Activists march in support of Medicare for All on June 25, 2017, in Los Angeles, California. (Photo: Molly Adams)

The Center for American Progress (CAP), a Washington-based Democratic Party think tank funded by Wall Street, including private health insurers and their lobbying group, unveiled a new healthcare proposal designed to confuse supporters of Medicare for All and protect private health insurance profits. It is receiving widespread coverage in ‘progressive’ media outlets. We must be aware of what is happening so that we are not fooled into another ‘public option’ dead end [1].

The fact that CAP is using Medicare for All language is both a blessing and a curse. It means Medicare for All is so popular that they feel a need to co-opt it, and it means that they are trying to co-opt it, which will give Democrats an opportunity to use it to confuse people.

This effort could be preparation for the possibility that Democrats win a majority in Congress in 2018 or 2020. It is normal for the pendulum to swing to the party opposite the President’s party during the first term in office. If Democrats win a majority, they will be expected to deliver on health care, but they face a dilemma of having to please their campaign donors, which includes the health insurance industry, or pleasing their voters, where 75% support single payer health care.

The public is aware that the Affordable Care Act (ACA) protects the profits of the medical-industrial complex (private health insurers, Big Pharma and for-profit providers) and not the healthcare needs of the public. “Fixing the ACA” is not popular. Last year during repeal attempts, people made it clear at town halls and rallies that they want a single payer healthcare system such as National Improved Medicare for All (NIMA). By offering a solution that sounds good to the uninformed, “Medicare Extra for All,” but continues to benefit their Wall Street donors, Democrats hope to fool people or buy enough support to undermine efforts for NIMA.

This is an expected development. If we look at the phases of stage six of successful social movements by Bill Moyer (see slide 8), we see that as a movement nears victory, the power holders appear to get in line with the public’s solution while actually attacking it. If the movement recognizes what is happening, that this is a false solution and not what the movement is demanding, then we have a chance to win NIMA. If the movement falls for the false solution, it loses.

Our tasks at this moment are to understand what the power holders are offering, recognize why it is a false solution and reject it.

“Medicare Extra for All” Versus National Improved Medicare for All

The basic outline for the new proposal is that people would be able to buy a Medicare plan, a form of ‘public option,’ including the Medicare Advantage plans offered by private health insurers. People who choose to buy a Medicare plan would pay premiums and co-pays, as they do now for private health insurance. The new Medicare system would replace Medicaid for people with low incomes.

Private health insurance would still exist for employers, who currently cover the largest number of people, federal employees and the military. While workers would have the option to buy a Medicare plan, it is unclear how many would do so given that most employers who provide health insurance have their own plans and that private health insurers are experts at marketing their plans to the public.

NIMA, as embodied in HR 676: “The Expanded and Improved Medicare for All Act,” would create a single national healthcare system, paid for up front through taxes, that covers every person from birth to death and covers all medically-necessary care. NIMA relegates private insurance to the sidelines where it could potentially provide supplemental coverage for those who want extras, but it would no longer serve as a barrier for people who need care.

Here are the flaws in the CAP proposal:

1. CAP’s plan will continue to leave people without health insurance.Instead of being a universal system of national coverage like NIMA, coverage under the CAP plan relies on people’s ability to afford health insurance. Only people with low incomes would not pay, as they do now under Medicaid. Just as it is today, those who do not qualify as low income, but still can’t afford health insurance premiums, would be left out. Almost 30 million are without coverage today. There is no guarantee that health insurance premiums will be affordable. 2. CAPS’s plan will continue to leave people with inadequate coverage. Under NIMA, all people have the same comprehensive coverage without financial barriers to care. The CAP plan allows private health insurers to do what they do best — restrict where people can seek health care, shift the cost of care onto patients and deny payment for care. This is the business model of private health insurers because they are financial instruments designed to make profits for their investors. People with health insurance will face the same bureaucratic nightmare of our current system and out-of-pocket costs that force them to delay or avoid health care or risk bankruptcy when they have high health care needs. 3. CAP’s plan will continue the high costs of health care. NIMA has been proven over and over to have the best cost efficiency because it is one plan with one set of rules. It is estimated that NIMA will save $500 billion each year on administrative costs and over $100 billion each year on reduced prices for pharmaceuticals. As a single purchaser of care, NIMA has powerful leverage to lower the costs of goods and services. The CAP plan maintains the complicated multi-payer system that we have today. At best, it will only achieve 16% of the administrative savings of a single payer system and it will have less power to reign in the high costs of care. 4. CAP’s plan will allow private health insurers to continue to rip off the government. NIMA is a publicly-financed program without the requirement of creating profits for investors. With a low overhead, most of the dollars are used to pay for health care. The CAP plan maintains the same problems that exist with Medicare today. Private Medicare providers cherry pick the healthiest patients and those who have or develop healthcare needs wind up in the public Medicare plan. This places a financial burden on the public Medicare plan, which has to pay for the most care, while private health insurers rake in huge profits from covering the healthy with a guaranteed payor, the government. 5. CAP’s plan will continue to perpetuate health disparities. NIMA provides a single standard of care to all people. Because all people, rich and poor (and lawmakers), are in the same system, there are strong incentives to make it a high quality program. CAP’s plan maintains the current tiered system in which some people have private health insurance, those with the greatest needs have public health insurance, some people will have inadequate coverage and others will have no coverage at all. 6. CAP’s plan will continue to restrict patients’ choices. NIMA creates a nationwide network of coverage and consistent coverage from year-to-year so that patients choose where they seek care and have the freedom to stay with a health professional or leave if they are dissatisfied. CAP’s plan continues private health insurers and their restricted networks that dictate where patients can seek care. Private plans change from year-to-year and employers change the plans they offer, so patients will still face the risk of losing access to a health professional due to changes in their plan. 7. CAP’s plan does not guarantee portability. NIMA creates a health system that covers everyone no matter where they are in the United States and its territories. CAP’s plan maintains the link between employment and health coverage. When people who have private health insurance lose their job or move, they risk losing their health insurance. 8. CAP’s plan will perpetuate physician burn-out. NIMA creates a healthcare system that is simple for both patients and health professionals to use. Under the current system, which the CAP plan will perpetuate, health professionals spend more time on paperwork than they do with patients and physician offices spend hours fighting with health insurers for authorization for care and for payment for their services. This is driving high rates of physician burnout. Suicides among physicians and physicians-in-training are higher than the general population.

The new proposal is a ‘public option’ wrapped in a “Medicare for All” cloak. It is a far cry from National Improved Medicare for All. And, contrary to what CAP and its allies will tell you, the CAP plan will delay and prevent the achievement of NIMA.

Co-founders of Physicians for a National Health Program, Drs. Steffie Woolhandler and David Himmelstein, explained why the public option would not work in the last health reform effort [2]:

The ‘public plan option’ won’t work to fix the health care system for two reasons. 1. It forgoes at least 84 percent of the administrative savings available through single payer. The public plan option would do nothing to streamline the administrative tasks (and costs) of hospitals, physicians offices, and nursing homes, which would still contend with multiple payers, and hence still need the complex cost tracking and billing apparatus that drives administrative costs. These unnecessary provider administrative costs account for the vast majority of bureaucratic waste. Hence, even if 95 percent of Americans who are currently privately insured were to join the public plan (and it had overhead costs at current Medicare levels), the savings on insurance overhead would amount to only 16 percent of the roughly $400 billion annually achievable through single payer — not enough to make reform affordable. 2. A quarter century of experience with public/private competition in the Medicare program demonstrates that the private plans will not allow a level playing field. Despite strict regulation, private insurers have successfully cherry picked healthier seniors, and have exploited regional health spending differences to their advantage. They have progressively undermined the public plan — which started as the single payer for seniors and has now become a funding mechanism for HMOs — and a place to dump the unprofitably ill. A public plan option does not lead toward single payer, but toward the segregation of patients, with profitable ones in private plans and unprofitable ones in the public plan.

What We Must Do

The movement for National Improved Medicare for All experienced tremendous growth in the past few years. All of the flaws of the Affordable Care Act are becoming reality as people are forced to pay high health insurance premiums, face high out-of-pocket costs before they can receive care and have their access to health professionals or services denied. There is a strong demand for NIMA that has resulted in more than half of the Democrats in the House of Representatives signing on to HR 676 and a third of the Democratic Senators endorsing the Senate Medicare for All bill. Medicare for All is becoming a litmus test for the 2018 elections and 2020 Democratic presidential nomination.

Power holders are feeling threatened by support for NIMA. They are looking for ways to throw the movement off track and allow lawmakers who don’t support NIMA to support something that sounds like NIMA. This is why they invented “Medicare Extra for All.” It is common for the opposition to adopt our language when we have strong support.

This is the time when the movement for NIMA needs to remain focused on our goal of NIMA, resist compromising and escalate our pressure for NIMA. We are closer to winning, it’s time to increase our efforts to pass the finish line.

Here are our tasks:

• We need to expose the reasons for CAP’s proposal. It is designed to protect health insurance industry profits. • We need to educate ourselves and others about the reasons why CAP’s proposal is flawed and deficient. • We need to educate and challenge lawmakers and candidates who speak in favor of CAP’s proposal and push them to support NIMA. • We need to be loud and vocal in our demand for nothing less than NIMA, as described in HR 676. • We need to make support for HR 676 a litmus test in the upcoming elections.

We need to practice “ICU” — being independent of political party on this issue by not tying our agenda to the corporate agenda of major political parties, being clear about what will and what will not solve our healthcare crisis, and being uncompromising in our demand for National Improve Medicare for All.

With a concentrated effort for NIMA, we can overcome this distraction and win National Improved Medicare for All. This is the time for all supporters of single payer health care to focus on federal lawmakers from both parties. Movements never realize how close they are to winning and victory often feels far away when it is actually close at hand.

The fact that the Democrats are proposing something that sounds like NIMA means we are gaining power. Let’s use it to finally solve the healthcare crisis in the United States and join many other countries in providing health care for everyone. NIMA is the smallest step we can take to head down the path of saving lives and improving health in our country.

The ‘public option’ dead end occurred during the health reform process of 2009-10. Faced with widespread public support for National Improved Medicare for All, and 80% support by Democratic Party voters, the power holders had to find a way to suppress that support. They created the idea of a ‘public option,’ a public health insurance for part of the population, and convinced progressives that this was more politically-feasible and a back door to a single payer healthcare system. Tens of millions of dollars were donated to create a new coalition, Health Care for America Now (similar in name to Healthcare-Now, a national single payer organization — this was intentional), that organized progressives to fight for this public option and suppress single payer supporters (they were openly hostile when we raised single payer). Many single payer supporters fell for it, and the movement was successfully divided and weakened. Kevin Zeese and I wrote about this in more detail in “Obamacare: The Biggest Health Insurance Scam in History.”

1. Read more about this from Dr. Don McCanne of Physicians for a National Health Program in his Quote-of-the-Day.

2. Read more about intentional distractions through incremental approaches to prevent National Improved Medicare for All in this presentation.