When Medicare was created 53 years ago this month, it was over the objections of Ronald Reagan. On behalf of the American Medical Association, Reagan warned that should Medicare become law, it would lead to “a mechanism for national health insurance capable of indefinite expansion in every direction until it includes the entire population.”

More than five decades of frustration later, advocates are still fighting to make Reagan’s “nightmare” of universal health care a reality. The recent formation of the Medicare for All Caucus by House progressives could prove to be an important development in this pursuit, according to members and advocates who introduced the new caucus at a press conference on July 19.

“We are united today by a common conviction that health care is a human right,” said Rep. Pramila Jayapal during the launch. “One of the best ways to ensure health care for all is to use the system that already exists for millions of seniors [in] Medicare.”

Jayapal founded the new caucus with Reps. Debbie Dingell and Keith Ellison. The caucus had 66 founding members at the 10 am press conference, but by midday that number was 70, according to a list provided to Truthout by Dingell’s office.

The California Nurses Association, National Nurses United, Public Citizen, Physicians for a National Health Program (PNHP), Health Care-Now, Our Revolution and other organizations were also supportive.

“For the first time ever, we have a congressional caucus that is committed to achieving Medicare for All,” said Martese Chism, a registered nurse and board member of the California Nurses Association, who spoke at the launch.

Others praised what they see as an important shift in how to tackle the issue.

The new caucus “clearly marks a shift in congressional approach to Medicare for All from more passive support to laying the groundwork for potential passage of this legislation, depending on how the makeup of Congress shakes out in the coming years,” said Benjamin Day, executive director of Healthcare-NOW, in an interview with Truthout.

Educating the Public

The press conference emphasized health care as a human right and also sought to educate the public about a policy about which there is a great deal of misinformation.

“The congressional Medicare for All caucus will help build the evidence base for Medicare for All,” Jayapal said. “Our goal is to sponsor briefings on a variety of topics, from the basics of Medicare for All to financing, to universal health systems around the world.”

For instance, it is common for critics and much of the mainstream media to emphasize new taxes without mentioning long-term savings. Others often portray single-payer as a radical idea, when in fact, it is within mainstream international norms: The widespread lack of health care coverage within the current US system is what stands apart as an outlier.

The Medicare for All Caucus is by no means a substitute for grassroots organizing. In fact, it exists largely because of strong grassroots pressure.

Countries that have public, universal health care systems spend considerably less on health care than the US. The per capita spending for the US, according to the Organization for Economic Cooperation and Development (OECD), is $10,029 — by far the largest in the world. The OECD average is less than $5,000.

“We pay a lot more than any other rich country, and we get a lot less,” said Robert Weissman, director of Public Citizen, at the press conference.

Despite paying such hefty sums, the US has poor outcomes compared to other rich countries. The US ranks 27th among the 36 OECD nations in life expectancy and 24th in infant mortality rates, with its outcomes falling far behind those of nations with publicly financed health care. These facts are not controversial, but they are also not well known.

“It is important to make the economic case for single-payer,” Carol Paris, president of PNHP, told Truthout. “If we want to do this, we need to get small businesses on board and try to win bipartisan support for the policy.”

Paris also notes that many Democratic Party alternative plans — general iterations of the public option — are trying to benefit from the popularity of Medicare for All. One example is the Center for American Progress plan, Medicare Extra for All. The plan is not a single-payer one — in fact it preserves employer-based care — but the name has blurred the distinction, leading to headlines such as: “finally, a universal program that would work for everyone.”

“These policies try to win support by using the popularity of Medicare for All as a brand — but they are not single-payer plans. They don’t have the cost savings, and many of them are not even universal,” Paris said. “If this caucus can help study those bills and explain how they are different from single-payer, that would be a valuable service.”

Using Grassroots Pressure to Seize the Current Momentum

Support for Medicare for All is at an all-time high in Congress. The surge in support came more than a year ago when, on the heels of the Bernie Sanders campaign, cosponsors to single-payer legislation in the House jumped from 62 in the last Congress to a record 122 in the current Congress: well more than half the House Democratic Caucus. Sanders’s own bill further accelerated the energy behind the movement.

Despite all the momentum for the policy, there are also some grim realities that progressives need to wrestle with if they want to succeed in their fight for universal health care. Most notably is that while Democratic Party voters are unambiguous in their support of the policy, the Democratic leadership is opposed to the policy: Medicare for All was shot down by delegates in the platform committee meeting in 2016, and the Democratic Congressional Campaign Committee is actively undermining the policy throughout the midterm elections. Meanwhile, the for-profit health industry continues to spend millions lobbying and contributing to candidates and members of Congress.

“There is also the major task of moving the rest of the Democratic Party on board,” Day said. “We took a major leap on that last year during the repeal-and-replace fight, but the work needs to continue … until we reach a tipping point where Democratic leadership feels they have to embrace Medicare for All and actively fight for it. I expect that will only happen with significant grassroots pressure.”

Grassroots pressure has proven to be instrumental not only in defeating Trumpcare, but also in keeping pressure on politicians to adopt single-payer positions.

“The Medicare for All Caucus is by no means a substitute for grassroots organizing,” Paris said. “In fact, it exists largely because of strong grassroots pressure.”

There is also a concern among some single-payer advocates that some co-sponsors of Medicare for All supported the measure mainly to avoid facing unruly and critical crowds at town halls, rather than due to a more genuine willingness to back it. Some co-sponsors to Sanders’s bill made a point to add qualifiers to their support.

Former Sen. Al Franken, for instance, who later resigned in response to allegations of sexual harassment and assault, had offered many qualifiers within his statement of support, undercutting Sanders’s bill as “aspirational,” a “starting point,” and less important than “bipartisan policies that improve our current health care system.”

Kamala Harris also gave about as lukewarm an endorsement as is possible, saying “all people should have access to affordable health care, and as we talk about moving toward a single-payer system” (emphasis added).

All of this has led to skepticism over how serious some Democrats are in supporting single-payer. Skepticism will likely persist toward the 52 co-sponsors of the House bill who have not joined the new caucus.

Paris, however, warns against knee-jerk criticism. “Each situation should be case-by-case. There could be reasonable reasons why someone doesn’t join the caucus,” she told Truthout. “But it is a good opportunity for constituents to raise the issue and talk with their representatives about Medicare for All and why we need it.”

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