How to Build the Necessary Ground Game To Put National Single Payer Health Care Front and Center

The Medicare for All Act of 2023

The Act retains many important elements from the previous bill, such as universal entitlement, comprehensive benefits including prescription drugs and long-term care, global budgets, and the elimination of private health insurance that duplicates services provided by the Act. The Act bans cost sharing and premiums, creates an office of Health Equity, and prohibits alternative payment and value-based models established by the ACA, including many of the models run by the Center for Medicare and Medicaid Innovation, such as the Medicare Shared Savings Program.

The Act also contains welcomed additions, such as comprehensive reproductive care which includes abortion, assistive reproductive technology (IVF and other fertility treatments) and contraception. It also adds comprehensive gender-affirming care as a covered service and expands the coverage of telehealth.

However, as we have discussed before, there are at least four ways in which the Act can be strengthened and improved.

First, the Act permits for-profit health facilities and corporations to function in the new system.

We recommend that for-profit providers of care opting to participate be required to convert to not-for-profit status. The owners of such for-profit providers can be compensated for reasonable financial losses incurred as a result of the conversion from for-profit to non-profit status during a 15-year period, through the sale of US Treasury Bonds. This process preserves the health care infrastructure.

Second, the Act does not include strong enough protections for displaced workers who will lose their jobs because of passage of this Act.

In addition to first priority in job placement and retraining, the Medicare for All Act of 2023 should be amended to include two years of annual salary to displaced workers. This is critical not only to a just
transition but also to winning the support of the workers and unions vital to passage of the bill.

Third, the Act does not include progressive funding.

Medicare for All Act of 2023 has no provision for funding by a progressive tax. Progressive funding should be added to assure that the tax burden is shifted from workers to the wealthy, the billionaires, and corporate entities.

Fourth, the Act has a complicated two-year transition period.

The Medicare for All Act of 2023 adds a transition period through a Medicare Buy-In sold on the Exchange. Expanding care while maintaining the private insurance companies, costs will skyrocket
before the savings of single payer kick in. Such a provision lends credence to the false claim that the nation cannot move directly to Improved Medicare for All. This transition will have unequal impacts on different age groups in the population, causing disunity and undermining support for national single payer. There should be no staged age group inclusion, no Medicare Buy-In, no selling of Medicare on the Exchange. That would be an expensive administrative nightmare and contradict sound health policy.

Medicare was implemented in 10 months in 1965, and Improved Medicare for All can also be implemented quickly.

What Have We Learned and Where are We Headed?

National single payer retains popular sentiment among the public–yet remains a political outlier. The introduction of the Medicare for All Act of 2023 is the opportunity for all single payer supporters to put it back on the mainstream political agenda. Today, the bill has the endorsement of over 100 Congressional Democrats. 

Prior to the passage of the ACA in 2010, John Conyers’ HR 676 had more congressional endorsers than any health care bill but was never given serious consideration. Introduction of legislation is just the first
step. Political horse trading, insider lobbying, and business as usual will not get it done. National Single Payer believes that our movement needs to recognize and learn from our past. Our victories for labor, civil rights, women’s emancipation, peace, and health care were won through strong independent and non-partisan grassroots movements.

Changing the Balance of Power

NSP works to mobilize the popular public support for single payer into a conscious and effective force.

It’s this public support that gives us optimism and confidence.  
Since its inception two years ago, National Single Payer has held six educational webinars raising awareness about the privatization schemes devised by the Centers for Medicare and Medicaid Services,
a governmental agency which instead of protecting Medicare, is bent on dismantling it. Our webinars have resulted in raising the alarm in Congress, the media, and the public about an under-the-radar
program called ACO REACH. Our principled opposition to Congressional allies resulted in a real victory: a letter that did not praise ACO REACH while demanding greater oversight of the program. The work we’ve done around ACO REACH in Texas and other states continues to spread like wildfire. We have published almost 20 articles, most recently an Open Letter to Congressional Cosponsors of HR 1976, highlighting how the bill needs to be improved before it is introduced. Currently, we are raising public
awareness about local ballot measures supporting a national health program, especially in rural counties.

How can labor activists inside and outside move union organizations into action?

Can we use our power and our allies to mobilize the existing public support to hold “teach-ins” and public Town Hall hearings to build our power? What can we do to build independent and principled relationships with other community groups, labor, civil rights, women’s, health care, climate change, anti-war, anti-poverty organizations, and all social justice groups to work together? How can we reach out to everyone suffering under this system, regardless of their political beliefs?  How can we show that national, improved Medicare for All is the foundation of eliminating the poverty of medical debt and the inequities of a profit based system? 

Let’s use the introduction of this legislation to shift the gears of our movement and create the necessary popular discussion and debate that moves our public support forward. It is the necessary step that puts popular power front and center. It is the only way.