If House Speaker Nancy Pelosi or Sen. Chuck Schumer had been leading a Democratic Congress in the 1960s, their health care positions in recent years indicate they would have used every tactic available to prevent a floor vote on Medicare. It never would have become law on July 30, 1965. Considering the complexities of starting any new or major federal program, it amazed the public and staggered proponents — and opponents — that Medicare was up and running a year later.

Today, congressional opponents have intimidated most of an obedient and self-interested flock into doing the same thing to a joint Medicare for All (M4A) bill: Sen. Bernie Sanders’s S. 1129 and Rep. Pramila Jayapal’s H.R. 1384. They will do almost anything to make sure neither bill gets to floor votes.

In its fight to survive and retain the status quo, the health care industry has formed a coalition lobby, Partnership for America’s Health Care Future (PAHCF), whose sole purpose is to kill M4A. Every public relations tool and ad-buy carries that message, from ads on social media to the mainstream media, Congress and voters of all political stripes.

The members of the PAHCF coalition spent a combined $143 million on candidates in the 2018 midterm elections. In the first two months of this year alone, they’ve spent $434,500.

However, the 2018 midterm elections triggered a high tide of voters furious about the nation’s poor health care situation, bringing in 37 pro-M4A Democratic newbies, as The Atlantic noted. They have proven to be defiant and outspoken in tangling with Pelosi’s “no-M4A” policy.

Pro-M4A House Freshmen Are Aware of Rural Health Care Shortcomings

Pro-M4A freshmen, such as Representative Jayapal, have done their homework. They know the health care industries earn billions off the non-Medicare age brackets of 19-64. Some of the 60 million ruralites are part of that frantic demographic. They certainly have felt those annual boosts in deductibles and monthly premiums, and the rising costs of prescriptions. At least 44 million Americans are underinsured and some 29 million are “going bare” (no coverage), and not by choice.

Pro-M4A freshmen know that Pelosi’s constant mantra that Americans are not ready for Medicare for All are contrary to current polls that reveal voters certainly are ready. For example, a Reuters/Ipsos poll of nearly 3,000 people last July revealed 70 percent favored M4A. An early May survey by the Harvard-Harris group added Independent voters to the mix and still found 64 percent polled in favor of Medicare for All (Democrats: 83 percent; Republicans: 44 percent; Independents: 64 percent). Results also showed enormous (77 percent) support from ages 18-34 — the millennials — and all women respondents (68 percent). The latter have outvoted men in presidential elections since 1964, in midterms since 1998 , and the trend is expected to increase.

The Harvard-Harris poll also reported that some 40 percent of rural voters, whatever their political leaning, said health care needs were not only their primary concern, but 55 percent favored M4A. And no wonder; they have horrifying mishaps the urban/suburban public are unlikely ever to experience: A 55-year-old losing limbs when a combine or tractor overturns; a 37-year-old breaking a back from a fall from a water tank; a 22-year-old crushed when a jack collapses under a pickup; a 12-year-old kicked senseless while inoculating a calf; tots who wander into livestock compounds and are trampled. These examples are hypothetical, but are indicative of the types of dangers farmworkers and ruralites are uniquely at risk of experiencing.

In view of this coming war against M4A in the rural U.S., it’s vital that program supporters roll out an immediate house- and farm-canvassing offensive.

Moreover, there’s the problem of long-distance travel to reach a medical facility. In an emergency, it’s a 75 mile-per-hour race on country roads. Delivering a baby at home without complications might not be a problem because of instructions by telephonic or electronic means, or neighborly or family help. But a stroke or heart attack requires instant care available only by helicopter to a major hospital miles away.

Under the expanded Medicare Part B umbrella, emergency costs of rural helicopter transport to and from a medical facility currently are 80 percent covered. Requirements are that a medical professional “determines 1) air transport is necessary due to time and/or geographical factors; and 2) that it meet Medicare-approved air ambulance requirements.”

Topping off these crises is the calamitous trend of rural hospital closures, 67 since 2013 with hundreds more foreseen, according to The New York Times. Part of the blame is attributable to a sizable rural population decline since 2010 in the nation’s 1,350 rural counties — from deaths of the elderly and the exodus of the young seeking career opportunities and livelier lifestyles. But another cause is skyrocketing premium charges and deductibles that can lead to increased insurance cancellations and, thereby, fewer patients to keep a facility operating and subsequent departures of medical staff.

Health Care Industries Count on Selling Three False Messages

Both elected opponents of Medicare for All and PAHCF rely on three main messages to annihilate M4A: that it is “socialized medicine”; stratospheric tax hikes for the 99 percent will pay for it; and it will strip at least 190 million people of their present private or employer-based health insurance.

For one thing, linking words like “socialized medicine” to describe M4A is unlikely to terrify most ruralites under age 40 these days, even most Republicans. Gallup’s mid-April poll reported that 43 percent of Americans think socialism is a “good thing,” and 47 percent would vote for a “socialist candidate for president.” Many recognize Medicare and Social Security are socialistic, but so is anything called “public”: infrastructure, schools, parks and firefighters.

Secondly, the anti-Medicare scaremongers of the 1960s predicted ruinous tax hikes and sky-high premiums, none of which materialized. Because M4A is to be absorbed into Medicare, the eventual individual costs will probably turn out to be relatively similar. For instance, in my family, one recipient’s monthly Medicare deduction from Social Security benefits for last year averaged $102 — about 2.6 percent of her $47,000 income. When she recently had colorectal surgery, out-of-pocket expense was $450 on a $40,000 hospital bill.

Neither congressional bill has stipulated premium costs as yet — or firmed up the numbers for taxes and outside financial resources to pay for the program. Those will be decided in a reconciliation session by House and Senate leaders before sending the final bill to the president. Sanders is suggesting a 4 percent premium for employees and “exempting the first $29,000 in income for a family of four.”

As to the third scare tactic about 190 million losing private or employer-paid health coverage, it’s a flat-out lie. When Medicare started, private insurance coverage for those above age 65 did indeed end, but they were automatically moved into the new program upon enrollment. The same scenario will happen with M4A.

M4A’s administrative costs are only 2 percent, according to most estimates, instead of private insurance’s 12 to 18 percent.

It’s doubtful these opposition talking-points will convince most rural voters to ignore M4A. One study estimated that over 1 million ruralites were on Medicare as of 2017. Familiarity with Medicare’s many benefits to older family members would seem to make it probable that most rural voters would favor M4A.

In view of this coming multimillion-dollar war against M4A in the rural U.S., it’s vital that program supporters roll out an immediate house- and farm-canvassing offensive.

Techniques of Successful “House Calls” to Rural Householders

A successful canvassing “house call” is marked by not being gabby or patronizing know-it-alls, but by first listening intently to householder recitals of family health care experiences. The canvasser’s “opener” with householders should start with that line of questioning because current data from the Center for Medicare and Medicaid Services reports that ruralites, especially those over 65, were getting “worse” care than urbanites.

Sighs of relief from householders over age 65 — something I’ve experienced canvassing on the issue in Portland, Oregon — come from their learning M4A’s inclusion in expanded Medicare will cover nearly 80 percent on hearing aids, dental implants/dentures, glasses and long-term care. Right now, Medicare recipients pay for those medical devices ($1,000 to $5,000) out of pocket.

Answering questions about why M4A’s premiums are so low and stable means explaining that, like Medicare, administrative costs are only 2 percent, according to most estimates, instead of private insurance’s 12 to 18 percent. Like Medicare, M4A will have neither CEOs earning seven-figure salaries and stock options, nor stockholders demanding regular and hefty dividends.

The canvasser’s “close” at departure time should emphasize that householders immediately call, email or write their congressional members demanding they vote M4A into law. They are the bottlenecks blocking this program.

A question-and-answer approach is based on people rightly wanting to know how M4A will affect them. They won’t want to hear factoids about national health costs in the next 10 years being $47 trillion; or a University of Massachusetts study showing M4A will slash that total by $6.3 trillion; or that 209 economic experts just told Congress M4A would be the most cost-effective health care system; or that current costs — $3.3 trillion annually since 2017 — are exorbitant and wasteful. Nor will they want to hear Sanders’s estimate that M4A would save between $380 and $500 billion annually, which is now charged by the private health care industry; or that a Universal Medicare Trust Fund will be established with the Treasury Department for program monies — just like Social Security Trust Fund.

This kind of detailed information should be in the literature canvassers leave residents after chatting with them. That leaves householders to read it at their convenience

One surprising result in these visits may well be that one of the householders is so enthused about M4A that they want to spread the word to neighbors and friends in town. It’s one reason for canvassers to carry an extra supply of literature.

Last, it’s usually a courtesy to contact local political leaders about barnstorming their territories for M4A — and perhaps posting fliers at feed-and-seed stores and gas stations. But given the implacable opposition to M4A by the major political parties and PAHCF, prudence and practicality strongly suggest doing so after the day’s canvassing route has been completed.

Overall, this “educative” effort about M4A in the country’s heartland can be won by a canvassing army of “believers” who know they and everyone else will be beneficiaries of the program. The same thing is true in mounting a canvassing army in the cities and suburbs. Most canvassers know from bitter experience that the health care industry puts profits before patients. As long as it does, Congress will accept its donations and, like Pelosi and Schumer, will do nothing to change or even address this inexcusable health care crisis.

But an activated public taking initiative, beginning in the rural U.S., can force that change as it once did to establish Medicare. All it took was a good pair of shoes, a clipboard and pen, a bag of literature — and fire in the belly for that vital cause.

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