Originally appeared at Jacobin, on April 19, 2019.
Senator Bernie Sanders speaks at the 2016 Democratic National Convention in Philadelphia, PA. (Smugmug)
The class war over Medicare for All is here. On one side is Bernie Sanders, who recently introduced new and improved Medicare-for-All legislation with the support of a burgeoning grassroots movement and historic small-donor fundraising. On the other side is UnitedHealth, the massive health care company — the fifth-largest US corporation by total revenue of any kind — whose stocks have been plummeting since Sanders revived the bill.
UnitedHealth can no longer hide their efforts to destroy Sanders’s public health system proposal: a whistleblower recently revealed that UnitedHealth’s insurance subsidiary, UnitedHealthcare, is working hard to ensure Democrats focus on reforming the Affordable Care Act (ACA) instead of pushing for Medicare for All, which will eliminate their entire industry. When asked about their stance on Medicare for All, the company’s chief executive Steve Nelson said, “We are advocating heavily and very involved in the conversation.”
They’re also warning their investors of the bill’s potential to “destabilize the nation’s health system.” Nelson explained that the company is “trying to be thoughtful about how we enter in the conversation, because there’s a risk of seeming like it’s self-serving.” Nelson, who made $7,580,440 last year at a company that pulled out of the ACA’s exchanges, is right to fear the optics.
In response, Sanders stated on Twitter:
Our message to Steve Nelson and UnitedHealthcare is simple: When we are in the White House your greed is going to end. We will end the disgrace of millions of people being denied health care while a single company earns $226 billion and its CEO makes $7.5 million in compensation.
This isn’t just a policy debate, it’s a political struggle. In fighting for Medicare for All, Sanders and his supporters are going toe to toe with one of the most powerful businesses in the world. This is just the beginning of the fight.
The Anti–Medicare for All Coalition
But UnitedHealth is not alone. UnitedHealth has spent millions on lobbying in recent years, but a new anti–Medicare for All coalition, the Partnership for America’s Health Care Future (PAHC), has spent a combined $143 million on lobbying in 2018 alone. The coalition’s key partners include the American Medical Association (AMA), American Hospital Association (AHA), and America’s Health Insurance Plans (AHIP).
In addition to lobbying representatives, this coalition of for-profit insurers and providers is unleashing a full counterattack on Medicare for All with white papers, ads, polling, press events, and more. Less than two weeks after Massachusetts representative Lori Trahan cosponsored the House Medicare for All Act, she became the first target of PAHC’s Facebook ads, which misleadingly suggested that she was trying to repeal the ACA: “In 2018, Congresswoman Trahan said: ‘I’m committed to improving and strengthening the ACA first and foremost . . .’ But now she wants to repeal it with Medicare for All?”
The partnership is hammering the message that Medicare for All will cost too much, the government can’t be trusted to administer health care, and therefore we should shore up the ACA instead.
The Democratic establishment has embraced this as their vision for health care policy. Despite 85 percent of Democratic voters saying they support Medicare for All, the PAHC’s talking points in press releases and op-eds are now being parroted by House speaker Nancy Pelosi.
After receiving a combined $43,740,947 in campaign donations from insurance and pharmaceutical industries, House Democrats have a vested interest in killing Medicare for All.
Fool Me Once
A national health insurance program like Medicare for All has never received a vote in the history of Congress. The first viable window for such a vote was the Wagner-Murray-Dingell bill under Franklin Roosevelt and subsequently Harry Truman. The American Medical Association opened its first Washington lobbying office in 1943, the year it was introduced. With the help of partners like the AHA and Chamber of Commerce, they launched a national campaign featuring a massive amount of spending ($1.5 million in one year alone, around $15 million in 2015 dollars).
This powerful lobby bombarded the public sphere with pamphlets, posters, and letters to the editor, targeting supportive senators and accusing the government of establishing socialism or even “state slavery.” Meanwhile, Ohio senator Robert Taft introduced rival legislation comprised of subsidies and means-tested programs. In a handful of years, industry titans were able to reverse the overwhelming public support for the bill from 75 percent approval to a mere 21 percent.
When the Wagner-Murray-Dingell bill reached hearings, lawmakers caved under the pressure. Despite the alignment of a Democratic Congress, supportive president, and a militant labor movement, they failed to even hold a vote.
This might sound all too familiar to the Medicare for All fight today (or the lobbyist assault on the public option ten years ago). Today, means-tested bills like Medicare X or Medicare for America are competing for attention while Donald Trump and Republicans smear universal health care as a “radical socialist” plan.
The parallels to our current moment should be a warning sign for advocates of Medicare for All. If we don’t organize a broad constituency ready to wage political struggle against these historic forces, we could see our movement undermined again.
Bernie Can’t Do It Alone
Right now a champion for Medicare for All is running for president in Bernie Sanders, and he has a serious chance of winning. Sanders has not just been consistent on policy over the years — he’s done so while foregrounding class struggle. This sets him apart from both past presidents and current contenders.
In this week’s Fox News town hall, Sanders condemned former Aetna CEO Mark Bertolini for taking a $500 million bonus after the company’s merger with CVS. He asked: “Do you think that’s how we should spend health care dollars?”
Just like his indictment of UnitedHealth, Sanders names names and draws out conflict between the working class and the wealthy few. He calls for a mass movement of millions of people to overcome this conflict and warns of the corporate interests mobilizing against such a movement.
In his recent Medicare for All press conference, he framed it clearly:
This struggle will be opposed by some of the most powerful forces in the United States. The insurance companies, the drug companies, and everyone who profits off the current system, will spend many, many hundreds of millions of dollars to defeat us.
We are getting a glimpse of this opposition now. Medicare for All’s backers should only expect more as the policy becomes an increasingly viable threat to the profiteering of private insurance companies.
Luke Thibault is an organizer with Democratic Socialists of America’s Medicare for All campaign. He lives in California’s East Bay.