, to halt it.
Caving to pressure from a coalition of physicians, workers, and grassroots organizers, the AMA abruptly withdrew from the partnership in August 2019. The American College of Radiology eventually exited the group as well.
Doctors have actually been among the most adversely affected by our market-driven health care system. Like other frontline health care workers, some doctors have succumbed to COVID-19 or been fired by their employers for speaking out about the lack of safety measures and PPE.
We can take heart that more white coats are using their credibility and respect to convince their colleagues of the need for a more equitable health system. But until conservative physician groups like the AMA are forced to change their priorities or at least are neutralized from thwarting comprehensive health reform, much more work is needed to empower the growing enthusiasm for single-payer among medical students and the majority of practicing physicians who already support Medicare for All to speak out.
Private Health Insurers Make a Killing
Humana, Anthem, and other private health insurers posted blockbuster profits even in the face of hundreds of thousands of deaths from COVID-19 and 14.6 million people losing their employer-sponsored coverage as a result of the economic meltdown. UnitedHealth Group alone pocketed an additional $4.1 billion in revenue during the first quarter.
“Americans are getting sick & dying, and doctors [are] risking their lives to save them, in this crisis,” tweeted Wendell Potter, former vice president of corporate communications for Cigna and industry whistleblower. “Meanwhile, health insurance companies are denying coverage & squeezing doctors to generate record profits. That’s the story of healthcare in America today.”
Thanks to Potter, we knew that the private health insurance industry exists to extract money by denying Americans health care when they need it. Now we know they can make even more dough even — perhaps especially — during the worst public health crisis in the United States in more than a hundred years. That alone should be reason enough for us to demand Medicare for All and to eliminate the private health insurance industry.
Canada’s Single-Payer System Is Upheld
In September, the Supreme Court of British Columbia beat back a legal challenge that threatened to transform Canada’s Medicare program from a universal, single-payer system into a two-tiered system based on an individual’s ability to pay for care rather than on need.
The “Cambie trial” was the culmination of ten years of legal maneuvering by Dr Brian Day, an orthopedic surgeon and the CEO of the Cambie Surgical Centre, a private, for-profit clinic based in Vancouver.
What does an attack on Canada’s universal health care system have to do with medical care in the United States? A lot.
Single-payer advocates have long pointed to Canada’s Medicare program as a model for what an American national health care program could look like. American neoliberals know this, of course, so they have worked tirelessly for decades to amplify the efforts of corporations and allies like Day who want to put health care in Canada in the hands of the free market.
The Cambie trial specifically highlights the influence of right-leaning think tanks within the Atlas Network, a vast collection of nearly five hundred organizations in more than ninety countries, who have a shared interest in promoting a neoliberal health care agenda that favors privatization, direct payment, limited government, and any other policy that increases market dominance under the guise of freedom of choice but which often leave patients with little or no choice about their medical care.
Conservative think tank leaders in the United States like Sally Pipes of the Pacific Research Institute routinely cite the wait time report to smear single-payer in her congressional addresses, public debates, and in editorials published in mainstream news outlets. Pipes, meanwhile, uses her think tank’s PR apparatus to characterize Day as a “crusader” fighting to liberate patients from the Canadian health care system.
Working in unison, Atlas affiliates create a kind of echo chamber that allows them to sow doubt about the efficacy of single-payer health care in virtually every corner of the globe. It isn’t merely “intellectual support” that Day and others receive from these right-leaning organizations. The Atlas-affiliated Canadian Constitutional Foundation donated $5 million to spearhead Day’s legal team, which is expected to mount an appeal to the Supreme Court of Canada.
“Most Canadians are unaware of how our healthcare system is under attack,” said Karen Palmer, a health policy adviser to Canadian Doctors for Medicare, an advocacy organization that opposes efforts to privatize Canada’s universal health care program. “I think the constitutional challenge to our health care system has caused some to sit up and pay attention because there is a lot at stake.”
Discrediting Canadian Medicare serves private interests like Day, but it is also used to undermine the Medicare for All movement here in the United States. Health care advocates on both sides of the forty-ninth parallel must remain vigilant in the face of coordinated efforts to privatize our social goods.
Medicare for All on the Ballot
At a time when political divisions in the United States appear to run deep and wide, universal public goods like Medicare for All are poised to fill the breach.
Despite a million-dollar ad campaign from the Partnership for America’s Health Care Future to keep it under wraps, Medicare for All emerged from the 2020 Democratic primary and the general election a clear winner.
One exit poll, among many, conducted by Fox News of all places recently demonstrated that the majority of Americans — 72 percent — are united in their desire for a publicly funded, universal health care system regardless of their political loyalties.
Not only is it now expected that progressive candidates back Medicare for All, their support for the reform could determine whether they are elected or not. “Every single candidate that co-sponsored Medicare for All in a swing district kept their seat,” noted Rep. Alexandria Ocasio-Cortez.
It is because of their work connecting people around shared struggle that the movement has been elevated to heights not seen since the 1940s when single payer enjoyed the support of two-thirds of the American public, the major labor unions, and even the president.
As Frances Gill, a medical student and organizer with the Democratic Socialists of America’s Medicare for All campaign, told me, “The popularity of [Medicare for All], the broader group of people who want nothing less — these are things we won over the last couple years and are going to be very powerful tools going forward.”
A North Carolina Health Care Union Victory
In September, 1,600 nurses at Mission Health hospital in Asheville scored the largest labor victory in the South since 1975 when they won union representation with National Nurses United (NNU) in the face of a brutal union-busting campaign during the pandemic by the country’s most largest hospital corporation, HCA Healthcare.
The victory could be a big boost for other workers in North Carolina and the rest of the anti-union South. It also has the potential to invigorate the Medicare for All movement in the region, which will almost certainly play a pivotal role in the reform’s passage.
Although single-payer was not a focus of the Mission nurses’ union campaign, the frontline health care workers often talked about how their jobs have been made impossible because of the profit motive of health care corporations like HCA.
The very groups that have linked rights in the workplace with the health of their patients have been nurses and health care unions, most notably NNU. For that reason, the nation’s largest nurses’ union devotes significant resources to winning Medicare for All.
The health reform represents such a threat to HCA’s bottom line that it joined the Partnership for America’s Health Care Future in order to stymie the single-payer movement.
Not only would Medicare for All eliminate the private health insurance industry, it also has the potential convert for-profit hospital conglomerates like HCA into nonprofits and reign in the profit motive for every hospital through the use of global operating budgets that would make it easier to ensure that public money is spent on services that produce healthy outcomes instead of bloated administrative departments or expensive medical equipment designed to attract well-insured patients.
Medicare for All would also give a boost to health care workers like the nurses at Mission who want to unionize, because hospitals would be barred from using public money to bankroll union-busting campaigns.
“HCA has 180 plus hospital systems, clinics, and outpatient surgery centers,” Mission nurse Susan Fischer told me during an interview for Jacobin earlier this year. “They’re just buying up the Southeast, and these hospitals are going to need unions to make sure that their patients and communities are safe when they walk through the doors of that hospital.”
“Until we can get Medicare for All, this is what we have to do,” she said.
Questions of Strategy and Movement Building
In 2020’s last weeks, comedian and podcaster Jimmy Dore called on Rep. Alexandria Ocasio-Cortez and other progressive members of the Squad to force a floor vote on Medicare for All in open defiance against Speaker Nancy Pelosi and other centrist Democrats. The call ignited passionate debate on the Left as Medicare for All advocates scrutinized the strategy.
Some people, including AOC herself, rejected Dore’s appeal on a strategic level, fearful that the political fallout from the vote’s assured defeat would set the growing Medicare for All movement back on its heels. Others embraced the tactic, excited by the chance to expose congressional Democtratic leadership for their refusal to support universal health care in the face of overwhelming need during the COVID-19 crisis.
Judging from the debate around the floor vote proposal, it is clear that the passion and excitement to fight for Medicare for All continues to burn bright despite the pandemic. Regardless of whether a vote on Medicare for All vote actually takes place in 2021 or not, we need more discussion of our tactics and strategy going forward. If we can’t, we’ve already lost the fight.
Jonathan Michels is a freelance journalist and health care worker based in Durham, North Carolina.