Last week DSA Medicare for All Steering Committee member Dustin Guastella and DSA M4A Northeast regional organizer Christie Offenbacher visited our chapter to talk about DSA's M4A campaign. And—not to brag— but our event was awesome!
Our chapter started Medicare for All outreach in February 2017, and we've spoken to more than 1,000 of our neighbors about M4A and the New York Health Act. But this was our first public Medicare for All event, and since we didn't want to disappoint our out-of-town guests, we really sweated the details: we phone banked our entire chapter membership two weeks before the event. The day of, 10 comrades showed up an hour early to get everything set up. And after Dino and Christie spoke, we had our canvassing sign-up forms (and lots of pens!) ready.
DSA Medicare for All Northeast Regional Organizer Christie Offenbach. Photo by Casey Brescia
We wanted attendees to leave the forum with a better understanding of what Medicare for All is, and what the five principles of DSA's campaign mean. But we asked Dustin to focus his talk on how we will win Medicare for All. We want all of our members to know that no clever media or lobbying "strategy" will win Medicare for All. Like Dino says, we have to build a movement deeply rooted in the struggles of nurses, teachers, and all workers fighting for healthcare justice.
DSA Medicare for All Steering Committee member Dustin Guastella. Photo by Cori Madrid
Dustin first set the stage on the context of our fight to secure true universal, comprehensive coverage for all.
Our healthcare system — a profit-driven, limited-coverage, patchwork, employer-based, multi-payer model — is a nightmare for working people.
Its a system driven by profits for the few and not built for the needs of millions.
We have the highest maternal mortality rates, infant mortality rates, rates of chronic and preventable disease, and heart disease rates of any rich country in the world. But our exceptionally poor health is not due to any unique biological defects in the American people, nor is it related to some kind of amorphous American culture of unhealthiness. For instance, we manage to have lower rates of smoking than Italy, France, and the U.K., yet still have lower life-expectancies than all of these countries.
Our health is a social issue. It is linked to our jobs, our environment, our access to basic social needs and ultimately to the politics that shape our daily lives.
Consider the effects of chronic injuries and long-term exposure to dangerous chemicals in the places we work, or the asthma, lead poisoning, and cancers caused by exposures to unregulated environmental pollutants in the places we live. Think of the diseases caused by restricted access to healthy and affordable food, or the tragic “diseases of despair” such as opioid and alcohol addiction, suicide, and gun violence. Even our ability to avoid asbestos poisoning or safely deliver a child depends on housing stock, federal interest rates and rent prices.
Each of these health crises stems from the brutal and deteriorating social conditions of life for American workers. They are all inescapably and fundamentally political.
The soaring cost of healthcare explains more than any other single factor why so many Americans are so unhealthy. Even if you manage to avoid dangerous working conditions or environmental hazards, maintaining your health depends on your access to health insurance. And with nearly 30 million uninsured and an additional 30 million underinsured, many Americans are effectively locked out of getting needed medications or regular check-ups. Even if you’re lucky enough to have health insurance, avoiding bankruptcy court depends on whether or not that insurance is good enough to cover medical emergencies. If you are a part of the working-class majority in this country, your health depends on whether or not you can afford to pay the high costs of healthcare.
All of this means that for most people, most of the time, our health depends not on our personal choices, culture, lifestyle, or biology. Instead, our health is determined by social conditions — working conditions, housing conditions, the education and healthcare systems. And in the U.S., these social conditions are shaped by the marriage of corporate and political elites.
The problem is straightforward: it is not profitable to insure sick people. Insurance companies seek to restrict coverage; they coerce sick people into dropping their plans or they push more costs onto the sick themselves. Each health insurer, in an effort to maximize their profits and minimize their risks, restricts coverage thereby shrinking their “risk pool” but as risk pools shrink health care costs increase.
Despite the past forty years of productivity growth, technological innovation, and the mandate included in the Affordable Care Act, health care costs continue to rise while wages stagnate. The U.S. spends more on healthcare per capita than any other rich country, despite the fact that our system covers fewer of its residents. Since 1999, health insurance premiums have increased by a staggering 213%. And those high costs are pushed onto workers.
Workers, not CEOs or investors, shoulder the burden of every insurance premium increase. Employers today pay less proportionately into their workers' health insurance than any time before.
Worse, much of these high costs are imposed from above. Health insurance companies and hospitals inflate their costs by expanding their organizations with billions of dollars of bureaucratic waste, hiring more claims and billings managers (managers who are trained to restrict coverage) and paying their CEOs obscene salaries (the average salary of a health insurance executive is $20 million per year). The CEO of Centene, a health insurance corporation, makes nearly $80,000 a day. Yet the vast majority of workers emptying your sick partner’s bedpan, giving your grandmother a sponge-bath, or helping you walk down the hallway after surgery — those workers who actually provide healthcare — they don’t make that kind of money in a year. Roughly 30% of all healthcare costs in the country are administrative. By comparison, the government-run Medicare system only spends 3% of its revenue on administration.
Health insurance is an extremely profitable industry. Yet windfall profits have not led to higher wages for healthcare workers or better service for patients. Nurses, care workers, physicians, and support staff are increasingly squeezed. The working conditions in hospitals, clinics, and nursing homes are precarious and unsafe, hospitals are routinely overpopulated and understaffed. In fact the only people who actually benefit from our healthcare system are the owners and operators of major health insurance firms, big pharmaceutical corporations, and giant hospital groups.
Today we hear a lot about the exceptional nature of the American health care system. Trump himself has recently claimed that other countries are somehow leeching off the American system and jacking up our pharmaceutical prices. The reality, of course, is that the leeches are homegrown. The fat layer of corporate executives, bureaucrats, health industry billionaires and their bought-and-paid-for politicians have caused this mess and they continue to profit off it to tremendous effect.
Our situation is exceptional and we should take care to see exactly why that is. Unlike our neighbors to the North with their single-payer Medicare system, unlike the British National Health Service, or Nordic social-democracy, or even the weaker German system the United States never established anything like a national health system.
However, we did try to establish a system much like the rest of the industrialized world. In 1943, following the release of the British Labour Party’s proposal for the NHS, the American labor-left in the Democratic Party wrote a proposal for a nationally administered health service. The Wagner-Murray-Dingell Bill –– I know the name is ridiculous –– would have established a single-payer insurance system and proposed the nationalization of hospitals and clinics alongside direct public investment in medical schools. It was an ambitious plan that failed to win the support of Roosevelt but was eventually reintroduced to Congress in 1945. British Labour won an unprecedented victory that year, in part because of Labour’s campaign for the NHS. Yet the New Deal coalition even with the force of an insurgent labor movement behind it failed to bring the plan to fruition.
The simplest reason for why the labor-left failed to secure a national health service in the post-war years is that the American capitalist class emerged from the war more powerful than ever before. In Europe the ruling classes were politically and economically discredited by the war. Their parties were seen as allied with with fascism and their firms were mostly devastated by the war itself. American capitalists, on the other hand, emerged triumphant. Their legitimacy restored and their economic power bolstered by the need to rebuild the industrial heart of a devastated Continent.
By the mid 1940s the employer-class was determined to crush the power of an insurgent labor movement. The organization of major business associations conspired to repel labor’s advance. The Chamber of Commerce, the National Association of Manufacturers, the Farm Bureau and numerous local and regional business alliances organized alongside the American Hospital Association and the American Medical Association to launch an all out offensive on health care reform.
The fight over health care was one of the opening shots in the ruling class offensive against the modest gains of the American worker. The subsequent defeat of the Wagner-Murray-Dingell Bill dovetailed with the defeat of the ambitious 1945 Full-Employment Bill and Republican victories in Congress led to the establishment of the so-called ‘right-to-work’ Taft-Hartley Act in 1947.
Since labor was defeated in the fight for a federal health insurance system unions retreated to fight piecemeal to establish long term benefits for their members. The war had made employer-sponsored health insurance a reality but unions knew that peace-time would threaten these “fringe benefits” and so between 1940 and 1960 they organized to secure some form of employer-sponsored health insurance for almost three-quarters of all American workers.
The model was built on a private system and a massive insurance industry was born. The insurance industry itself became another soldier recruited in the billionaire battle against socialized medicine. Industry titans joined the organizations of the business community in order to maintain the profitable and business-friendly private system. The organizations of the corporate elite helped to orchestrate a more perfect “executive committee of the bourgeoisie” and with their outsized resources, elite networks and structural leverage in the economy this group of bankers, manufacturers, doctors and insurers managed to strangle even modest attempts at popular health care reform.
Today, the American Medical Association remains among the largest lobbying organizations by dollar amount in the country, spending over 20 million dollars a year to convince Congress of the virtues of a for-profit “free-market” healthcare system. They’re lobbying operations is second only to the premier political organization of the business community –– the American Chamber of Commerce.
He also spoke about the danger of compromising on Medicare for All's five guiding principles and the centrality of our time's working class heroes — teachers, nurses and other working people — to the fight:
The movement 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 process of shop-to-shop, door-to-door, face-to-face and person-to-person organizing.
In order to build this movement we first need ideological clarity. Democrats have released a flurry of policy proposals to confuse or distract from our demands. They call them “Medicare for Everyone” “Medicare for Anybody” “Medicare Extra” everything but Medicare for All.
They see the wave of support for Medicare for All and they want to go “half the way with M4A” to claim they did their best. This is why from the start we have organized our campaign around the principles that define a real and robust Medicare for All system. These five principles are:
A single health program: not a patchwork
Comprehensive coverage: for all services requiring a medical professional
Free at the point of service: no fees, no copays no deductibles, no premiums
Universal coverage: all US residents will be covered because the flu doesn’t check if you have a green card and neither should we
A just transition for workers: that means jobs and severance for those affected by the abolition of private insurance
Any plan that fails to meet these demands is not enough. It is our job as democratic socialists to ensure that millions know exactly what we mean when we say Medicare for All, so they can become advocates themselves. So they can demand specifics and make concrete and programmatic statements about what we want. It is our job to make it clear that these principles and this agenda are the bedrock of a coherent independent working class political movement for Medicare for All.
Second, we need to unite our coalition. Too often progressive politics is founded on moral claims of righteousness but devoid of any political claim to social power. High-sounding moral slogans and vague “justice” agendas tend to attract the broadest base, but these coalition repeatedly prove unstable, shallow and fickle. We have to resist taking these short-cuts and instead build a stable and durable coalition around our concrete demands. In the absence of a workers’ party and amidst the weakening of union power, it’s crucial that we use this opportunity to build a deep institutional relationship to the only force that has the power to make this demand a reality: the labor movement. No other institution in American society has the structural leverage, mass base, organizational resources and political legitimacy capable of raising this demand to the height of political power. We will of course need our lawyers, doctors and those rare members of the professional managerial class who support our efforts but it is the nurses, the teachers, the electricians and the steelworkers that will be able to win this fight. Our movement cannot simply be a coalition of willing and eager students and middle-class liberals but principally must be movement of the working class.
Luckily, the union movement is far less divided on the question of single-payer than it once was. Unionists increasingly recognize that their health benefits are becoming a liability at the bargaining table. Medicare for All would take healthcare off the agenda 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 healthcare package. The support for Medicare for All among nurses and support staff is also borne out of their own experience as caregivers in a fractured and broken health system and their desire for a more rational and just alternative.
Of course, union support does not automatically translate to mobilization and organization. It is our job as democratic socialists to try to win the union movement to the cause in a real way and move our union brothers and sisters into action. In our workplaces and union halls we should invite our co-workers to canvasses, bring them single-payer town halls, and give them our literature. We should make the workplace a cite of political recruitment in order to build the ground troops we need to make this fight winnable. This is even more true of two strategic sectors: teachers and nurses.
Teachers are right now the unchallenged working class heroes. Their militancy, bravery and political foresight is unlike anything we have seen in decades. And guess what almost all of these strikes in this massive and historic strike wave are principally about? The insurance fix. Uniting teachers and nurses in the fight for Medicare for All will facilitate the growth of a massive and powerful constituency. Nurses with their patients, and teachers with their students represent fundamentally social occupations. Each teacher and each nurse has a network, they serve a community and have won the trust and respect of the public. When teachers strike, the students are with them, when nurses demand safe-staffing, so do their patients. These particular workforces are uniquely suited to demand Medicare for All, and good luck to anyone who stands in their way.
After Dustin and Christie spoke, we had a Q&A period and then a happy hour with lots of good questions and discussion about how we build this movement. We signed up many of the attendees for their first-ever door-knocking shift. You should bring someone from DSA's Medicare for All campaign to speak to your chapter!