What’s the next step toward Medicare for All?

THE PRESS conference earlier this month where Bernie Sanders announced his "Medicare for All" legislation shows both the massive opening and the serious challenges facing the struggle for truly universal health care in the U.S.

Sanders' legislation comes after a summer of successful struggle to stop Trumpcare. The Senate Republicans' latest attempt to "repeal and replace" Obamacare collapsed this week after a handful of both hard-right and more "moderate" Republican senators came out against it.

Donald Trump tweeted angrily about John McCain, but a very important reason for the defeat of the various Trumpcare proposals was the upsurge of protest organized by liberal organizations, unions and other health care advocates.

The angry demonstrations at events held by Republican lawmakers throughout the year, as well as actions in Washington, helped expose how the GOP plans for "repeal and replace" would have worsened an already ailing system governed by Obamacare--particularly by dismantling Medicaid and Medicare. Beyond the protests, popular opinion ran heavily against Trumpcare.

This opposition went far beyond single-payer advocates, but it helped our movement by reminding millions of people how critical federally funded health care is--and getting them to more seriously consider Medicare for All as an alternative to both Trumpcare and Obamacare.

The effect of this on Sanders' proposal has been telling. For almost three decades, the mainstream of the Democratic Party has systematically undermined and marginalized proposals for single-payer health care. But this month, 16 Democratic senators, including most of the known hopefuls for the 2020 presidential nomination, lined up in support of Sanders' legislation.

Of course, it's easy for liberal Democrats to support Sanders' bill when it has no chance in becoming law under a majority Republican Congress, with Donald Trump in the White House. The Democrats can appeal to millions of people persuaded by the case for Medicare for All, without having to face the fury of the for-profit health care industry.

But even at the level of purely rhetorical support, Sanders' legislation is a big deal. It is a crack in the political edifice on the issue of single-payer health care, which opens up opportunities to mobilize greater pressure from outside Washington. Whether the crack gets widened or sealed up is a critical question facing our re-energized movement.

THIS IS a useful moment to pull the lens back and look at what it will take to make Medicare For All a reality.

The first dynamic to understand is that we haven't seen anything close to the opposition that will cohere among the health care industry and the ruling class as a whole when a Medicare for All proposal like Sanders' gets closer to being enacted.

Health care accounts for as much as one-fifth of all economic activity in the U.S., according to estimates. There is a considerable amount of wealth at stake in the profits of the prescription drug industry, from medical supply and equipment sales, and, of course, for private insurance.

Medicare for All would allow the government to bargain with health care companies with an unprecedented leverage and economic scale--and it would be a huge blow to private insurers, even if it doesn't totally eliminate them. Moreover, Sanders' bill is filled with taxes on the rich and powerful--higher taxes on business, wealth taxes, a more progressive income tax structure, and even a one-time tax on offshore financial holdings.

The opposition to single-payer will manifest itself in two general ways.

The most blatant will be an extremely well-funded propaganda campaign that claims Medicare For All would produce "death panels" and financial ruin to every household in America.

The resounding defeat last year of a Colorado ballot initiative that would have changed the state constitution to permit universal coverage for every resident gives a taste of how the economic and political powers--including plenty of Democrats who claimed to oppose Trumpcare this year--would line up against single-payer.

Likewise, in California and New York, it was Democrats who did the dirty work of the insurance industry in blocking legislation to move toward a statewide Medicare for All system.

The second, less obvious way opposition will take shape is the "Trojan Horse" effect.

Right now, powerful mainstream Democrats like Elizabeth Warren, Cory Booker and Kristen Gillibrand have nothing but nice things to say publicly about Sanders' bill. But there has been and will be intense pressure to water down single-payer legislation.

NONE OF this means the fight for Medicare for All is unwinnable.

In fact, Sanders' introduction of this legislation--at this political moment and with support beyond himself, at least for now--shows how easily a government-run system that guarantees universal coverage could be embraced by the majority of people.

Right now, Sanders is probably the most popular politician in the country. Certainly, he is at the federal level, where his favorability rating being higher than his unfavorability is unique. Sanders stands for a progressive political agenda that has partially filled a massive void in mainstream politics.

His Medicare for All bill isn't perfect. Members of Physicians for a National Health Program are critical of the legislation for allowing co-payments for some medical necessities, including drugs and biologics. There are questions about how far-reaching and systematic its funding mechanisms are, and whether four years is too long of a rollout.

But supporters of Medicare for All have shaped the bill in important ways. It bars deductibles and most co-pays, fully funds abortions and covers undocumented immigrants. The pressure to reverse these important provisions will be relentless. The larger the movement--and the larger the Left within that movement--the more people we will have a bill worth fighting for.

With Medicare for All, Sanders--in stark contrast to Democratic Party leaders--is offering something concrete and popular that would change most everyone's life for the better.

But Sanders' popularity obviously isn't enough. The most important factor that will determine whether we see such a program in our lifetime is whether the widespread popularity and unprecedented momentum is organized so that it becomes an active force, felt in workplaces, communities and the media.

There are many ideas about how to build from the grassroots. Do we need a national march? Do we need to focus on "base-building"? Do we need different forms of coalitions and activist organizations? The answer is all of the above--but the question of strategy and timing will take some time to figure out.

ACTIVISTS AROUND this issue need to recognize that we won't win this battle by continuing to do what we currently are doing, just on a grander scale. Whatever organizing we do, we need to be clear on some things.

First, this isn't an inside game. Medicare for All won't be won by concentrating on how many members of Congress we persuade, but on how many tens of thousands of people are convinced to take action in various forms for single-payer.

Our organizing needs to be focused on this fact. We need to figure out how to build networks and organizations that can bring in larger numbers of activists, who can then make collective decisions about how to reach the next layer of people.

One step in this direction would be to broaden our approach to the issue--which needs to center both how transformative a future Medicare for All system would be, but to highlight the suffering that goes on in the health care status quo as the price we pay for not having single-payer.

In the public mind, the health insurance industry should be no different than the tobacco industry. We need to create a climate where health insurance industry profits are seen for what they are--blood money--and any politician unwilling to do something about it is treated accordingly.

Second, health care has to become a central issue of a re-inspired labor movement. Many people currently think of health care as related to their job, so there's a natural connection.

Unions already played a role in mobilizing opposition to Trump's health care disaster--though not in the numbers they could have. But Medicare for All could become a main issue for labor.

One possibility would be to organize workplace committees in support of Medicare For All. This has already taken shape in National Nurses United and New York State Nurses Association, and could be built on and serve as a model for other unions.

For health care unions, in particular, the question of workplace issues and how to make the health care system accessible come together, creating the basis for a stronger struggle.

We need to think in unprecedented ways about how to use union power to win this struggle. In this context, I could see an argument for a national day of strike action for Medicare For All.

Striking for political reasons--or really striking in general--isn't something the labor movement is very familiar with in recent decades. But the tradition does exist. Also, the unions that are strongest on Medicare for All are also unions with more experience of going on strike recently.

THERE ARE many other initiatives being discussed to build wider and active support for Medicare for All.

One that has been discussed this year is a proposal from some members of the Democratic Socialists of America for a national march for single-payer in Washington, D.C.

If such a mobilization gave expression to the wide support for Medicare for All that has developed especially through the course of this year, it would be a major step forward in projecting the importance of this issue. But that also raises the question of organization: What forces would be involved in planning and carrying out such a march?

National initiatives like a march or a day of action in support of Medicare for All can be focus for local organizing to win wider numbers of people to activism on this issue. There will also be more statewide initiatives, as in California and New York. And possibilities for local organizing around health care develop all the time--including workplace action backed by unions, up to the level of strikes.

One opportunity for organizing will arise soon--Sanders is supposed to tour the country to build support for his legislation. Our organizations need to find ways to meet people inspired by Sanders' proposal and bring them into organizing.

There's a long way to go before we'll have built organization that can express the widespread sentiment for Medicare for All. But activists can use the opportunities as they arise to build in that direction.