March 2, 2018

From Demand to Reality: YDSA Workshop on Medicare for All

by Dustin Guastella

The following remarks were delivered at the 2018 YDSA Winter Conference.

I want to open with a brief explanation of what Medicare for All actually is. Medicare for All is simple –– it means socializing health insurance –– making the Federal Government the insurer of all residents.

It means the establishment of a single, public, universal health insurance system where everyone, regardless of their employment or immigration status will have insurance. It means comprehensive care: all services provided by a medical professional will be covered. It means free, on-demand, unlimited care at the point of service paid for not on the backs of the sick but through taxes on the rich. That means no fees, no co-pays and no deductibles. And it means the establishment of a jobs program to provide jobs for those who currently work in the health insurance industry and would lose their jobs if the private health insurance system were abolished.

And while all of this is attractive to workers, it’s worrisome for our political and economic elite.

Of course insurance companies directly benefit from the high costs of health care, but other major employers will stomach rising premiums so long as it gives them a bargaining chip against their workers. Our financial and business elite are against any reform that limits or regulates their power, and especially those that lessen workers’ dependence on the market and waged work. And while many major employers would actually see cost savings under a Medicare for All system, the corporate class have political interests beyond just their profit margins. They are also aware that the current system chains employees to their jobs even as their working conditions deteriorate. Indeed, as workers conditions worsen and their wages remain static, employer-dictated health care helps create a pliant and captive workforce less willing to strike or walk off the job for fear of losing their care.

Finally, it’s important to remember that the ruling elite look out for one another; they practice class solidarity. In their eyes any social benefit that comes at the expense of profit sets a dangerous precedent.

Removing health care from the market challenges their power to manage their workers and affirms the state’s right to decommodify social goods and services. Every corporate executive, financial baron, tech guru and industry titan knows that if we were to socialize health insurance, their industry could be next.

For now, major executives will tolerate the high costs of health insurance in order to maintain their dominant position in the class struggle. Unfortunately, for them, the majority of American workers cannot tolerate these costs and the demand for a new system of social health insurance — Medicare for All — has become increasingly popular. In fact, the demand for Medicare for All represents the leading edge of a renewed egalitarian and even democratic socialist mood in this country. And to quote Maggie Thatcher, “there is no alternative” to a social health insurance system and, eventually, socialized health care. Obamacare was the single best attempt at a market-oriented health plan that elites have come up with. It has failed.

The demand for social health insurance has won the support of the labor movement with the AFL-CIO endorsing Medicare for All at its most recent convention. The National Nurses United alongside a variety of independent nurses unions around the country are enthusiastic supporters. This is largely because the realization of Medicare for All would put more monthly take-home pay back in workers’ pockets and would replace high and unpredictable premiums with low and stable taxes. The program would also take health care off the bargaining table for union workers, so they would be in a better position to bargain for wage increases and better working conditions rather than protecting an increasingly flimsy and expensive health care package. The support for Medicare for All among nurses and support staff is also born out of their own experience as caregivers in a fractured and broken health system and their desire for a more rational and just alternative.

But I think, for democratic socialists in particular, the fight for Medicare for All means even more.

First, as a political demand, Medicare for All represents the core of democratic socialist politics. The call for socialized health insurance epitomizes an oppositional working class politics and speaks to the material and felt needs of most Americans. The idea itself challenges the rule of capital, the political elite and the profit motive. Its popularity has exposed the contradictions in the Democratic Party: polling suggests that 70-80 percent of registered Democrats support the demand yet party leaders like Nancy Pelosi consistently mock single-payer advocates. Ideologically, advocating for Medicare for All opens space for socialists and progressives to speak to a frustrated electorate tired of the politics of the billionaire class. In other words, the demand alone affords us the unique opportunity to carve out a real democratic socialist politics at the level of the national political discourse and in the process expose both the weakness of market liberalism and the barbarism of Republican alternatives.

Second, campaigning for Medicare for All offers us the ability to build a mass constituency for democratic socialist politics and durable ties between our organization and a broad working class base. The institutions of the working class and the left have been destroyed over the past 40 years of defeat. As a result, the newly reborn democratic socialist movement is isolated from the mass base we need to realize any progressive reforms. Campaigning for positive programmatic demands like Medicare for All can have the galvanizing potential to unify the working class majority and integrate our organization with that popular base. Through campaigning for Medicare for All we can also avoid the do-goodery and charity approach to politics so often associated with non-profit activism. Instead we aim to build bonds of solidarity and legitimacy as an organization democratically committed to the needs and interests of our own members and connecting them to the desires and aspirations of the majority of Americans.

Finally, the realization of Medicare for All would, for the first time in the history of the United States, establish a universal social program. It would mean the appropriation and socialization of 1/6th of domestic GDP. It would signal a decisive turn away from market-dependence and toward social freedom not only in the realm of health but in all spheres of life. As a result, it would build the capacities of individual workers to organize and strike. And of course, the realization of Medicare for All make this country a much healthier and more equal place. By virtue of the dramatic improvement most people would see in their health and day-to-day lives, the program would generate a built-in constituency among the electorate: those who benefit from the new system would soon become enthusiastic and vocal defenders of it. In this way Medicare for All represents a transformative demand: a demand that not only builds working class unity but potentially swings the political pendulum towards working class power.

All of this raises the question how can we win?

Any reform that empowers working class at the cost of profitability will be met with tremendous resistance. But we can take lessons from the fights fro worker oriented health care around the world. In particular, the success of the Labour party in the United Kingdom following World War II. After the war, England’s ruling class was largely discredited and their legitimacy as a governing force was severely damaged. The Labour Party was able to sweep to power and implement broad reaching reforms because they were able to unite a mass working class base, isolate the ruling elite from broad support and divide the class amongst itself.

Similarly, in the United States, our contemporary ruling class is in the midst of a legitimacy crisis. The moneyed elite –– along with the intellectual and technical elite –– staffing our government are almost universally distrusted. Our task is twofold: we must continue to facilitate the delegitimization of the ruling elite among the working class majority, as well as isolate them from any popular support. Simultaneously, we need to generate intra-class divisions between the various sectors of capital such that the entire elite are incapable of acting in unison.

In other words, we need to unite the mass of Medicare for All supporters –– health care workers, nurses and support staff, trade union members, students, retirees, physicians, and Sanders voters –– to create a durable and powerful insurgency that can effectively raise the demand to the highest levels. We also need to successfully neutralize moderate liberals like the newly formed –– and elite driven –– “United States of Care” among other ameliorative reform efforts that offer nothing but failed half-measures. But perhaps most importantly we need to isolate the insurance industry from other sectors of the corporate class in order to weaken the corporate grip on health care policy. Ultimately, in order for the state to be vulnerable to mass pressure from below, we to generate deep political divisions in the business community. Our goal should be to create total political chaos in the Chamber of Commerce. And amidst that chaos an organized, unified and effective popularly insurgency can step in with a legitimate solution: Medicare for All.

Of course, the scale and breadth of the popular movement we need cannot be built overnight. Unlike many defensive or reactive civil resistance movements –– it will not be set off by a spontaneous spark or a major event. It cannot be convened through high-profile press-conferences, celebrity endorsements, appeals to liberal elites or fleeting stunt activism.

Instead, the movement of the kind we need to achieve Medicare for All will only be built through connecting with millions of people across the country, in their neighborhoods, town halls and workplaces. It will only be built through the painstaking, labor-intensive process of person-to-person organizing around a clear and programmatic agenda for Medicare for All. It will be built with the knowledge that there are no guarantees of victory or even short-term success.

However, it will be organized with the certainty that, if we win, it will mean much more than the achievement of socialized health insurance; it will mean establishing a piece of real democratic socialism.