On Medicare for All: Fight, Don’t Follow

By Megan Anderson, Timothy Faust, and Steve Way

This Wednesday, Representative Pramila Jayapal released her Medicare for All bill. It’s a bigger, more robust bill than last year’s HR 676—in some ways astonishingly strong. We believe that DSA is right to trumpet it out and endorse it. It will now have to be reconciled with Senator Bernie Sanders’s Medicare for All bill in the Senate, which will be introduced in the next few weeks, and this is where we must focus our work. But Sanders’s Senate Medicare for All bill, which DSA endorses alongside Jaypal’s, fails to meet even our own internal DSA criteria for a single-payer bill.

It is our belief that DSA can and must confront our heroes when they fall short of the goal, and that we have failed to do so in the case of Sanders and Medicare For All (M4A).

Jayapal’s bill was written by many hands, and this time people with disabilities got the seat at the table they have always deserved and long been denied. As a result, it includes robust, person-centric long-term-care support. This, finally, enshrines the basic human dignity of people with disabilities and senior citizens within the policy umbrella of expanded and improved M4A.

Why’s that important? Well, when people with disabilities are unable to take care of themselves without assistance, they are warehoused in nursing homes that are often rampant with grift, abuse, and corruption in the pursuit of profit. Lawmakers in Arkansas and Kentucky have been caught working with nursing home corporations to make it harder for patients to sue for malpractice. Trapped, unable to live freely, work or leave: for people with disabilities, nursing homes are, too often, places to be harvested for profit and left to die.

Others who need long-term support suffer from the cruelty of Medicaid’s eligibility guidelines. Strict income and asset requirements mean disabled individuals often forgo marriage or have to divorce, lose their careers, and may even be required to sell their homes to qualify for vital home health care services. Thanks to Medicaid means-testing, people with home-health needs who want to work are unable to work, for fear of exceeding the program’s punitive income and asset limits — set as low as $2,000 total.

Far too many families struggle to find and afford adequate care for their loved ones near the end of life, relying on Medicaid to cover a patchwork of mostly for-profit facilities. Home health workers themselves earn an average of only $10 an hour nationwide for these essential services. Yet Sanders’s 2018 Medicare for All bill leaves out this wide spectrum of care, from simple help around the house to mobility services to comprehensive life-sustaining support.

Just a month ago, the Sanders team announced in a closed meeting with disability activists that they did not intend to include long-term care in this year’s bill. Instead, his current plan delegates long-term care back to state Medicaid programs, which are rife with abuse.

We must demand change. Sanders will not suddenly wake up and realize that long-term care is neglected in his bill. If long-term care is included, it will happen because people with disabilities have been talking to him for months: CCD, ADAPT, Ady Barkan (see above), as well as concerned staffers in his office. It will happen when they realize, in the last minutes of drafting, that an organized movement on the left would oppose a bill which did not support all care for all people. 

Temporarily able-bodied people have an obligation to demonstrate that concerns about long-term care exist outside the disability community. When we demonstrate together—when we all  show up—we can shift the balance of this discussion.

Politicians respond when they receive credible pressure. Jayapal, afraid of a fractured base, wrote her bill by actively seeking out and discussing long-term care with an organized disability community. Learn by their example. We cannot be a movement of 55,000 puppy dogs who are obedient to our candidates and our electeds, even the ones we really like, in hopes of socialist treats. We are a movement that must demand justice and win it, wherever we can.

And thus we are offered a moment of reflection. Why have we said nothing? DSA has been quiet about long-term care, even though the current Sanders bill has never met the criteria listed in DSA M4A’s own five principles for Medicare for All, and has not for year and a half we’ve had to look at it. We know that a single-payer bill with no long-term care would continue to perpetuate suffering for profit upon our comrades with disabilities. So why have we not spoken up, or even argued for the Disability Integration Act, an activist-written bill guaranteeing home health services for people with disabilities?

We have a responsibility to demonstrate to Bernie Sanders—and other elected officials—that a movement exists on the Left that must be recognized and reckoned with—our organized movement for housing justice; for voting justice; for health justice; for environmental justice. We have the opportunity to take this responsibility seriously. We can call Sanders’s Senate office and campaign; we can petition both. The three of us have put together such a petition here you can sign.We can make the issue a priority in our chapter meetings and our endorsement decisions.

As activists on the left, we are not simply a reserve of foot soldiers for whatever candidate sings most sweetly to us. We are a movement. Socialism is a gospel of liberation. But if we do not preach it to those who need to hear it, if we do not demand it of the powerful, and if we do not act upon our own preaching, how can we expect anyone to believe us when their time of need comes?

Megan Anderson is a member of DSA Metro Cincinnati and Northern Kentucky.

Timothy Faust is a member of the Boston DSA. Over the past two years he’s driven around the US, speaking to DSA locals about single-payer and health justice.

Megan Anderson is a member of DSA Metro Cincinnati and Northern Kentucky.

Timothy Faust is a member of the Boston DSA. Over the past two years he’s driven around the US, speaking to DSA locals about single-payer and health justice.

Steve Way is a member of the North New Jersey DSA.