By Simon Brown, Sam Hughes, Mia Lehrer and Jamie Gardner
Immediately after the 2016 presidential election, the California Nurses Association (CNA) jump-started a campaign to win single-payer healthcare in California. This February, the East Bay chapter of Democratic Socialists of America decided to join the nurses and make the Healthy California campaign our organization’s central fight.
Within a month, our chapter held a preliminary canvassing event to train a dozen canvassing captains. Then we multiplied our capacity and held a second event three weeks later with more than 160 volunteers. These volunteers — mostly first-time canvassers — spread throughout the East Bay to educate the community about the single-payer system and mobilize supporters in favor of SB 562. Nearly 1,000 East Bay residents have already signed up to support single payer. After a few hours door-knocking, one volunteer reported, “I learned there are two kinds of people: people who aren’t home, and socialists.”
That’s why we’re holding a third canvass this Saturday, April 1st that we expect to be even bigger. Door-to-door advocacy for single payer gives DSA an opportunity to talk to the public about healthcare policy in a distinctly socialist way. Neighborhood-by-neighborhood we’re organizing a base that’s defined not by a one-off single issue, but by a vision of overturning the ruling class in the long term.
Single payer is the socialist answer to the market-based ACA
A publicly financed single-payer system treats the provision of healthcare as a matter of meeting basic rights, not maximizing the efficiency of a market. Under Senate Bill 562, introduced by State Senators Ricardo Lara and Toni Atkins, all medical costs for all California residents will be covered. Healthcare will no longer be contingent upon employment. Co-pays, deductibles and premiums will be eliminated by publicly financing doctor’s visits, prescriptions, procedures, mental health, vision, dental care and more.
The liberal approach, through the federal Affordable Care Act, extends coverage to a degree, but it ultimately subsidizes a private market that profits from driving up costs and excluding the most vulnerable. On the principle that healthcare is a human right, single payer will eliminate the private insurance market and replace it with a universal guarantee to care.
The clearest distinction between the ACA and a universal program can be seen in the ways each plan serves, or does not serve, undocumented immigrants. While the ACA formally bars undocumented people from receiving subsidies on the healthcare market, the California single-payer proposal will cover all Californians regardless of immigration status. When we assert healthcare as a human right, we can condemn the exclusion of immigrants as a failure of equality rather than efficiency.
The ACA, like any plan that relies on the profit motives of four major insurance companies to provide 90% of coverage, is bound to see unpredictable changes and increases in costs. Californians are expected to see an annual 13% increase in their premiums from the ACA’s exchange — called “Covered California” in the state — making financial planning that much harder for the working families that depend on it. Single payer, by contrast, will harness the power of collective bargaining to rein in the cost of health care. By advocating for a healthcare system constructed to meet people’s basic rights, socialists can address these legitimate objections to the ACA.
With all its faults, public opinion for the ACA has rallied in the face of sustained threats to “Repeal and Replace” from the Trump Administration and Republican congress. The Republicans’ alternatives — relying on tax breaks and incentives that overwhelmingly benefit the wealthy and private insurance companies — have so far failed because the American people have fought back in town halls across the country. Now the movement for a national single-payer program is growing stronger by the day.
A grassroots campaign for a single-payer healthcare system finds particularly fertile ground in California’s current political climate, but victories in the state can provide a viable model for the rest of the nation. A Gallup poll from May found that 58% of Americans support a federally supported plan to insure healthcare for all. Articulating a vision for what that plan could look like in unapologetically socialist terms could appeal to basic beliefs many people already share about healthcare.
An opportunity in California
Senate Bill 562 is not the first of its kind. We’ve started down this road before. A stroke of the Governor’s pen felled single payer in 2006 and 2008, and six Democratic defectors blocked it again in 2012. But, as we know, the old political landscape was bulldozed by the election.
Senator Lara’s bill was proposed in February; California legislation usually takes a year to pass, so we could see it become law by 2018. There’s a long road ahead: the bill must be fleshed out in Senate committees, passed to Assembly committees, debated and passed in the Senate chamber and then the Assembly, and finally placed on the Governor’s desk. Every turn holds chokepoints where corporate Democrats, like the Governor himself, could stall the bill — or kill it completely, leaving Californians at the mercy of a broken system. We can’t let them.
It’s true that Berkeley and Oakland are ripe for organizing, but here, as in most of the country, the average East Bay resident feels disconnected from political life. Voters feel (not wrongly) that the government doesn’t represent them. Organizing around a winnable issue that would materially improve the lives of nearly everyone is a powerful way to build a working-class political movement.
Single payer is socialist
Any socialist organization in America would do well to focus on single payer: the time is right and the change is radical.
It means better health, free from debt: at least a third of Americans have not sought treatment for medical care at some point out of fear of the cost. After all, medical bills are the number one cause of bankruptcies in America.
It means labor rights: too often healthcare is used as cudgel to keep employees from organizing or walking out. With single-payer legislation, workers could make more demands without fear for their health or the health of their families.
It means working class solidarity: single payer would be a life-changing reform for middle class and poor families, employed and unemployed or disabled people, documented and undocumented residents, the housed and the homeless alike. At present, divisions caused by means-tested programs — such as the Medicare donut hole or the embarrassingly low income ceiling for Medicaid programs — form the fault lines of intra-class resentment. Workers struggling on insufficient wages resent those who are just a little poorer for their better healthcare. Meanwhile, those living on the cusp of being deemed too comfortable for low-income programs can’t afford to lose coverage by fighting for increased wages. Universal programs like single payer shift the terrain from intra-class competition to a shared interest in ensuring the success of the program. Medicare and Social Security remain politically popular and across generations, providing these programs with some safety from the ax of austerity. Meanwhile means-tested programs like SNAP face cut after cut. Universal programs have universal appeal, while means-tested programs inevitably become a venue to punish and stigmatize the poor.
Most of all, it means a political movement.
Simon Brown, Sam Hughes, Mia Lehrer and Jamie Gardner are members of East Bay DSA.
Individually signed posts do not necessarily reflect the views of DSA as an organization or its leadership. Democratic Left blog post submission guidelines can be found here.