JOHN GEYMAN, MD FOR BUZZFLASH AT TRUTHOUT
With growing support among the public and with many Democratic candidates taking strong positions for single-payer Medicare for All, a battle is being engaged again between supporters and opponents in the Democratic Party. Support for universal coverage through Medicare for All, or national health insurance (NHI), should become a litmus test for Democrats and their platform for 2020, but already we are seeing vacillation among centrists in the party establishment reminiscent of the surrender in advance strategy that prevailed in the run-up to the 2008 elections.
This article briefly reviews that history, summarizes what is happening now, and shows how the Democrats are likely to once again lack enough unity and political courage to advocate for this issue in the public interest.
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Barack Obama, after his inauguration as President in 2009, missed his opportunity to enact lasting health care reform despite his 2003 speech to the Illinois AFL-CIO: "I happen to be a proponent of a single payer universal health care program reform health care. . . (applause). . . I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14 percent of its Gross National Product on health care, cannot provide basic health insurance to everybody." (Obama, Speech to the Illinois AFL-CIO, June 30, 2003.) That failure started with how the Democrats framed the issue—they rejected the words "universal health care", substituting "guaranteed affordable choice" and "competition", thereby playing right into the GOP's playbook.
The Democrats' failure to enact universal health care reform, despite controlling the White House and both chambers of Congress, was foretold by these events during 2008-2009:
• Senator Max Baucus (D-MT), an opponent of NHI and chairman of the key Senate Finance Committee, barred eight single-payer activists from an open hearing of the committee, having them handcuffed and sent off to jail for "disorderly conduct."
• Centrist Democrats put forward an incremental idea—the public option— but Obama withdrew support for it when confronted by opposition from the private health insurance industry.
• As a member of the Baucus Eight, Dr. Margaret Flowers summed up the political dynamics of the time in this way:
In order to disarm the corporate interests, the health industries that had opposed previous reforms were included on the inside. In order to disarm the Right, bipartisanship was at the forefront. In order to disarm the supporters of a single payer plan, who are the majority, a campaign was developed around a promised 'compromise', the public option, and given tens of millions of dollars for organizing and advertising. The public option succeeded in splitting the single payer movement and confusing and distracting it with endless discussion about what type of public option would be effective.
Although health care is a leading issue during the approaching 2018 midterms and the 2020 election cycle, we now see increasing division among Democrats over NHI as well as the expected opposition from the private sector within the medical-industrial complex, together with large amounts of campaign money intended to defeat single-payer Medicare for All. Here are some of the markers of this effort:
• Senate Minority Leader Chuck Schumer, who said in 2017 that "single payer will happen . . . in 10 or 20 years," took in more than $2.7 million in campaign contributions from the health sector in 2017, according to the Center for Responsive Politics.
• A new group disingenuously named "The Partnership for America's Health Care Future," led by private insurers and Big PhRMA, is leading the latest fight against single-payer Medicare for All over the next two years, and of course, will be very well funded.
• The five members of Congress who comprise the top leadership of the Democratic Congressional Campaign Committee (DCCC) have already received almost $3 million in contributions from the health care industry in their careers, with more than $780,000 in the current election cycle; the DCCC is opposed to single-payer Medicare for All.
• Third Way, the New Democrats' most prominent think tank, opposes single-payer by warning that "it is not as popular as advocates suggest" and that "Republicans are salivating to use single-payer as a cudgel." (Winning on Health Care. .)
• The Center for American Progress (CAP), another prominent liberal think tank, promotes its vaguely worded "Medicare Extra for All" proposal, which would "build on Medicare" but leave the multi-payer private health insurance industry in place, a major problem of today's system; we can expect this proposal to confuse the public, sound good to the uninformed, and please their campaign donors.
• Other centrists want to bring back the public option, which was killed in 2009, and which, like the other timid incremental proposals, would fail to provide universal coverage, contain costs, or improve access or quality of health care.
• After their short August recess, Senate Democrats have decided to run in 2018 on the merits of the ACA, especially favoring its banning of insurers' coverage based on pre-existing conditions, without apparent concern for the failures of the ACA to contain costs and prices of health care and the fact that more than 30 million Americans remain without health insurance. Senate Democrats stay focused on health care even during short August recess.
Although a July 2018 Health Tracking Poll by the Kaiser Family Foundation found that more than three of four respondents say that single-payer should be considered or is very important or the single most important factor in the upcoming election, powerful corporate forces are already mobilizing against it as they derailed real reform in 2008-2009.
As Yogi Berra classicaly said, this is "deja vu all over again." That applies here within a split Democratic party, which is frittering away its potential power through needless internal divisiveness. There is a plan for real reform—single-payer Medicare for All. Democrats have the opportunity to confront the profiteering medical-industrial complex and ensure that all Americans gain access to all necessary health care in the most efficient, affordable, and fair way. Do they have the spine and political will to seize this opportunity?
Adapted in part from my soon to be released book, Trumpcare: Lies, Broken Promises, How it is Failing, And What Should Be Done.