We live in perilous and confusing times. On the one hand, the US government is dominated by a reactionary two-headed regime that is attempting to throw over 20 million citizens off of health insurance, while giving a huge tax break to the wealthiest 1 percent. On the other hand, the idea of universal healthcare appears to be catching on fast in progressive circles and possibly across the political spectrum in the United States. The Kaiser Family Foundation has noticed a shift in attitudes and even conservative commentators George Will and Charles Krauthammer have recently predicted that the US will eventually have a single payer system. Whatever the outcome of the current effort to repeal and replace the Affordable Care Act, universal health care will be on the agenda.
But, as we have seen countless times in the past several years, nothing is inevitable and everything is contested. There are extremely powerful forces that find universal healthcare abhorrent. In a “normal’ political system, a bill that had an approval rating of under 20% would have no chance of making it through Congress, but given the power of the insurance industries, the outsized influence of billionaires like the Koch brothers, and the right-wing media and blogosphere cheerleading for cruelty, this awful bill had a good chance of becoming law. The clear implication is that while universal healthcare is catching on as an idea among newly energized progressive groups, there is a very difficult and expensive fight ahead to make it a reality. If progressives are not prepared, they may lose the best chance in decades to pass a law that guarantees health care to all Americans.
In a recent article on the Intercept website about the attempt in California to pass universal health insurance legislation, journalist David Dayen argues that some progressives are not taking this challenge seriously. There have been several attempts to pass single payer legislation in recent years in California, but all have been vetoed by the governor or failed for other reasons. In the latest attempt, Anthony Rendon, the Speaker of the California Assembly refused to move the bill forward, arguing that it did not address funding and several other issues that needed to be sorted out first. The response from some quarters, including the California Nurses Association, which pushed hard for the legislation, was very critical of Rendon, accusing him of favoring the insurance industry that is opposing the bill. RoseAnn DeMoro of National Nurses United asked what legislators are supposed to be doing other than “hold hearings and make amendments to legislation they think need changes.” In other words, what the legislation in California is facing is political opposition, not a technical problem.
Dayen argues that the entire exercise was dominated by cynical political maneuvering. The half-baked bill was pushed forward by its supporters as a public relations gimmick instead of as part of a deliberative legislative process that dealt with the many unique challenges of such large programs in California that would need to be worked out. While there is value in taking a principled position and passing a piece of legislation in order to move the issue forward and stimulate serious consideration of associated issues, Dayen may be correct in pointing out that the politics of it should have been on more solid footing. It is noteworthy that important labor organizations were not fully behind the bill as indicated in this New Republic piece by Clio Chang.
Public support is also malleable in California, which is consistent with the Kaiser Family Foundation’s national survey. While recent polls in California showed support between 65 and 70 percent, when people were asked to consider the possibility of new taxes, support fell. Going forward, as Chang observes, the purported price tag of any sort of universal plan will be an effective scare tactic by the insurance industry and its allies. There is a strong argument to be made by progressives, but they have yet to gain significant traction either in California or nationally. As Chang puts it:
A single-payer program would inevitably incur additional taxes, but the overall healthcare costs would be lower for most people and businesses. Democrats have to convince voters that those pocketbook benefits are as real as the higher tax bill they will receive.
For another painful example, we can look at Randy Bryce’s attempt to answer the cost and tax issues relating to universal coverage. Bryce, a strong progressive, has thrown his hat into the ring to challenge Paul Ryan in Wisconsin’s 1st congressional district and has raised an impressive amount of cash in small donations. But in a short interview on CNN, when asked about the supposed immense price tag for universal coverage, Bryce’s response was that there were a lot of people whose taxes should be higher as well as corporations that are able to avoid taxes by parking much of their profits in off-shore tax havens. He did not contest the unrealistically high figure ($32 trillion over ten years) or make the more general points that healthcare would cost less overall and that the net out-of-pocket costs for individuals and families could be lower, depending on how it was implemented.
Fortunately, there is a fairly straight-forward argument to make: that the US pays far significantly more per person for healthcare than all other industrial countries while achieving poorer results. The reasons are lower administrative costs, the negotiating power of government-wide entities that allows them to keep costs down, minimal advertising and marketing, among others including not having to pay for massive profits to big pharma and the insurance corporations. It’s a subtle argument, but progressives need to do a better job showing how a system based on guaranteed universal coverage (and there are many different options) could work in this country.
Given the vociferous and unprincipled attacks that are sure to come when any universal plan gets put on the table, democrats and progressives need to be absolutely clear and unified in their messaging and their own plan of attack against entrenched interests, an attack that needs to be direct, fact-based, and sustained. And they need a powerful political strategy, supported by a broad unified movement to win the fight. We’re not there yet; not even close.