July 21, 2017

The proposal for a national Medicare-for-all demonstration could be a first step toward turning growing sentiment for a single-payer system into action and organization.

DONALD TRUMP and the Republican Party suffered another setback in their drive to wreck an already ailing health care system and loot the rubble for more tax cuts for the super-rich.

Earlier this week, Senate Majority Leader Mitch McConnell's second attempt at a "wealth care, not health care" bill stalled due to opposition within the narrow Republican majority. This was followed quickly by the breakdown of a Plan B proposal to repeal Barack Obama's Affordable Care Act (ACA), but not bother replacing it.

With Trump blustering about canceling the Senate's August recess until it acts, McConnell and the Republicans will keep trying. They could succeed--perhaps with help from the spineless Democratic Party. But for now, Trump-McConnell-Ryan-care is stuck in a ditch.

That's good news: All the versions of the Republican legislation are a disaster. The allegedly more "moderate" Senate proposal, for example, would slash more money over the long term from the Medicaid program for the poor than the House bill passed in May.

Protesters take to the streets of Los Angeles to demand a single-payer health care system (Molly Adams | flickr)

But there's bad news, too: The Republicans' failure to pass a destructive law doesn't change the fact the health care system under the ACA is sinking deeper into crisis.

Obamacare contained some important advances that should be defended against the Republicans. But by establishing a framework that leaves tens of millions of people at the mercy of profit-hungry private insurers, it set the stage for chaos and crisis among the people who were supposed to be helped by the ACA.

If the Republicans are in a position to try to saw off the limbs of the health care system, it's because they were able to exploit mass dissatisfaction with the ACA status quo.

The only way out of the health care hunger games is a radical alternative to both Trumpcare and Obamacare: a single-payer system covering everyone under an expanded and strengthened Medicare-for-all system.

The real good news is that there is a groundswell of support for this alternative--a Pew Research Center survey last month found that support for a single-payer system has grown by half in three years to 33 percent--along with new left-wing initiatives to organize this sentiment into protest and political action.

There's a long way to go before Medicare-for-all is achieved. But more and more people are refusing to let the length of the journey discourage them from taking the first steps.

WHEN McCONNELL admitted defeat for a second time, support for his health care bill had sunk as low as 12 percent, according to a USA Today poll.

The legislation is so obviously disruptive--the gutting of the Medicaid system alone will cause chaos in a sector of the economy that accounts for one in every six dollars of U.S. gross domestic product--that much of the health care industry itself is opposed. Yet it was just a vote or two away from being rammed through and signed into law.

With the margin so close, the wave of protests that put the GOP on the spot in Washington and around the country was incredibly important.

On Capitol Hill, for example, the disability rights organization ADAPT organized a "die-in" at McConnell's office in June. Police pulled some protesters out of their wheelchairs in arresting 43 people.

Other actions upped the pressure on Republicans while they were still in Washington, but there was no relief when they headed home for appearances at town hall meetings. Since the beginning of the year, GOP lawmakers have faced the kind of dissent once mobilized against Democratic members of Congress during the Obama years. Republicans got the message--many cancelled appearances in their home districts.

Democratic Party-leaning organizations may have called for these protests, but the grassroots organizing that made them flashpoints of dissent is a stark contrast to the attitude of the party establishment--which has been to keep their heads down.

The party's strategy is to stay out of the way while Republicans shoot themselves in the foot--and wait for gains in the next election. This cynicism was crystallized after the House Republicans voted through their health care bill--and a group of smug Democrats started singing in premature celebration of election victories to come.

The Democrats can't be trusted to put up a fight, even against the destruction of Obamacare. In fact, it's just as plausible to envision McConnell getting some Senate Democrats to go along with an altered version of Trump-McConnell-Ryan-care as it is to imagine Republicans getting their act together.

THE LEFT should remember this fact in the months to come: It took a protest movement to challenge Trump and the Republicans on health care. This fits with the overriding lesson of the Trump era, both during the campaign last year and in the opening months of Trump's presidency.

That lesson: You can't fight the right from the center.

Trump and the Republicans have one thing going for them: The health care system is still a mess for millions of people because of the failures of Obamacare. The positive measures in the ACA are outweighed by its toxic core, which leaves insurance companies free to prey on millions of people who are required by law to buy their defective, overpriced product.

Since the ACA passed in 2010, the insurance giants have gotten federal agencies to loosen the new regulations on them, while they figured out how to game the Obamacare system to maximize profits. Premiums are rising, along with out-of-pocket costs passed onto policyholders--and the ACA's "exchanges," where individuals are supposed to purchase insurance, are in danger of breaking down altogether as insurers pull out of different states.

That's not Trump lies or Republican propaganda--it's the truth.

The cure, of course, isn't the GOP's poison that would make the system sicker. It's the radical break that the Obama administration never considered in 2009: A single-payer system providing universal health care, like exists in almost every industrialized country in the world except the U.S.

The urgent need for that alternative has broken through to a wider number of people than ever before. Despite the slanders of the health care industry, one-third of people told the pollsters from Pew that they support single-payer right now. Fully 60 percent say the federal government should be responsible for ensuring health care coverage for all Americans--which is only possible under a single-payer system.

The time is ripe for supporters of Medicare for all to take the movement to the next level. But that requires a clear understanding of what's in our way: The for-profit health care industry and the Republican reactionaries, obviously--but also the Democratic Party.

THROWN OUT of power in Washington by the 2016 election, leading Democrats are feeling freer to give rhetorical support to single-payer. For the first time, a majority of House Democrats has signed up in support of a Medicare-for-all proposal. Not only Bernie Sanders, but Sens. Elizabeth Warren, Kirsten Gillibrand and Kamala Harris have voiced varying degrees of backing.

But when it gets close to actually achieving a single-payer system, the Democrats' enthusiasm grows cold.

In California this year, health care activists pressed for the state legislature--which is wholly controlled by the Democrats, along with the governor's mansion--to take up a bill that would have begun work on a single-payer system.

The popular legislation passed the state Senate easily. But in June, as the bill was due to be taken up by the State Assembly, Speaker Anthony Rendon announced it would remain in committee indefinitely--a legislative death sentence.

Rendon's excuse? He claimed the postponement was to make fighting Trumpcare in Washington "the top health care priority."

This is laughable, of course. Passing single-payer legislation for the first time--and in the most populous state in the country, no less--would be a stirring challenge to the Republican reactionaries in Washington and galvanize the struggle against Trumpcare across the country.

The real reason Rendon killed the bill is because Democrats may see political advantage in saying they support single-payer--but they don't want to incur the wrath of the health care industry by doing something about it if they don't have to.

By contrast, the health-care activists who mobilized in California and New York state--where similar legislation advanced through one house of the legislature, but was stopped in the other--showed that you can fight Trumpcare and champion single-payer.

In fact, the two battles need to be linked--because protests against the Republican health-care disaster will be much more effective if we have something better than Obamacare to put forward as an alternative.

MOMENTUM IS building on the left to take up single-payer. When the Democratic Socialists of America (DSA)--which has quadrupled in size over the past year--surveyed its members on what campaigns to prioritize, Medicare for all came out on top by a wide margin.

DSA members around Jacobin magazine, among others, are proposing that their organization, in coalition with other left groups, call a national demonstration for single-payer in Washington, D.C. As Dustin Guastella wrote at Jacobin:

[A] march would give socialists the opportunity to vocally and aggressively lead on a major working-class demand. It would help us build organization, forge political consensus, and reintegrate the socialist movement with a key sector of the workers' movement. That same level of unity and clarity of focus could not be achieved by lobbying-style tactics like phone-banking senators or through hyper-local campaigns.

Health-care activists need a way to build momentum at a time when local and state campaigns have run into obstacles, as with California. And a nationwide action could provide a focus for galvanizing the broad sentiment for single-payer, which is far bigger than existing organization.

But some on the left have opposed the national march initiative, including within DSA. A document circulating on the Internet from DSA members in Washington, D.C., argues a demonstration would eat up resources that could be used on local organizing, while having no real impact.

Unfortunately, the document includes some common caricatures of the left that are often used to discredit the idea of protesting at all. But even setting that aside, the criticism that a national march would take attention away from local organizing is mistaken. Past experience shows that mobilizing for a national march is an excellent way to bring together people who might not meet otherwise.

In addition to shining a spotlight on an issue that the media, like the political establishment, prefer to ignore, a Medicare-for-all march could help turn a general mood into tangible organization--which could then move on to next steps, whether local, national or both.

The Republican onslaught won't be stopped in its tracks by a single demonstration anywhere--nor is a nationwide victory for single-payer in the cards in the near term. But if we hope to win at any time, our side needs to get organized, and we need to take every opportunity to do so.

Right now, the spotlight is on health care, and the Republican train wreck is exposing not only the misery they want to inflict on us, but also the crying need for something better than Obamacare as an alternative. Socialists have something to say about that.