Medicare For All — The Democratic Party Audition for 2020

By Thomas Neuburger. Originally published at DownWithTyranny!

Bernie Sanders’ November 2016 aggregate approval rating. Net favorable: +18%
Hillary Clinton’s November 2016 aggregate approval rating. Net favorable: –15%
Donald Trump’s November 2016 aggregate approval rating. Net favorable: –17%

The next two years will present multiple tests of the soul of the Democratic Party, just as have the last 10 years. But two of those tests have “high profile” written all over them. The outcome of these tests could determine the Party’s future, and consequently the nation’s, in the 2020 presidential election.

One test is the Green New Deal. The other is Medicare For All. Both are mere proposals for now, and neither is as well defined as it needs to be in order to become law. But that day is coming for both, and the first time either comes before the House as an bill, the soul of the Democratic Party will be tried and judged, in full public view, with the bright 2020 klieg lights fully upon them.

How will the Democratic Party, in the aggregate, respond when those bills present Party leaders with a moment of decision — to support or not to support; to sabotage in secret or to show their approval in plain sight and by their actions?

The Party “In the Aggregate”

A note about the meaning of “in the aggregate”: Yes, there are many forces and factions within and around the Democratic Party and its ecosystem, and many voices offering different directions to go. Similarly, there may have been many voices in the wheelhouse of the Titanic as well, with factions offering different decisions to consider.

But in the end, one decision was taken, the ship “in the aggregate” stayed its course, and “in the aggregate” it sank to the ocean floor.

It make no difference, in the end, if a small group of senators is opposed to flash-confirming Trump nominees, for example, while Chuck Schumer and his leadership faction act otherwise. The Party “in the aggregate” confirmed those nominees. That’s what the public sees; that’s what the public bases its opinions on.

Three Questions

With respect to the issues identified above — Green New Deal, Medicare For All — the outcome will be determined by answers to the following questions:

A. Will progressives by then have taken control of the Party, or will current anti-progressive leaders still be in charge?

B. Will current Party leaders keep control but “see the light,” thus joining with progressives and the electorate in supporting the strongest possible versions of these bills?

C. Or will money-corrupted leaders controlling the Party dig in their well-funded heels and fight instead to defend the donor class and its destructive privileges?

If either of the first two answers is yes, the Party’s 2020 presidential chances look bright. But if both of the first two answers is no and the last answer is yes, the odds are at least even that a faux-change Republican will win or keep the White House.

2016: The Past as Prologue

Consider: The 2016 presidential election should have been a blowout, and Democrats, in their wisdom, turned it into a squeaker by nominating an uninspiring status quo candidate in a change (actually, pre-revolutionary) year.

Democrats have now taken the House. 2020 will certainly be another change election — and another pre-revolutionary year — unless things come completely apart first. The Party’s aggregate behavior (meaning, its actions as directed by whoever is in charge) will serve as a two-year audition for the trust of the American people.

In that sense, the 2020 campaign has already begun, and Democrats, especially but not exclusively in the House, are giving an early and important audition for the role of savior of the nation.

If the Party (in the aggregate) continues to show that its first loyalty is to the donor class — Bernie Sanders’ now famous “billionaires” — its voting base will be reduced to Party loyalists, the 25% shown in the graphic below, and any status quo or suspicious-but-progressive-sounding candidate will attract only the “never Trump” or “never Republicans” portion of the larger independent-voter pile.

Almost half of the American public identifies with neither party, and a great many dislike both

This is what happened in 2016. The Party, with Clinton as its candidate, turned a sure thing into a squeaker. Bernie Sanders, a genuine change candidate, would have wiped the floor with Trump, a pretender at best.

Note the 2016 election-day approval and disapproval ratings at the top:

  • Clinton, –15% approval
  • Trump, –17% approval
  • Sanders, +15% approval

The race between Clinton and Trump was close, and Donald Trump won. It’s easy to see the past as prologue, unless Democrats (in the aggregate) act differently.

The “Medicare For All” Test of the Democratic Party

Let’s look at Medicare For All (we’ll turn to the Green New Deal separately). Early indicators of the shape of the Medicare For All battle are not promising, despite nominal support from otherwise weakly progressive or pro-corporate Democrats. I’m especially troubled by the implications of these recent stories.

First this, about congressional “call time,” the practice of “dialing for dollars” by calling members of the donor class for cash. Every such call is an implicit contract: You support me with dollars; I’ll support you with votes.

For most members, fundraising is becoming an ever-steeper hill to climb. Incumbents in the House and Senate raised $486 million in 2000. By 2016 that number had nearly doubled to $909 million — far outpacing inflation. Members don’t have to report how much time they spend on fundraising, but leaks to the press have indicated that the parties expect new members to budget four hours a day of call time, plus an hour a day for fundraisers, which can be anything from a breakfast to a cocktail hour to a pass-the-hat potluck to a $1,000-a-plate gala dinner.

“Both parties have told newly elected members of the Congress that they should spend 30 hours a week in the Republican and Democratic call centers across the street from the Congress, dialing for dollars,” Rick Nolan, a Minnesota Democrat who retired from Congress this year, said recently, adding: “The simple fact is, our entire legislative schedule is set around fundraising.”

This is a vastly undercovered story, because its so obviously embarrassing, and there are too few public rebels, like Ocasio-Cortez, against “call time.” How many others like her will there be? Enough to change the grip on Congress of the money that buys its members?

When the day to be bold arrives, will the donors who finance elections call in their chips and sink Medicare For All? Based on the following story, I’m convinced they will:

Chamber of Commerce CEO vows to ‘use all our resources’ to fight single-payer proposals

Thomas Donohue, the president and CEO of the Chamber of Commerce, on Thursday vowed to use all of the Chamber’s resources to fight single-payer health care proposals. … “We’ll use all our resources to make sure that we’re careful there,” he said, though his previously released prepared remarks had said the Chamber would use all of its resources to “combat it.”

The billionaire industries that benefit financially from our destructive status quo health system are not going to go without a fight. Medicare For All represents an existential threat, and they recognize that.

Finally, will their corrupting influence extend to Democratic members of Congress? Based on the following, it already has:

When Medicare For All becomes a bill, the fight will be a cage match with the bright lights on. What will the Democratic Party (in the aggregate) do in response? Will it support, whole-heartedly and by its actions, the health and welfare of the American people, or continue the abuse of the American people by supporting those who extract wealth from suffering?

I’d love to be wrong, but I fear the Party (in the aggregate) is almost certain to blow it. If it does, the public is certain to notice.

Which means the nation’s last hope lies with Party rebels, perhaps Bernie Sanders, perhaps this guy, to make another insurgency run for the nomination, save the Party from itself, and save the nation from the predators who currently run it.

Unfortunately, the last time that happened, the Party made sure the insurgent never had a chance.

Print Friendly, PDF & Email


  1. cat sick

    No more wars is going to be the other dynamic, Tulsi is the only Dem who has a resonable policy on this front, no more war is the only easy way to fund medicare for all …

    1. Samuel Conner

      Eternal war is certainly an important policy argument, and one hopes the argument will happen, but “no more war” is not the same as “reducing military expenditure”. One hopes for both, of course.

      But “reducing military expenditure” is not in principle a pre-requisite for “funding” M4A. I don’t know the details of the real resource consumption of our current “garrison the planet” stance, but I suspect that there are sufficient underutilized real resources to provide comprehensive medical care to the US population. There might be a shortage of primary care physicians, but that constraint can be pretty readily overcome by policies that promote the diversion of talent into medical training and away from financial engineering. Of course, that requires political will, the supply of which we will discover in coming years.

      1. Jim thomson

        The size of the unemployed and underemployed population, 5-10% of the work force is a good estimate of unused or underutilized resources in our country.
        That is a huge potential resource to be used.
        But, just eliminating profit and admin overhead would reduce health care sornding by 20-30% Kelton calculates.
        And compare US spending to other countries.

  2. Acacia

    Sorry to be obtuse but isn’t the answer to the three questions just obviously “C”?

    money-corrupted leaders controlling the Party dig in their well-funded heels and fight instead to defend the donor class and its destructive privileges

    Why is there even discussion of a “test” of the “soul” of the Democrat party? That was sold, long ago, to the donor class, Wall Street, the CIA, the MIC, etc etc.

    1. worldblee

      Agreed; the Democratic Party goal is to NOT have Medicare for All since its funders don’t want it. Whether they get the presidency or not is immaterial, the main goal is to make sure the people don’t want to get what they want and need so the right sort of people (the investor class in all its permutations) get their way.

      And fundraising is actually easier when you have someone like Trump in the White House. Not to mention the investor class gets their huge tax break (which is not opposed by the Democrats in any meaningful way) while saying they’re against Trump and “for the people”.

  3. Damon

    Given the analysis above (and what seem to be contemporary party instincts) perhaps this entry would be better entitled“Mediocre for All — The Democratic Party Audition for 2020”

    Never mind that political imagination of Democratic laity seems to stop at the restoration of the 90s but with a better racial/gender/lgbtq overlay.

  4. Keith Newman

    In response to cat sick: No new funding is required for Medicare for all. It will result in vast savings and free up resources for other programs. The US spends about 7 GDP points more on health care than other first world countries that fully cover 100 per cent of their population. That number, about $1.4 trillion, is the amount looted by Big Pharma, the insurance companies, doctors, and no doubt others. The challenge is entirely political. Those who stand to lose will gear up to stop any real change and spend tremendous amounts to do so. Only on the ground political work on a wide scale will be able to overcome the power of their money.

    1. Mickey26

      True enough in theory. The country (probably) spends enough on health care presently to fund MFA. But that consists not only of current Medicare/Medicaid spending but employer premiums, deductibles, co-pays, employee contributions, etc. How will these disparate existing streams be captured, unified and directed towards MFA? I am CFO of a company that currently spends a noticeable portion of its revenue on health care premiums. With MFA do I just immediately get a massive increase in profitability compared to companies with less generous (or no) current plans?

      All in favor of MFA and agree that cost would probably not be significantly higher than current expenditures but redirection mechanisms not even remotely clear to me.

      1. Keith Newman

        Mickey 26: There are indeed a lot of moving parts and ways to transition from the current situation to MFA would need to be worked out. However every other first world country has done it and the US would need to work out its own best way. As a CFO you would certainly appreciate the easy reduction in labour costs your firm would enjoy.

      2. rc

        Yes. If done properly, the system should save 20% to 40% of existing spend out of the gates. It would cut administrative expense and costs of services, devices, drugs, etc. by the U.S. acting as the buyer for all. That translates to $800 billion to $1.6 trillion per year. In other words you would spend 12% to to 16% of GDP for universal care–still the highest in the world.

      3. rd

        Employees do not understand the magnitude of the health care costs that employers are paying and they really do not understand what percentage of their gross income health care insurance is. That is why COBRA and ACA insurance creates such sticker shock. Employees don’t understand that their employment costs to the employer have been rising because of health care insurance even though they have not been getting pay raises.

        Single payer premiums for universal coverage of core services would be funded largely through a payroll tax system with some progressiveness. Based on Canada etc., this would be substantially lower that current US insurance policy costs. Insurance companies would still exist for covering “Cadillac” services. For example, Canadian public health care insurance typically covers hospital stays in a four-bed ward. Private insurance, usually provided by employers, then provides for upgrade to private rooms.

        Single payer dramatically reduces administration costs and the insurer is not trying to pawn the problem off on another insurer. You are either covered or you are not (some elective procedures). Cost schedules are generally quite fixed with little mystery. Everybody is “in-network”.

        Thew single payer systems are getting good at using population-wide, lifetime health data to figure out what works and what doesn’t because they now have information on patients going back to the 60s. They have been using that data to streamline healthcare. One of their focuses has been keeping people out of hospitals at almost any cost to the system because hospitals are expensive and they often don’t produce decent outcomes due to patient inactivity, infections, and mental confusion. So hospitals are now a place to do procedures and then get patients out the door quickly back into their home settings where the system will then provide services. This is what I have been seeing with geriatric parents iand other people in the Canadian system.

        Basic vision care and dental is not covered in Canada under single-payer. That is typically employer provided insurance.

        1. Jim thomson

          No need to have any premium payments at all. Pay for it just like another war, aircraft carrier or farm subsidies. Congress appropriates in a bill and the treasury marks up the accounts or cuts the checks.

          1. Keith Newman

            WIth respect to taxes, assuming a universal non-profit publicly administered plan, there should most definitely not be a MFA tax increase of any kind, personal or corporate income tax, payroll tax, whatever. The massive decrease in spending resulting from the savings the program would generate would be highly deflationary. A tax increase could cause a serious recession. In effect MFA should be ”paid for” with a decrease in taxes! Or more spending elsewhere. With respect to the phase-in of the program: how about declaring that on January 1, 2020 everyone 60+ will be covered under Medicare as well as everyone from birth to 10 years old, You’d need to include pregnant women as well. Then on January 1, 2021 everyone 55+ is covered as well as everyone from birth to 20 years old. Etc. In a few years everyone is covered: no exclusions of any kind, no premiums, no new taxes, no deductibles or co-pays, no pointless middlemen in the form of insurance companies, Just like every other first world country.

      4. Avidremainer

        Forgive a Brit interfering.
        I am retired. Throughout my working life I paid 10.25 % of my gross salary to National Insurance Contributions ( NI). This payment covered the following: Health Insurance, Pension, Sick pay, and Unemployment Benefit. If there is only one person per family paying NI then all members of the family are covered. If there are two family members working then tough, they both pay NI.
        There is only one further payment for prescriptions of £8.75 per prescription, no matter how many items are on the prescription. The following are exempted: Chronic sickness, pensioners, pregnant women and children under 5.
        The Nation Health Service ( NHS) is a comprehensive health care system. There are waiting lists for elective surgery. Eventually any corrective surgery needed will be done. Emergency treatment will be given immediately. Life threatening disease- cancer, kidney failure etc will be treated with appropriate alacrity.
        The main problem lies with which is the party of government. The experts calculate that the NHS needs a 4% increase per annum in funding. The Labour Party usually meets this target, not so for the Conservatives. Since 2010 Cameron and May have only increased the funding by 1% per annum and it is no use pretending that the system isn’t creaking. Political will is the difference between the system working well or not.
        The NHS is not the only type of comprehensive health care system in Europe. The Swedes appear to have melded the Socialisation of health care and the market. Each Swede receives a voucher which covers all health care costs, they then ‘spend’ the voucher wherever they wish. The French Dutch and German systems also merit close inspection.
        If your politicians cannot design a system which reduces the USA’s health care costs to 9-11% of GDP then you have to ask a) what use are they? and b) whose side are they on?
        Your HMOs appear to be rent extractors and price gaugers and should have no place in any free market system
        Ford Motors, and every other corporation in competition with Europe etc must carry a huge fixed cost in the form of employee health care. This unnecessary cost goes into the price of the end product. This is such a disadvantage. I don’t understand the rationale.

  5. Amfortas the hippie

    Both my parents(76 yo) have discovered MFA…and think it’s a shoe-in. Their news diet consists almost entirely of MSM.
    When I answer with an impassioned rant about PayGo and the perfidy of Chuck and Nancy and the Vichy Dems, both of them indicate that they worry about my sanity.
    “why would you say that?!”
    I take this an indicative of where we’re at, at least as far as the Comfortable Classes go.
    it will come down to what percentage of the Dem Primary vote have imbibed the koolaide(and what innovative shenanigans the DNC, et alia can use this time around to negate the non-koolaide set).

      1. Amfortas the hippie

        Sabbatical has long been one of my favorite words.
        I’ve avoided news like the plague since Jan. 1st….even to the point of switching mom’s tv and “losing” the remote.
        Only online activity has been farming related and various philosophical endeavors…and netflix.
        I’ve got the little attached greenhouse ready to go…little pots filled, and a couple of poly barrels painted black and filled with rain(heat sink…report on efficacy forthcoming).
        seeded out all the tree seeds I collected around the hospital this fall(various oaks, mountain laurel, sycamore, etc).
        Tis the season…since “The Season” is finally over… to endure, and wait for spring to spring. Scorpio is rising just ahead of the sun…and, a worrisome indicator of screwed up climate, the earliest flowers are a month and half earlier, and several varieties of tree are budding out when they shouldn’t be. This is in spite of the cold.
        reading W.E.B. DuBois and Arnold Toynbee and Ch. Freeman’s “Closing of the Western Mind”, among other things.
        We’ll find out friday if all the chemo is having an effect.
        of all the billions of humans on the intertube machine, I’ve missed y’all the most.

        1. ChristopherJ

          Cheers bro and best re the c stuff.

          Yes, my garden is all over the place. Citrus trees that no longer recognise seasons…

          Anyone that denies we are in for some wild weather, and we are the cause, is delusional or blind.

    1. katiebird

      My parents (dad is gone now though) agree with me on issues but (unlike me) fall for Dem politician’s pretty speeches, especially compared to Rep’s not so pretty ones. And even now that the speeches aren’t so pretty they haven’t got over it.

      But they (just Mom now, I guess) like hearing me rant, even if they can’t go that far against the Dems themselves…

  6. Carl

    Have to agree with the author…there’s no reason for optimism, based on the Democrat party’s behavior since 2016. Most likely, they will still be debating the “feasibility” of MFA 20 years from now. These people do not change, do not share power, cannot learn from their mistakes (if you can call them that), refuse to see how irrelevant they’re becoming. Keep clinging to those identity politics, though; that should work. Until it doesn’t. Excuse the rant.

  7. rob

    There is no hope, because there is no media support. Where are the masses going to learn that the only way to move forward with any good ideas, is to remove all the old democratic(and republican) players. How will they have the certainty that no matter what the democratic party says, they don’t mean it. They SHOULD have figured it out by now, but the masses are propagandized to the point of total control by their masters. Are they going to listen to NPR? that won’t help.
    there is a game with opposing teams, R and D. Team R scores on the team D goal all the time, and when team d gets the ball, they turn around and score on their own goal. all the time. then they say we could have gone for the goal of team R, but they would have fought us… so we figured we would have a better chance if we just scored on our own goal, because our defense sucks…. Guess what, team america will never win, with both teams scoring on the same goal…..And we the people will never benefit, if we leave it up the the republicans and the democrats to “push it though” for us.
    The media is key. If the voting population was informed by democracy now, or any of the actual progressive news sites, like this one… maybe they would realize only people who walk the talk, are ever worth being voted for.We need a couple hundred people like AOC… which in a nation of 300 million is possible, but since 99%+ of the media is 100% propaganda…. it is not in the cards.
    The ONLY thing standing in our way is us.

    1. integer

      the masses are propagandized to the point of total control by their masters… 99%+ of the media is 100% propaganda

      “Shortly, the public will be unable to reason or think for themselves. They’ll only be able to parrot the information they’ve been given on the previous night’s news.”

      – Zbigniew Brzezinski

      1. John Wright

        I believe Bush Jr.’s pitching of Iraq War II was the most significant battle in the Propaganda War, a war that continues.

        When only 23 USA senators could be found to vote against a resolution that authorized military action against a country that, might, just might, do some harm to the USA in the future, the elite KNEW they owned the political class and the media.

        When so many supporters continued to maintain their important political offices or media positions (Biden, Clinton, Kerry, McCain, Cheney, Tom Friedman, the NY Times editorial staff, Charles Krauthammer), that was a symbol that they had done no harm to their careers by assisting in killing/maiming people and destroying property throughout the world.

        Even George W. Bush, who is the poster child for being an exponentially dangerous screw-up his entire life, is being rehabilitated.

        With media concentration and wealth concentration in the USA, perhaps hoping for dueling wealthy interests producing a favorable outcome as a side effect is the only cause for optimism.

        1. rd

          The US War College recently concluded that the only victor in the Iraq War was Iran, which wasn’t even a participant.

          American exceptionalism gets in the way of realistic understandings of major things like wars and health care. When other countries are getting better healthcare outcomes for half the cost, it is time to step back and take a really hard, critical look instead of just chanting jingoistic speaking points.

      2. MyLessThanPrimeBeef

        The media is key. If the voting population was informed by democracy now, or any of the actual progressive news sites, like this one

        In the name of education or educating.

        The bad guys don’t come out and say they are propagandizing. They most often say, ‘we are educating you, or the public need more educating.’

        ‘Inform’ sounds better, though one’s ‘inform’ is the other side’s propaganda.

    2. ChiGal in Carolina

      Pretty potent signalling here. Seems it’s already over.

      The House Democrats have decided that their single payer Medicare for All bill will not carry the HR 676 number.

      They let that number go this week to a bill that reiterates “the support of the Congress of the United States for the North Atlantic Treaty Organization (NATO).”

      Some in the single payer movement see the abandonment of HR 676 as a betrayal of years of grassroots activism, activism that drew 124 co-sponsors to HR 676 in the House last year.

      Now, with Democrats in charge of the House, the Medicare for All single payer bill is being rewritten, watered down and renumbered.

      “For the past 16 years, HR 676 was our gold standard bill defining a national improved Medicare for All single payer healthcare system for the United States,” said Margaret Flowers of Health Over Profit for Everyone. “It was based on the 2003 Physicians Working Group proposal by Physicians for a National Health Program.”

      “Now that the Democrats can no longer ignore that their base is demanding a single payer health system, we have lost both HR 676 by number and its status as the gold standard. From what we have heard, as we have still not seen the text of the draft as promised, the new health bill being written by Congresswoman Pramila Jayapal (D-Washington) has an unnecessarily long transition period and maintains the for-profit providers in the system. The delayed transition means more preventable deaths and suffering. Keeping the for-profits means higher costs and lower quality of care.”

      Jayapal’s bill is being written behind closed doors.

      Last month, single payer advocates called on Jayapal to share the draft text of HR 676 with the single payer movement for review and input. She has refused.

      Kevin Zeese of Popular Resistance didn’t miss the irony of losing HR 676 to NATO on Martin Luther King Jr.’s birthday. It was King who said – “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

      “Congressman Jimmy Panetta (D-California) the son of former Defense Secretary Leon Panetta, took HR 676 and turned it into a bill to support NATO,” Zeese said. “NATO is no longer a defensive force against the non-existent Soviet Union but has become a military aggressor working with the US in illegal wars among them Afghanistan, Syria, and Libya. It has not only expanded to cover most of Russia’s border with bases, missiles, and troops but has spread to Colombia which borders Venezuela, another nation the US is threatening with war.”

      “To top it off, on April 4, the anniversary of the murder of Dr. King, NATO will be holding a 70th-anniversary meeting in Washington, DC. This is also the anniversary of King’s Beyond Vietnam speech. In that speech, King warned that ‘A nation that continues year after year to spend more money on military defense than on programs of social uplift is approaching spiritual death.’”

      “Congressman Panetta’s replacement of healthcare for all with military aggressiveness exemplifies that spiritual death.”

      1. mle detroit

        The loss of the number is appalling news. But let’s keep the gold standard and call it “the Conyers bill.” He has long been a jerk in his private life (we in Detroit know all too well) but he deserves public credit for public service, especially MfA.

        1. Jeff W

          …let’s keep the gold standard…

          I think that’s important. Rather than gnashing our teeth at the loss of a number with all that that signals, let’s use the Conyers/676 bill as an “anchor” to keep people’s expectations from being shifted and keep pushing legislators back to that reference point. We’re much better off with that concrete bill in existence, even if it’s been apparently abandoned by Congresswoman Pramila Jayapa and House Democrats, than without it.

        2. ChiGal in Carolina

          This comes down to who has the power to name things (been reading Stoller).

          This is a done deal because they have the power and this tips their hand like nothing else.

          We may continue to refer to it as “Conyers’s bill” in this community all we like, but do you think for a second that the MSM will refer to it as such? That the vast bulk of the citizenry, even those leaning in favor of M4A, will follow us rather than politicians and journalists?

          So what is the mechanism by which we force the continuation of OUR naming of M4A and refuse to let it be watered down? It isn’t taking to the streets (see Jo6pac’s links in WC on the LA teachers strike). So what is it?

          Sorry, very discouraged by this. When I think of all the lobbying materials, the educational handouts, the signs, the buttons and stickers, films even, that now at one fell swoop are confused if not entirely compromised by the fact that HR 676 now refers to something else, I am just undone.

          This is really a masterful stroke: the Empire Fights Back.

      2. MyLessThanPrimeBeef

        “Give me a kiss, and to that kiss a score…Treble that million…Let’s kiss afresh as when we first begun.”

        Are we seeing something similar here: “Fool me once, and to that a score…make it a million times…and fool me again like you did the first time…the very first time, as Madonna would sing….?”

        “Seems it’s already over.”

        A warning is given here, and many times before.

        Do we demand AOC resign from the D party?

        Be an Indepedent?

  8. Luke

    I have an idea on how to implement “Medicare for All”, that doesn’t take convincing one single legislator, legislator-bureaucrat, or legislator-judge that it’s a wonderful idea. It’s even arguably the most ethical path for implementing it.

    How about the people that think it’s a swell idea organize a voluntary association that does the whole thing, from payments in, getting care. being a nurse/doctor/owner of a laboratory or hospital, etc.? If it’s a genuinely good idea, then it’s just a matter of competent marketing. If people can’t be convinced it’s a good idea, and it can only be implemented by government guns, then maybe it’s more Stalinist/Maoist than American, and should be dropped as a proposal altogether.

    1. pretzelattack

      how does your idea work with the present system, then? and how is it “the most ethical”. i don’t think it could be implemented, sounds like more free market pie in the sky.

    2. NotTimothyGeithner

      Where is the money for the MRI coming from? The incubators for the premies? The hospitals? The x-ray machines? Because all of this needs to ready day 1?

      What happens if you run out of money? Do you go to the sick? What if they are in treatment and not working? Does the operation shut down? Do you tell people to sit tight for three months?

      When leeches were on the cutting edge on medical science and sawing off infected limbs, this sort of worked.

      Then of course, since we already have a single payer system and a system of healthcare facilities, why would we start over with something new? It seems likes a huge waste.

    3. False Solace

      In Luke’s plan, “ethical” means the existing private for-profit parasites continue to extract their pound of flesh, meanwhile the people are furthermore required to shell out for a voluntary system that actually provides the care they need. Hey how about we just scrap the for-profit layer of cruft that doesn’t work and produces morally obscene outcomes? The government does plenty of things with “guns” that the overwhelming majority of people do not support. M4A has large majorities in support, withdrawing from unending wars has large majorities in support. Representatives owned by billiionaires refuse to obey the will of the people. What in there is Stalinist/Maoist, the people or the donors? The people want their supposedly democratic government to enact their will. The donor class is intent on thwarting them and profiting from human misery.

      For-profit health care just doesn’t work as a system. If your motive is in keeping people sick longer and doing unnecessary procedures and refusing to pay for needed procedures, guess what? People will be sick longer and subject to unnecessary procedures and won’t get the care they actually need. It’s morally indefensible and totally unworkable, as the US has proved in spades.

  9. Peter Lynch

    I think all of the ideas are important. But in order to be truly successful, you must FOCUS on one problem and
    throw all resources at it. It must be the most important problem – I think, without question, the number one problem we face in addressing climate change at a magnitude and speed matching its threat. If we do not the future of human life is at stake, at least in a form that is close to resembling our way of living now. Plus by doing this it will generate a huge number of jobs and dramatically increase cash flow to address other problems

    1. marym

      What’s standing in the way of universal healthcare is the same as what’s standing in the way of addressing climate change. It’s “cash flow” in the sense that cash flows from the many to the few, not anything inherit in the amount of cash that’s flowing.

    2. jrs

      You are right of course about ultimate priorities and I dearly wish it was very high on everyone’s list. But I’m not sure it is and that it’s that easily sold. MFA maybe is.

      Is MFA everyone’s top priority? Oh heavens no, in addition to those like you looking at the big picture, there are people without jobs (and even without housing), it’s rightly fairly low down Maslow’s hierarchy for them as unless they are also quite sick, they have way more immediate concerns than seeing a doctor, like getting an income, having a roof etc.. But MFA is broadly popular not just popular among those financially in a bad place.

  10. cripes

    Hey “Luke”

    That’s an excellent idea that should be the test for all warmaking, housing bubble, predatory financial engineering, and health care services:

    Let the purveyors of war, extractive “health” care, financial exploitation and crushing housing costs stand on the corner with tin cups asking “consumers” for spare change to fund the schemes that impoverish them. Without any government assistance or compulsion.

    Yes, by all means, let the “market” decide.

  11. Hepativore

    I wonder if it would be a viable strategy to try and enlist some business interests and Republican politicians on board with a single-payer or Medicare-For-All system. I do not mean trying to water such proposals down to appeal to them, but…

    It would be a long shot, but I am actually quite surprised the Chamber of Commerce is so dead-set against it. Do you think that it would be possible to try and have corporate greed work in our favor by pitting some massive corporations against the healthcare industry by showing how they would save a lot of money by not having to offer health insurance plans for their employees anymore? We could try and set billionaires against each other by showing how much the health insurance industries are ripping them off as well in terms of how much money they have to spend on employee health coverage.

    I am not hopeful it would work, but I wonder if it could at least be partially tried.

    1. NotTimothyGeithner

      but I am actually quite surprised the Chamber of Commerce is so dead-set against it.

      1973 is going to be an exciting new year.

      In all seriousness, single-payer gives workers power immediately. They are no longer held captive to the fear of getting sick. It also would help new business formation and small businesses, but they aren’t the bank rollers of the Echo Chamber of Commerce.

    2. ChiGal in Carolina

      It has been. M4A advocates have recruited business people to share their stories. A film you may have heard of is Fix It (I believe you can watch it for free somewhere online). The group I was (long story) active with, Healthcare For All Y’all, does free screenings of it. It was made by an entrepreneur and tells the story of how he discovered all the waste in the for-profit system that resulted in him providing his employees with ever crappier coverage at ever greater cost.

      Also Ed Weisbart, the head of the MO chapter of PNHP gives talks from the business perspective and there is an audio of him available through Margaret Flowers’s group HOPE (health over profit for everyone). We put on an event featuring him and made a video which I think is on YouTube.

      Sadly, we are still in the boat we’re in and Bezos, Warren, and Dimon ain’t gonna advocate for M4A.

    3. JBird4049

      >>>It would be a long shot, but I am actually quite surprised the Chamber of Commerce is so dead-set against it.<<<

      Power over others and not wealth or a successful business seems to be the most important thing for some. Which is not something I fully understand. Is it ego gratification or is the fear of being just like anyone else? Raise yourself up by crushing others perhaps?

  12. Judith

    A companion piece from Real News Network:

    ….I think it takes us to the fight that we can’t avoid. And a lot of the Democrats that come up with alternatives to what we mean by improved Medicare for All, say for example a buy-in proposal or even this notion of Medicare Advantage for All, these are attempts to avoid the fight. Because as Bob says, you have to put the insurance function in the hands of a publicly accountable program and eliminate the profiteering, the marketing, and the waste, inefficiency, administrative burdens of the private insurance system. And so, even advocates who say, like in that Robert Pear article, “Oh, we should go to Medicare Advantage,” but they say we should heavily regulate the insurance companies as a utility.

    So you have a choice. You’re either going to be in a fight over a regulatory regime, and we see how that’s worked out with the ACA, and it’s been very unstable, not sustainable, and in fact, not universal. And then, on the alternative to that fight over regulation is a direct transformation of the healthcare system into one that will guarantee healthcare for all with no barriers to care. And that’s the fight that we have to have, and it is a fight with the insurance industry, and not just them, but with pharmaceutical and hospital corporations as well. And Bob and the PERI study that he authored shows very clearly that we can transition from the current system to a Medicare for All system. We can take care of those workers in the insurance industry, we can guarantee healthcare for all. We can literally do everything except accommodate the insurers, which is what all these alternative efforts are trying to.

    …So let’s play a little game here, in a sense thinking about how this gets sold, sold both to the left and progressives who understand what the heart of the issue is, and also kind of to the greater American public and to the political establishment. And Michael Lighty, I’ll start with you, and we’ll come back to Bob. And please feel free to jump in with each other as well. But you know that if this is pushed hard in the U.S. Congress, Medicare for All, with this new Congress coming in, a very different mindset from many of the younger people who are now in Congress, that the pushback is going to be severe. And establishment forces inside the Democratic Party are not going to want to see a Medicare for All the way you two are describing it at this moment.

    So what is the politics of that, to push that, and how that happens and how that get organized, and what you’ve seen in your work as an organizer with the nurses and more? So talk a bit about that, what does that strategically look like?”

  13. Richard

    I get so smart reading all you guys. Seriously. I know this is a column about M4A, and the dems being torn asunder by contradictions and cognitive dissonance. And I could say something about that. But I’d rather say that this is the most amazing place ever, and I don’t know how you all found it, but I’m glad you did. I’m just feeling very grateful now for this intellectual home.
    Okay, enough mushiness…:)

  14. Tom Stone

    “C” and Kammie Harris is the way to bet.
    Systemic failure is what we are experiencing.
    It’s not going to be boring…

    1. JBird4049

      Please no. Kamala Harris is a vacuous political opportunist. She makes Governor Gavin “Goodhair” Newsom look presidential.

  15. KLG

    Late to the party. I hate when work intrudes.

    Sent my first Campaign 2020 prediction to a friend last night:

    A year from now Trump finds himself in electoral trouble that even he can sense. Consequently he goes all-in for Medicare-for-All. Professional Democrats are gobsmacked, flustered. And neutered. Trump wins, this time losing the popular vote by only about a half-million.

    No, he doesn’t follow through on the promise, but what else is new? My friend replied that I give Trump too much credit. Well, feral beats feckless every time. As in 2000, 2004, 2016…

  16. Hepativore

    How do you think the Democrats will fumble in 2020? Do you think that Sanders will simply choose not to run, or do you think the Democratic party will raze both him and itself to the ground in an attempt to keep him from winning the primaries while being fully aware that it would be suicidal? If the Democratic party does this, what method do you think they will use?

    This question also goes to what do you think is going to happen with more progressive-leaning candidates like Warren or Gabbard.

    1. JBird4049

      I believe that the Democratic Party will scorch the political earth using every illegal, immoral, and unethical act that they can; they will do what they can to make it look like they are not, but will do so regardless of what the anyone besides their wealthy patrons think.

      I see a small conservative effort for reform, but it seems to be several cycles at least behind leftist efforts especially as conservative movements are run more top down. But the fabulous corruption, abuses, and general dysfunction is making the lower 80% unhappy regardless of ideology. Still with the probable destruction of any either parties’ honest reformer’s campaign for 2020, I am looking at the midterms of 2022, or much more likely the 2024 general election, to get… interesting.

  17. Scott1

    Leadership matters a good deal. The soul of the progressives exists as Senator Bernie Sanders. He had to run as a Democrat. The Democratic Party controls real precinct offices territory. Women staff these offices. Women were not going to listen to any arguments against Clinton Unit II because of their desire to see a woman in the White House. If Clinton Unit I had divorced Clinton Unit I she would have one. Demonstration of Clinton Unit rule has been Haiti.

    We will see if there are leaders who can inspire the best ideals of a republic that gives all citizens the vote. Vote flipping & vote stealing & voter suppression have kept the GOP in power.

    The facts of how the US Treasury is a power denied to the people since the bail out is to see the people’s Treasury as a reinsurer for Wall St. or the Finance Industry. Small minds can’t deal with large numbers. Further the Fed is only focused on inflation.

    The Fed forgets about full employment. The Treasury can make sure there is full employment. The corporations that get cheap Labor do not want a system that props up wage levels regardless of a minimum wage which the Corporations despise. Even where people were getting rich Jobs had labor agreements with competitors that was secret.

    The government has descended to closure and forced work without pay. Forced work without pay is slavery. Democrats must call it so and force it so people working get paid. In the order of things Democrats must do that first by hook or crook.

    I’ve wanted to see a physical march to the US Treasury where the Financial Engineer David Cay Johnston would be the MC for MMT economists who will explain Domestic Economic Warfare which is Class War with Plutocrats & the international oligarchy Trump is a part of.

    A march is a march is a march & is what you do short of violence. Two million showed up for the Women’s March and some leaders cursed. Next thing is showing their breasts. The gossip of women is a great power & when millions show up the leaders see them as armed whether they are or not.
    They see and Trump would see what they fear.

  18. Luke

    Cripes, I largely agree with you. I don’t think that the U.S. needs bases outside its borders, or sustained military action that does not follow a Congressional clear declaration of war.

    Re the medical industry, I can choose to have nothing to do with insurance companies and a given pharmaceutical company. If you can tell me how I can choose (short of self-exile) to boycott a government agency (the IRS, CPS, divorce courts, EEO, OSHA, EPA, ADA, DOA, FCC, etc. would all be on my list), I’d love to hear about how.

  19. Bob Hertz

    If a single payer plan starts by covering everyone who is not on Medicare and Medicaid, it will be covering about 200 million persons.

    If the single payer plan has no deductibles or copays, I think it has to cost a minimum of $6,000 a person. (and this is after paying Medicare rates to drs and hospitals, and after administrative savings.)

    So this means that the government needs $1.2 trillion a year, and this is without setting a formal reserve funds for rough years. ( I know that the MMT crowd says that the $1.2 trillion is not needed, but real Congressmen and women do not operate that way.)

    Raising a fresh $1.2 billion would take a payroll tax of 15% on every single firm in the US, including restaurants and retail.

    There could also be a mix of payroll and income taxes.

    A national sales tax is not going to happen, but even if it did the amounts raised would not be $1.2 trillion or even close.

    Personally I like single payer, but I also like a frank discussion of how to pay for it. I have two position papers on this that anyone can get by contacting

Comments are closed.