This article won a third place Saul Miller Award in the Organizing category at the 2020 Labor Media Awards, presented by the International Labor Communications Association.
LOS ANGELES—Is it time to step away from the term “Medicare for all” and start saying “single payer?”
This was one of the issues Mark Dudzic posed to a grouping of labor activists and educators that met at the Los Angeles County Federation of Labor headquarters one afternoon last week. Dudzic is the executive of Labor Campaign for Single Payer. Los Angeles was his seventh out of eight California labor council meetings on the subject. He was joined in the presentation by California healthcare advocate Dr. Bill Honigman and local Nurses activist Mari Lopez.
The pathway to a single-payer healthcare system (more on the terminology below) runs through California, Dudzic says, as part of a plan to establish a working statewide model for other states to emulate. The preeminence of California derives from the fact that both of California’s legislative chambers have Democratic supermajorities now, and Gov. Gavin Newsom has shown himself as a bold proponent of the single-payer idea. During s 2017 candidate forum held by the National Union of Healthcare Workers, he said:
“There is a lot of mythology about the cost of a single-payer system—that somehow we are adding on top of an existing multipayer system when in fact it’s about reallocating existing resources and using them more effectively and efficiently by replacing the current multipayer system. A single-payer system drives down the cost of healthcare. Even with Covered California, millions have seen double-digit increases in their premiums. Single payer is the way to go.”
Recent polls both in California and nationwide have found that 53% of Californians back single-payer, as do nationally 56% of all Americans.
Dudzic cites the 1944 promise by Pres. Franklin Delano Roosevelt, in the wake of the New Deal and the soon to be concluded World War II, to make healthcare a human right. Though that promise was thwarted at the time, 20 years later Congress did pass Medicare under Pres. Lyndon B. Johnson. In 2009-10, with Pres. Obama in the White House, the moment seemed right for further progress. Although single-payer was not invited to the discussions at the president’s table, in that two-year window in which Democrats controlled the White House, the House of Representatives and the Senate, the Affordable Care Act (Obamacare) did pass, which has proven to be popular. Defending it became the single greatest issue in the 2018 midterm elections, which Democrats won handily. Obama has since become more outspoken about the need for single-payer.
Single-payer is based on two principles:
1) That healthcare is a fundamental human right, a public good like education, firefighting, and libraries, not a commodity in the marketplace. Healthcare has not followed that model in the U.S., says Dudzic, frankly because it is “the most profitable business in the history of capitalism.”
2) “This stuff is not rocket science.” Most other countries have figured it out. As a partial model one need only look to our own Medicare, which most Americans are happy with, and also to Veterans Affairs (VA) healthcare. But so far, “we don’t have the [organization] to take on the political and economic power of corporate healthcare.”
Simply unsustainable
“Linking healthcare to employment is a really bad idea,” says Dudzic. It came about post-WWII in lieu of FDR’s 1944 proposal in the more conservative and McCarthyite Truman years. But the chaos of the present system is “simply unsustainable.”
In 2018, the average healthcare cost for a working-class family was $28,000. The employer paid $16,000, and the family paid $12,000. But to keep even that level of coverage, union workers gave up anywhere from two to four wage increases over that many contract cycles since 1990.
How to organize and include low-wage workers in healthcare is a major problem because neither the workers nor the employers can afford it. “One of the drivers of low-wage work is the healthcare crisis.” Even if non-union workers could match union workers in pay, they would be undercut by healthcare. As the labor force changes, with more and more workers in the gig economy, receiving healthcare coverage through your employer is a prospect receding ever farther into the distance.
According to Dudzic, the crisis has created wage stagnation. Workers have demanded of their unions that in negotiation, “Whatever you do, don’t give in on healthcare.” But “the boss knows that and will hold that as a sword over you in bargaining.” So contracts have consistently compensated with fewer vacation days, less overtime, less regulated working conditions, and lost wages. “When you bargain over healthcare, you’re really bargaining against yourself.”
The latest single-payer bill in Congress, HR 1384: Medicare for All Act, is now endorsed by unions representing a majority of organized workers in the labor movement. A similar Senate bill has been introduced by Bernie Sanders. There are still some unions that believe their healthcare benefits are better than those in Medicare for all. But those benefits are precarious at best: People lose their jobs and they and their families suddenly aren’t covered; and not everyone in their communities gets healthcare, creating an “us vs. them” conflict.
It’s simply better to “take healthcare off the bargaining table.”
There has also occurred a massive movement in public opinion. Now some 70% of Americans believe the government needs to guarantee healthcare. This is “a gigantic paradigm shift that doesn’t happen very often,” Dudzic says. It’s only comparable in recent years to the shift on same-gender marriage.
But the labor movement has not yet prepared the public for the struggle ahead over healthcare. The medical-industrial-business sector has a vast propaganda system in place designed to preserve their profits, with fake front groups, mass media and social media ad campaigns, newspaper editorials in the monopoly press lined up to persuade Americans to act and vote against their own interest. Among the themes the oppositional campaign will emphasize are the following:
- It’s too expensive—we can’t afford it. It will cost $30 trillion over the next ten years. Labor’s response is that healthcare is already too expensive, costing Americans $34 trillion if we continue to do nothing over those ten years, and continuing to get worse overall health outcomes than in comparable advanced countries.
- Rationing—with horrifying examples of a Canadian waiting a month for a knee replacement! But Americans already have healthcare rationing according to the kind of benefit package you have, or if you have one at all. People are literally dying in the streets, while others are compromising their health by cutting their pills in half so they can pay their sky-high rent.
- The government can’t do anything right. Yet the government actually does pretty well at collecting and spending money, which is what we want in a fair and equitable healthcare system. Since 1935, not one person has ever missed a Social Security check, and few people get away without paying their taxes.
- Money will go to freeloaders. Such as? Immigrants, IV drug users, people with “unhealthy” lifestyles, LGBTQ people, women having “too many” babies, people who will take advantage of free doctor appointments. In the recent West Virginia teachers’ strike, one of the complaints was that teachers had to wear activity monitors in order to qualify for healthcare benefits.
- You’re going to lose what you have. This plays on people’s natural fears of being caught with no health insurance whatsoever, and of Medicare being swamped and compromised by all these other people coming in.
“We have to inoculate people against this counterattack,” Dudzic says. Even some Democrats might say it’s too big and we have to proceed slowly, incrementally. We don’t have the power to enact this now, they say, so we have to make concessions.
To that Dudzic answers, “Build the power!”
Indeed, there are some Democrats, in a state like California where the voters emphatically want progress on healthcare issues, who have not yet endorsed HR 1384. They should not be afraid of their voters. But perhaps they are beholden to some of their campaign donors. At the time of this meeting, those include such representatives as Brad Sherman, Norma Torres, Lou Correa, Tony Cardenas, Gil Cisneros, Julia Brownley, Raul Ruiz, Scott Peters and Harley Rouda. Their constituents need to start speaking out.
In any new legislation, whether on the state or the federal level, the labor movement has to address the issue of a just transition. Yes, Medicare for all will displace workers in insurance companies and in doctors’ offices, and there must be a future for them. New opportunities must be offered in community clinics, perhaps also in early retirement buyouts, but it’s imperative not to allow the bosses to use this as a wedge. This has been the case with coal and fossil fuel workers, who have been slow to embrace new, greener technology without good jobs for the survivors of old industries.
Nor can the labor movement wait until a Democratic president is elected and unveils their plan. The healthcare movement must ensure that only a strong Medicare for all advocate can win a Democratic primary.
Mark Dudzic outlines five guidelines for action:
- Fight for what we want, not what we think we can get.
- We, not the corporations, set the terms of the debate.
- Educate and mobilize union members to go out into their communities with the message of urgency for Medicare for all.
- Hold the politicians’ feet to the fire, and accept no more empty platitudes.
- Use every tool in the organizer’s handbook to built the power we need to get this done.
Why is “single-payer” labor’s favored term?
It may seem to most people that “Medicare for all” and “single-payer” are synonymous, and they are often used to mean the same thing. But some in the labor community prefer the latter term. Medicare as we know it now does not embrace the range of concerns the labor movement has in improving healthcare in the United States. For example, it does not cover dental, vision and hearing. As Dr. Honigman, a now retired doctor of emergency medicine in Orange County, says, “Every night in the ER, people come in with dental infections” that have started impacting other systems. “Since when are eyes, ears and teeth not a part of the human body?”
Single-payer would also eliminate supplemental plans, and do away with co-pays and deductibles. In Honigman’s experience, patients simply do not come in for treatment because of those co-pays. “They make the wrong healthcare choice because of the economic factor.” “Single-payer saves money and costs less. We’re going to recover that money and put it into healthcare. It makes good economic sense.”
HR 1384 does address some of these issues, but people hearing the term “Medicare for all” may assume it’s the just the less-than-perfect Medicare they know but made available to everyone. Single-payer is both broader and more specific and accurate.
Furthermore, Honigman says, “In California we could do better than Canada,” and he insists on including mental healthcare too. “We have to make the political winds blow our way…. We need to call b.s. when we hear it…and we need people to stand on this issue, not just resist Trump.”
Mari Lopez of the Nurses closed out the session with a brief report on what organizing is already taking place, involving broad outreach to students, the faith community, rank-and-file union members, neighbors, communities of color, canvassing, town hall meetings, and film showings (of Fix It: Healthcare at the Tipping Point).
“In 99% of the doors we knock on, we find that someone in that house has a healthcare issue.”
“It’s not a matter of if,” Lopez says of achieving single-payer. “It’s a matter of when.”
More insight came in response to questions from those in attendance. One, coming off the current measles epidemic, had to do with communicable diseases. “We’re just two steps away from all being in the hospital,” Lopez says. Mark Dudzik adds that preventative medicine also has to be part of the healthcare system we imagine.
Another discussion arose around homelessness, the opioid and HIV/AIDS epidemics. With hospitals closing, and with the extent of the homelessness crisis, Dr. Honigman says, access to care is poor for those with untreated medical and mental illnesses. He also cites climate change, as well as industrial and corporate waste, as contributing to more communicable diseases.
Single-payer appears more achievable day by day. It is certain to play a leading role in the 2020 election, which the Trump Republicans have already framed as a debate about socialism.
When it passes, it will transform America.
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