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The recent debates about Medicare for All in the United States reflects a number of positive developments. For one, the campaign for truly universal health care has gained serious momentum for the first time since the Affordable Care Act (ACA) passed in 2012. At that time, despite valiant efforts to insert a single-payer proposal, most politicians and activists stayed loyal to President Obama’s public-private partnership strategy. Before the ACA, Michael Moore’s 2007 documentary Sicko — which focused on the victims of the for-profit health insurance industry rather than on the United States’ exclusion of fifty million people from health care coverage — provided a serious boost to activist organizing for Medicare for All. The only other time in the last forty years that Medicare for All took center stage was in 1992, after Bill Clinton made universal health care a frontline campaign promise. Hillary Clinton’s subsequent task force buried that possibility after handing out shovels to the health insurance industry. It therefore seems fitting that her historic failure of a presidential campaign has paved the way for this much-needed resurgence in the movement for universal health care. A coalition of single-payer activists groups — including National Nurses United (NNU), New York State Nurses Association (NYSNA, of which I am a member), Amalgamated Transit Union, United Electrical workers, and a number of smaller unions and locals grouped together as the Labor Campaign For Single Payer Healthcare, Physicians for a National Health Program, and Healthcare-NOW — are stepping up the fight for health justice. In January, this network of Medicare-for-All supporting organizations settled on a new strategy. Instead of reacting to Trump, the groups decided to go on the offensive. We agreed that, while the ACA lacks public support and perpetuates an unequal system, Trump’s health care proposals will be much worse. In this context, Medicare for All will gain popularity on the local, state, and national level. The guiding idea — validated by Bernie Sanders’s campaign and Hillary Clinton’s defeat — was that you can’t fight the Right from center. So far, this strategy has been vindicated. In the face of various iterations of Trumpcare, angry voters confronted their representatives at fiery town hall meetings. Medicare-for-All initiatives in California and New York came within one or two votes of reaching their governors’ desks. As is often the case, overt and covert Democratic Party obstruction killed these bills, but the legislation garnered more support — both from politicians and voters — than ever before. Indeed, a recent poll shows that 62 percent of Americans now believe that the government should make sure that everyone has health care coverage. This means that while Trump, McConnell, and Ryan are trying dismantle as much of the federal government’s responsibility for health care coverage as they can, almost two-thirds of the population wants the exact opposite. And many of them know that the status quo of Obamacare is not going to get us there.

Changing the Political Landscape The Medicare-for-All movement is engaged in a number of strategic debates right now. Should we puruse a state-based legislative strategy or a national one? How much of our collective resources should we devote to political lobbying and electoral campaigns versus broader political organizing? How do we organize the millions of health care victims? How do we build Medicare-for-All committees in communities and workplaces? But the question receiving the most attention, especially among the growing socialist movement, is whether we should hold a national march. Jacobin has published multiple arguments on either side of the debate, and the authors have brought important considerations to light. I’d like to offer my perspective as an organized socialist, a pediatric emergency room nurse in a public hospital who has built several successful (and many failed) workplace campaigns, an active participant in the Medicare-for-All movement, and an elected leader of the NYSNA. I believe that a national march can push us further toward our goal, but only if a coalition of unions, socialist organizations, and other social forces combine efforts to build a large, unified mobilization. First off, our movements need to build power to win. Their side has money, our side has collective action. All progressive movements must figure out how to use this power in the face of obstacles. A national march would play a positive role in this process. We shouldn’t overstate the effects of Washington, DC, days of action. Some produce little discernable change, and not all are worth the time and energy required to plan them. But they can transform the people who participate in them, advancing a number of critical ideological and organizational processes. Even some supporters of the national march proposal dismiss its effects on the political landscape. But a cursory glance at similar mobilizations from the last twenty years should convince them otherwise. The anti-globalization actions from 1999 through 2001 in Seattle, DC, and Los Angeles helped develop a critical approach to institutions like the WTO, IMF, and World Bank, as well as policies like North American Free Trade Act (NAFTA) and the Free Trade Area of the Americas. They created a generation of activists who built power throughout the 2000s, culminating in Occupy Wall Street. Those who participated in the Battle for Seattle likely didn’t know that their work would set the stage for the activists in Zuccotti Park, but we can’t tell the story of the Occupy movement without reference to these earlier struggles. Likewise, the global day of action on February 15, 2003, drew over one million protesters to New York City to resist the Iraq war. The New York Times called the new antiwar movement the world’s second superpower. This year, the Women’s March helped set the tone for resistance to Trump’s agenda, erasing any belief that the new president had a popular mandate. Michael Kinnucan, in his argument against the national march, sees these events differently. He writes, “While some [marches] have shaped the national mood, none has significantly altered the political landscape.” Perhaps this statement depends on how you define “political landscape.” A more narrow view would only rate actions as successful if they move politicians to change their public positions. Indeed, Kinnucan offers only dismal predictions for a Medicare march: It is hard to imagine how demobilizing and dispiriting this project will be for the activists involved, many of whom are new to politics … A futile march on Washington will not interest anyone except the tiny minority of Americans who already support single payer, who already engage in left-wing activism, and who can travel across the country for a protest. But many protesters I’ve marched with take different lessons from these mobilizations. Time and time again, I come away from national demonstrations with the conviction that even the most routine event can change thousands of people’s lives forever. Indeed, my experience reminds me of a John Berger quote, which appeared in this excellent article about the Women’s March: The importance of the numbers involved is to be found in the direct experience of those taking part in or sympathetically witnessing the demonstration. For them the numbers cease to be numbers and become the evidence of their senses, the conclusions of their imagination. The larger the demonstration, the more powerful and immediate (visible, audible, tangible) a metaphor it becomes for their total collective strength. When we consider the health care march, we should expand our understanding of the political landscape to include how an action changes popular opinion, provides momentum for the movement, and politically develops the participants. From that perspective, the strategic question becomes not whether a national march is ever useful, but whether the outcome in a particular moment justifies the effort that went into it.

Mobilizing is Organizing Berger’s quote points to one of the main dangers of strategic debates: creating false, or at least exaggerated, dichotomies. Some of those discussing the march put national action in contrast to local organizing, or oppose organizing to mobilization. These are, of course, different aspects of activist work, but rather than thinking of them in tension, we should recognize that these dynamics are intricately connected. For example, my union first started getting involved in the climate change movement following Superstorm Sandy. Since then, we’ve volunteered for relief efforts, adopted an official position on the Keystone XL pipeline, and held press conferences and workshops. But it wasn’t until the People’s Climate March in New York that our work cohered. This national action included local rallies all over the country and became the largest environmental demonstration in American history. It also represented the largest union mobilization around climate change: over one hundred locals and several internationals endorsed the march, and close to ten thousand union members participated. NYSNA used this opportunity to convince others in the New York labor movement to join the struggle and to develop strategies to educate and organize union members around climate change. Our union held lunchtime educational session in hospitals, which drew over two hundred attendees and helped educate and train rank-and-file nurses, elected leaders, and union staff to connect climate change, health care, and labor.. This year, we mobilized again for the People’s Climate March in Washington, DC. This effort built on the previous mobilization and subsequent organizing work, increasing the number of nurses who participated and developing key organizers. It’s naive to think that a national mobilization wouldn’t be able to help local organizing, or that Medicare for All can succeed without developing a national character. On a similar note, Kinnucan rather simplistically opposes the concepts of organizing and mobilizing, a central issue in the labor movement. Some unions focus on staff-heavy turnout drives that don’t build power in the workplace, using their strength to demonstrate electoral capacity to politicians rather than to win a particular demand. But as Dustin Guastella points out, all organizing involves mobilizing and all mobilizing involves some degree of organizational buildup. Social movements need a dynamic mix of both to accomplish either, and dogmatically weighing one over the other will not help us make strategic decisions in the fight for health justice. The question remains: should we plan a national Medicare-for-All march on Washington? I say yes, so long as the organizers work alongside the current movement. The issue can reach beyond those already involved in leftist organizing and the fight for single payer. For example, this February in the small town of Newburgh, New York, the conservative Democratic congressperson organized a town hall. The feisty meeting was so overcrowded they had to move to a much larger space. The crowd repeatedly shouted down their representative around two major issues — the construction of the Pilgrim natural gas pipeline and Medicare for All. The fact that a leading Democrat faced challenges from the Left on health care in a county that voted 51% for Trump proves that we have entered a new stage of the fight. Participating in a national mobilization could become a transformative experience for these new activists. This would also make a major difference in areas without a state single-payer fight. Further, we can’t assume that all or even most members of large health care unions support Medicare for All or, if they do, have decided to devote their time to building the movement. Focusing on a national mobilization can help create a systematic process for increasing their level of involvement. For example, the Service Employees International Union (SEIU), the largest health care union in the US, has taken an ambiguous position on Medicare for All. We can change this. Building toward a national march will give rank-and-file members the opportunity to engage in the campaign and potentially overcome their organization’s political hesitancy. Same goes for any number of other international and local unions. It provides those unions with the opportunity to back a fight that is increasing in popularity and will improve the lives of millions. Focusing on a national march does not mean abandoning state-level campaigns. State single-payer fights will play a crucial role in the path to a national victory. California and New York have high concentrations of taxable, super-wealthy individuals who can provide funding. Both states have Democratic governors who, while beholden to corporate interests, are vulnerable on their left. Also, as the single-payer movement in Canada demonstrated, state-based campaigns can provide an effective model. There, activists won government-provided health care first in Saskatchewan, where it became so popular, it helped bolster the national movement.