Tag: Medicare for All

Opinion: To Win a Political Revolution, We Need a New Mass Organization / by Jeremy Gong and Nick French

Since Bernie Sanders’s defeat in 2020 and the start of the COVID-19 pandemic, the US left has been largely disorganized. The time is ripe for Bernie and the Squad to create a new mass organization to confront today’s crises.

It’s hard for leftists in the United States to find much to celebrate these days. After the excitement of Bernie Sanders’s victories in the early 2020 Democratic primaries, our hopes were dashed when the center consolidated around Joe Biden and handed him the nomination. The wave of inspiring uprisings against police brutality later that summer was followed by disappointment too, as demands for serious reforms to attack racial and economic injustice were co-opted or sidelined. The Left, as some have put it, finds itself in purgatory.

Meanwhile, Joe Biden’s administration has turned out to be what his most astute critics predicted: a presidency that, despite some early bright spots, has failed to meaningfully tackle economic inequality, the climate crisis, or much of anything else. Biden’s approval ratings are now at record lows as inflation batters the economy. (It’s unclear whether a last-minute compromise deal with West Virginia senator Joe Manchin on climate, health care, and taxes will salvage the administration’s popularity.) On top of that, the Supreme Court is rolling back abortion rights and threatening our democracy, and Biden and Democratic Party leaders are dragging their feet on any sort of response. The increasingly reactionary GOP now seems set for victory in the midterms.

There are some positive signs: Left-wing ideas are more mainstream than they have been in decades, in part thanks to Sanders’s presidential campaigns. Along with other insurgent politicians like “Squad” members Alexandria Ocasio-Cortez and Rashida Tlaib, Sanders has put policies like Medicare for All, the Green New Deal, and free public college into the mainstream. Democratic Socialists of America (DSA) has nearly one hundred thousand dues-paying members, four members in Congress, and dozens of elected officials at the state and local levels. The labor movement is stirring again, with this year’s successful Amazon warehouse unionization effort in Staten Island, the ongoing wave of Starbucks organizing, and the election of a strike-ready leadership to the 1.3-million-strong International Brotherhood of Teamsters.

Still, the Left hasn’t been able to coordinate effective political interventions at the federal level, let alone exercise power. With leftists still a tiny minority in Congress, progressive priorities like Medicare for All and a Green New Deal are off the agenda, and even less ambitious reforms are consistently stymied by conservative Democrats like Joe Manchin. And despite growing their legislative presence, socialists and their allies have failed to expand beyond deep-blue districts.

Sanders’s presidential campaigns brought in tens of thousands of volunteers, millions of voters, and a huge number of small-dollar campaign contributions (many from working-class donors). But it wasn’t enough to win, and the underlying theory of the campaigns — that class-struggle rhetoric and a popular platform of wealth redistribution could turn out masses of working-class nonvoters to carry Sanders to the nomination — didn’t pan out. Despite the popularity of Sanders-style politics and mass discontent with the status quo, socialism remains largely the preserve of young, college-educated professionals in solidly Democratic districts — isolated from the broader working-class constituency it purports to represent.

In a phrase, Sanders’s “political revolution” simply never came.

There are many theories as to why Sanders didn’t win. Part of the explanation, though, must involve the lack of working-class organization (including unions) and left institutions. The defeat and disorganization of the Left and labor since the 1970s has deprived the working class of the struggles and organizations that undergird them — what Friedrich Engels called “schools of class war.” Having never felt the power of collective struggle, many voters were understandably skeptical that Sanders’s campaign would deliver. And with most Democratic voters taking their cues from the corporate media and party elites, Sanders simply didn’t have a strong enough media counterweight.

Today, the absence of mass working-class organization continues to haunt the US left. With the Right putting fundamental liberties like reproductive freedom on the chopping block and the Democrats asleep at the wheel, the time is ripe to build a mass organization that can make desperately needed political interventions. And we think that Sanders and the Squad need to take the lead in building such an organization.

Movements Need Organizations

The Left’s recent defeats — compounded by COVID-19, which has made in-person organizing much more difficult — have fostered demoralization and demobilization. But much of the post-2020 malaise can also be attributed to the inability of activists — let alone millions of ordinary people — to keep participating in a movement that has the power to change the world, especially at the national level, where the stakes are highest. While activists have supported impressive campaigns and righteous protests, millions of former Bernie supporters understandably feel helpless amid political and ecological crises.

Still, there are inspiring examples for the Left to build on. In Richmond, California, the Richmond Progressive Alliance (RPA) has beaten landlords and Chevron to win city council majorities on and off for over a decade. The Vermont Progressive Party continues to be a significant force in state politics, even holding the office of lieutenant governor from 2017 to 2021. In New York City and Chicago, DSA-backed elected officials have formed socialist caucuses.

These efforts are exciting because they elevate the political process above individual candidates and fleeting election campaigns, fuse legislative fights with permanent membership organizations, and create clear and oppositional political identities distinct from the Democratic Party. As labor activist and RPA leader Mike Parker wrote earlier this year, building broader political organization is the “main task when it comes to political action,” not a “side issue.” Organization is how we make Bernie’s “Not me, us” more than a slogan.

Without organization, it’s hard to build, let alone sustain, the type of mobilization needed for Bernie’s political revolution. Massive protests wane without clear demands, let alone a compelling strategy of how to win them. Thousands of progressives either don’t know how to start building campaigns or lack the resources to do so. Movements around important issues get co-opted by corporate Democrats’ reelection campaigns, grant-seeking nonprofits, and prominent social media personalities who aren’t democratically accountable to any base. Ongoing organization is also essential to train onetime protesters into skilled, politically sophisticated, and lifelong movement cadre.

In electoral politics, progressive candidates face enormous pressure to avoid criticizing establishment Democrats. Once elected, lone progressives have few resources to push against the business-friendly common sense at every level of government: corporate candidates can rely on well-funded lobbyists to help write legislation, educate the public, and even mobilize supporters; anti-corporate candidates must do this all on their own. Without a broader organization at their back, it’s no wonder that the progressive politicians we support are not able to be constantly fighting on all fronts at once.

Only mass organization can bring together the resources and the people of the Sanders movement on a permanent basis. The idea of such a party-like organization has been popular on the Left since the end of Sanders’s 2016 campaign, popularized in a 2016 Jacobin article by Seth Ackerman and expanded on recently by many others.

If the Left had a mass party–like organization in 2020, the end of Sanders’s second presidential race wouldn’t have meant losing the feeling that, together, we could change the world. While supporters of Sanders and the Squad can donate to individual election campaigns when asked, there is no way to permanently join and help build the movement these elected officials appear to lead. Many of us called for Sanders to convert his 2020 campaign infrastructure into a permanent organization after the campaign, to no avail.

Such a party-like organization could have helped progressives in Congress and their many supporters win more of the progressive items in negotiations over Build Back Better since 2021. As Ben Beckett argued in Jacobin last fall, Sanders and the Squad could have built a powerful movement to pressure Manchin and Arizona senator Kyrsten Sinema by mobilizing with activists, including DSA members, battle-hardened teacher unionists — who led historic mass strikes in West Virginia and Arizona in 2018 — and other progressives. Such a movement might also have pushed the Biden administration to use its bully pulpit or the power of executive action to enact sweeping change (like canceling student debt). The movement to defend abortion rights desperately needs this kind of mobilization today.

In a similar vein, Neal Meyer writes that “mass mobilizations require mass organization. We have to put the days of lone-wolf politicians acting on their own . . . behind us.” A Sanders-led party-like organization with permanent local chapters across the country could have coordinated this movement with progressive electoral challenges in West Virginia and Arizona and pressure campaigns against Democratic leaders like Nancy Pelosi in California and Chuck Schumer in New York. A mass organization could in turn bolster Sanders and the Squad to fight for a better deal in Congress, as well as support local and state-level candidates nationwide — including in purple or red districts where the Left does not yet have a foothold.

Ultimately, we need something like the organization described here to help convince millions of working people who are disconnected from politics that a better world is possible through collective action, and to sustain mass activity once it’s in motion. That’s how we can build the base that will elect Sanders-style progressives and democratic socialists by the hundreds across the country and grow a movement that can exert bottom-up pressure through mass disruption.

Build Back Bernie

It is premature to write a precise blueprint for what this party-like organization should look like. But there are a few principles that should guide us.

First, socialists and progressives should call on Bernie and the Squad to participate in building and leading this new organization. For better or worse, only these national political figures have the resources and legitimacy to bring together millions of supporters and many disparate threads of progressive activism into a single organization. Their leadership would make the project much more likely to succeed, and sooner.

Second, such an organization should be democratic and membership-based. Local and national leaders should be elected by the members, and members should be able to influence the policy platforms of elected officials like Sanders through conventions and internal debates. As Mike Parker and Martha Gruelle write in a different context, democracy is power: only democratic organizations can give their members a sense of ownership over strategies and campaigns, grow the sophistication and size of their activist base, refine their approach based on real-world experience, and deal with competing ideas without alienating the minority of activists who don’t get their way.

Third, the group should support progressive election campaigns, but also year-round organizing outside the halls of official politics. The history of progressive movements shows that mass disruption, outside of the normal political process, is critical to securing legislative wins. No anti-corporate political project will be successful if the Left isn’t also helping build fighting unions and social movements.

Fourth, a progressive party-like organization should be working-class-funded, primarily through membership dues. That means rejecting all corporate and billionaire donations, large unreported donations from anonymous sources, and donations from PACs, foundations, or other groups that launder capitalist cash. Campaign-finance statutes complicate efforts to coordinate election spending, but David Duhalde and Seth Ackerman have both explained how such a nonparty political organization could navigate the law.

Finally, this organization should be effectively nonpartisan, meaning it will support candidates running as Democrats and as independents, depending on what makes sense in a given local context. Sanders himself has run as an independent for Congress, but caucuses with the Democrats, and made his biggest impact by running in the Democratic presidential primaries. This flexibility will be needed both to build an independent political brand that resonates with voters sick of both corporate parties and to keep together leftists and progressives who might currently disagree about the long-term future of the Democratic Party. In the near term, though, the organization can appeal to voters who are still loyal to the Democrats or who are worried about the “spoiler effect” in districts where that is a concern.

Along with mobilizing to defend abortion and other rights, activists and groups that believe in this organizational vision should plan local and national convenings to discuss how to make it a reality. We’re members of DSA and believe DSA has an important role to play in backing this effort. But we also believe that a Sanders-led party-like organization must have a broader ideological base than DSA, since today’s fights are for near-term reforms, not for overthrowing capitalism. As with our election campaigns, unions, and protests, our mass political organizations should be open to the millions of people who want to defend democracy and support Sanders’s agenda but aren’t ready to join an explicitly anti-capitalist organization.

Other membership organizations and nonprofits like the Sunrise Movement and Justice Democrats, local or state-level political formations like the RPA and the Vermont Progressive Party, grassroots groups fighting for economic and social justice, and progressive unions like National Nurses United, which hosted the People’s Summit after Sanders’s first run in 2016, should also sign on to this project.

A New Political Moment

Sanders has attempted to start a mass membership organization before: Our Revolution, which sprung up in the wake of his 2016 presidential run. For all its accomplishments, though, Our Revolution isn’t suited to play the role of a mass party–like organization right now.

First, though at least some chapters had democratic mechanisms, members were not empowered to democratically determine the national organization’s strategy. Second, Sanders himself was not involved in the organization, which likely hindered the group’s appeal and political effectiveness. Third, as Duhalde noted in 2020, most of Our Revolution’s staff left the organization to work for Sanders’s 2020 campaign, and some of its key early leaders are no longer involved.

That points to another problem with Our Revolution: it was formed at a particular moment (post-2016), with many activists no doubt expecting another Sanders presidential run, and with a particular strategy of attempting to reform the Democratic Party from within. But that political moment is over: Sanders lost the 2020 primary, progressives have largely found themselves marginalized by the Democratic establishment, and we need everyone who was activated by the Bernie campaign and more — including Sanders himself and the Squad — to come together to devise a new strategy. We should reconsider Our Revolution’s strategy of running for internal Democratic Party positions, for instance, and think about establishing a political identity more independent of the Democrats.

The new left has much to be proud of since 2016, but the organizations and tactics that got us this far aren’t enough going forward. If we want to fight for democracy and justice, and build the power to make more ambitious changes in the future, we need to get serious about our strategy. Isolated protests, strikes, and election campaigns have brought many of us into politics. But we need these to add up to more than the sum of their parts so we can wage the struggle that establishment Democrats can’t or won’t.

We know the creation of the kind of group we’re calling for is a long shot. But we’ve seen the ability of Sanders and the Squad to inspire millions, and we believe they have the power to start building the effective, broad left organization that this moment demands.

Jeremy Gong is a member of the Democratic Socialists of America in California’s East Bay.

Nick French is an assistant editor at Jacobin.

Jacobin, August 6, 2022, https://jacobin.com/

Hey, Bernie, Make It a Real Single Payer Bill…No Profits / by Kay Tillow

Senator Bernie Sanders has announced that he is going to introduce his Medicare for All bill in the Senate—and hold a hearing.  This is most welcome news.

As Bernie campaigned for the presidency, he elevated national single payer health care, an improved Medicare for All, into the public spotlight and onto the nation’s agenda.

His advocacy for Medicare for All informed millions and lifted spirits building hope that a universal single payer plan is possible in the US.

He has not done that well at writing legislation.  His most recent bill, the Medicare for All Act of 2019 (S. 1129), falls short of essential single payer principles and lets stand billions in profits that will undermine care and steal public funds.

With a majority of people in the U. S. now delaying care because of cost and life expectancy sinking to 5 years below other wealthy countries, the crisis is too great and the life or death urgency too immediate for half measures.

Here are the issues in Sanders’ 2019 Medicare for All Act (S. 1129) that need to be resolved prior to introduction of Medicare for All in 2022.

1. S. 1129 leaves institutional long term care to the states under Medicaid instead of including it in the national Medicare for All program. Leaving long term care to the states means that it will continue to be means-tested, and people will have to become impoverished to be eligible. The rules and care will vary from state to state leaving the fragile elderly and disabled persons dependent on state budgets that are continually being cut.

2. S. 1129 allows the investor-owned hospitals, nursing homes, dialysis centers—all the for-profit facilities–to continue to exploit patients and drain the public treasury. Objective research consistently shows that investor-owned entities have both lower quality care and higher costs.  That’s why a sound single payer bill must convert those facilities and ban for-profit health care institutions, ending the waste of public funds on facilities that subject patients to inferior care.

3. S. 1129 does not provide for global budgeting, lump sum payment to hospitals and similar institutions to cover operating expenses, that would eliminate wasteful per-patient billing. Global budgeting, separating operating budgets from construction, expansion, and modernization, is essential to assure that funds are not wasted.  Separate capital budgets will guarantee that facilities are built where they are needed.

4. S. 1129, in section 611(b), adopts the payment systems of the Medicare Access and CHIP Reauthorization Act (MACRA) and the Affordable Care Act (ACA), basing payments on an unworkable, unfair, and wasteful system supposedly rated according to value. Such payment schemes have proven to discriminate against those physicians who serve the poorest patients and minority communities while adding massively to the administrative tasks and burn out of physicians.  These alternative payment models (APM) or value-based payments (VBP) in S. 1129 embed risk and profit into the payment system and should be banned.  They impose schemes that incentivize denial of care to enhance profit.  These payment systems are the basis of the current privatization of Medicare through the direct contracting entities (DCE) program, recently renamed ACO REACH.

5. While S. 1129 removed most copays and deductibles, it keeps a copayment on certain drugs.Copayments have been proven to deprive patients of necessary care and are detrimental to health.

6. S. 1129 inserts supposedly incremental steps of public options and Medicare buy-ins for four years prior to arriving at a real single payer plan. Because the plan expands care while maintaining the private insurance companies, costs will skyrocket before the savings of single payer kick in. The incremental steps will become a roadblock rather than a path to single payer.  Perhaps the worst part of this inclusion of the public option and the Medicare buy-in is the reinforcement of the false notion that there should or must be incremental steps to single payer.  Neither the public option nor the Medicare buy-in are based on sound policy.  To place them in the bill endangers the single payer goal.

7. S. 1129 is silent on the establishment of a progressive taxing mechanism that would shift the tax burden from working class Americans onto the corporate elite and the billionaires.

8. While S. 1129 provides for up to 1% of the budget to be used for temporary worker assistance programs for those who experience economic dislocation as a result of implementation of Medicare for All, there is no specific annual compensation for a specific period that could win the support of workers in the insurance industry.

Ricky Goldwasser, managing director at Morgan Stanley just announced that there will be even more consolidation in the healthcare industry in the coming year with more Wall Street mergers and acquisitions and more takeovers of physician practices by private equity.  Some highly-respected health policy experts are now asserting that Medicare for All is not enough and that the nation must move to a national health service to escape control by the profit-takers.  The introduction of health care legislation reflecting that opinion would also be welcome.

The very least that Congress can do is propose a real single payer bill, stripped of the profits, and covering us all.

Originally published in Counterpunch, April, 22, 2022

Kay Tillow is a retired unionist who worked primarily in organizing and collective bargaining with nurses and other workers in hospitals and nursing homes.  She is currently Chair of Kentuckians for Single Payer Health Care and Coordinator of the All Unions Committee for Single Payer Health Care.

ML Today, April 25, 2022, https://mltoday.com/

Medicare for All Is Not Enough / by David U. Himmelstein, Steffie Woolhandler, Adam Gaffney, Don McCanne and John Geyman

Hospital workers, union members, and local politicians protested the imminent closure of Hahnemann University Hospital at a rally in Philadelphia on July 15, 2019. (Bastiaan Slabbers / NurPhoto via Getty Images)

Communities, not corporations, should own our most vital health care assets.

We have long advocated for single-payer national health insurance. By eliminating private insurers and simplifying how providers are paid, single-payer would free up hundreds of billions of dollars now squandered annually on insurance-related bureaucracy. The savings would make it feasible to cover the uninsured and to eliminate the cost barriers that keep even insured patients from getting the care they need. And it would free patients and doctors from the narrow provider networks and other bureaucratic constraints imposed by insurance middlemen. We still urgently need this reform.

However, the accelerating corporate transformation of US health care delivery complicates this vision. In the past, most doctors were self-employed, free-standing hospitals were the norm, and for-profit ownership of facilities was the exception. Single-payer proposals hence envisioned payment flowing from a universal, tax-funded insurer (like traditional Medicare) to independent clinicians, individual hospitals, and other locally controlled, nonprofit providers. This was usually the state of play when national health insurance (NHI) was achieved in other nations, such as Canada in the 1960s and ’70s—the model for single-payer reform in the United States.

But insurers are now being joined by a new set of corporate middlemen asserting control over American care. Amazon plans to expand Amazon Care from Seattle to 20 other cities this year, and then to all 50 states. Wall Street is buying up doctors, hospitals, and other health care institutions, distorting care to generate profit. Today, most doctors are employees of large organizations, and most hospitals have become subsidiaries of corporate enterprises encompassing many facilities and firms with tenuous ties to the communities they serve. Meanwhile, for-profit control of health care providers—including by private equity firms—has burgeoned, despite strong evidence that profit-seeking siphons off resources and undermines quality.

These sweeping changes require an expansion of the traditional single-payer vision. Reform needs to go beyond changing the way we pay for care: It also needs to change whom we pay for care. Communities, not corporations, should own our nation’s vital health care assets.

The rise of corporate ownership of American health care has been stunning. For-profits now own the vast majority of hospices, nursing homes, urgent care and dialysis clinics, imaging facilities, ambulance companies, and home care agencies. They garner nearly one-third of the total revenue of psychiatric and substance-use treatment hospitals, and control a growing share of general hospitals. Meanwhile, insurers are buying up clinics and doctors, eliminating any semblance of clinical independence. Optum—a subsidiary of UnitedHealth, the nation’s largest insurer—controls more than 1,500 clinics with 60,000 doctors, and CVS/Aetna already runs 1,200 Minute Clinics, with plans to expand its offerings in primary and behavioral care. Increasingly, Americans’ insurer is also their doctor.

Even more malevolent actors have now entered the fray. Private equity firms’ health care acquisitions totaled about $750 billion over the last decade, more than $119 billion in 2019 alone. KKR and Blackstone now employ or control more than 40,000 doctors, physician assistants, and nurse practitioners, and provide staffing for about one-third of US emergency rooms. Those companies were largely responsible for the epidemic of surprise bills. And private equity has been gobbling up primary care practices and mental health, orthopedics, and vision care providers; they already employ nearly 10 percent of dermatologists.

At least UnitedHealth and CVS plan to stay in business for the foreseeable future, and may be constrained by the worry that substandard care will damage their reputation. Private equity companies face no such constraints. They promise investors quick profits, and often sell off the businesses they’ve bought within five years, often after stripping their assets and loading them with debts that hobble future operations. Philadelphia’s Hahnemann Hospital epitomized the danger of private equity takeovers. Its billionaire owner shuttered the vital safety net hospital, whose downtown real estate was worth more for condos than for caregiving. Moreover, private equity owners are exempt from SEC (and most other) reporting requirements, allowing them to hide their actions (and the identity of the investors). patients and staff don’t have the right to know whom to blame for misbehavior.

A raft of evidence warns that for-profit ownership undermines quality. Two giant for-profit chains (one based in Germany) have gained dominance in dialysis, even as research has documented for-profit dialysis centers’ high death rates—driven in part by their over-prescribing of sometimes dangerous medications that boost dialysis firms’ profits. For-profit hospices shun (even insured) patients whose extensive care needs make them unprofitable, provide a narrower range of services, use less-skilled clinical staff, and have high rates of substantiated complaints of substandard care. And the for-profits that have long dominated the nursing home industry skimp on nursing care are more often cited for quality deficiencies, and have a higher death rate.

Even against the background of for-profit abuses, a transition to private equity ownership signals further deterioration of care. In the wake of PE nursing home takeovers, nurse staffing has declined and fatality rates have risen, resulting in 20,150 excess deaths. Meanwhile, the owners shield their assets from lawsuits by injured patients (or their survivors) by transferring ownership of the nursing home’s real estate to a separate subsidiary. Private equity firms that buy up dermatology practices intensify a focus on selling cosmeceuticals and elective procedures, and some gin up profits by performing unneeded surgeries on frail nursing home residents with Alzheimer’s disease. Their tendency to overdiagnose melanoma appears partly responsible for a growing epidemic of unnecessary, but lucrative, skin cancer operations.

While the conflict between financial ambition and clinical mission is most acute in for-profit organizations, even in esteemed nonprofits finances now often drive priorities.

Johns Hopkins Hospital sued thousands of its patients for medical debt, including many who worked for it, often garnishing their wages. The University of Virginia health care system filed more than 36,000 lawsuits against patients for unpaid medical bills over a six-year period, emptying their bank accounts, putting liens on their homes, and sending some spiraling into bankruptcy, as a Kaiser Health News investigation found. Meanwhile, the nonprofit (Catholic) Ascension health system, which owns 140 hospitals, partnered in a billion-dollar private equity fund, whose first investment was in a debt collection business accused of illegally demanding money from patients, even while they were still in the emergency room.

Yet bad behavior goes beyond debt collection. A memo from nonprofit Mayo Clinic’s CEO, who also oversees the clinic’s network of hospitals outside Minnesota (sited in locales chosen for their business opportunities rather than clinical needs), prodded the staff to prioritize care for patients with the best-paying insurance—a rare explicit statement of a ubiquitous management strategy that’s usually left unsaid.

The parent corporation of Boston’s Massachusetts General and Brigham and Women’s hospitals, which reaped a profit (technically, a surplus) of $3.2 billion last year and is now headquartered in the Prudential Tower, devoted $100 million to “rebranding” when the firm changed its name, and touted its new chief marketing officer for his expertise at selling Oreos and Ritz Crackers during his stint at Nabisco.

In both the for-profit and nonprofit sectors, in other words, the corporate takeover of care has been driven by market rules and incentives rigged to favor the biggest—and most avaricious—fish. Corporate control has driven up costs and bureaucracy, and failed to deliver the improved clinical coordination, efficiency, or quality promised by advocates of market-based health policies.

In the context of this galloping corporate takeover of health care delivery, replacing current insurers with a single NHI plan is necessary but not sufficient; it would funnel payments to corporate owners rather than to the people and facilities who care for patients. That would continue to delegate control of care to profit-seeking middlemen with little involvement in providing care. In the past, such corporate providers have proven impervious to regulators’ efforts to restrain profit-driven abuses, including the efforts of public payers who already provide the lion’s share of health providers’ revenues (e.g., almost all payment for dialysis and hospice care). Health firms’ growing financial power and the entry of behemoths like Amazon amplify the ability of corporations to evade regulation.

Responding to the evidence of for-profits’ misconduct, most Medicare for All bills and proposals have prudently called for either the exclusion or public buy-out of for-profit providers. However, the first option, excluding them, is not a viable solution, because their facilities—like the the 5,300 dialysis clinics owned by Fresenius and Davita, the two dialysis giants—are needed for patient care. And while a public buy-out is economically feasible, who would then own and operate such providers? And what of the nonprofits whose boards often run them as private fiefdoms and increasingly behave like for-profit wannabes?

In both instances, a transition to public, community-based ownership—a reform model generally labeled National Health Service (NHS), in contrast to NHI—seems the most appropriate solution, especially since taxpayers have directly or indirectly bankrolled the construction of most hospitals and other health facilities.

Such an NHS should have federal funding and oversight, similar to the Veterans Health Administration—a publicly owned and operated health system that delivers higher quality of care at lower cost than the private sector. However, as Democratic Representative Ron Dellums proposed in the 1970s, the NHS should delegate day-to-day governance to local communities. The system should direct new investments to currently underserved communities, develop the primary care infrastructure that is the bedrock of effective and efficient care, and build the linkages between public health and medical care whose lack has hobbled the US’s pandemic response—and in so doing, turn the tide of faltering health in America.

David U. Himmelstein is a Distinguished Professor of Public Health at the City University of New York at Hunter College.

Steffie Woolhandler is a Distinguished Professor of Public Health at the City University of New York at Hunter College.

Adam Gaffney is a critical care physician and an assistant professor at Harvard Medical School.

Don McCanne, a retired family physician in San Juan Capistrano, Calif., serves as senior health policy fellow for Physicians for a National Health Program, and founded the popular health policy blog McCanne Health Justice Monitor.

John Geyman is a professor emeritus of family medicine at the University of Washington School of Medicine in Seattle, where he previously chaired the Department of Family Medicine.

The Nation, March 31, 2022, https://www.thenation.com/

House Democrats to Hold First Medicare for All Hearing Since Pandemic / by Julia Conley

Protesters supporting Medicare for All hold a rally outside PhRMA headquarters April 29, 2019 in Washington, DC. The rally was held by the group Progressive Democrats of America. (Photo: Win McNamee/Getty Images)

“Congress must implement a system that prioritizes people over profits, humanity over greed, and compassion over exploitation,” said Rep. Cori Bush.

Two years after the Covid-19 pandemic suddenly left an estimated 14.6 million Americans without employer-sponsored health insurance due to economic shutdowns and layoffs, the House Oversight Committee next week will hold the first hearing since the pandemic began on Medicare for All, with witnesses expected to testify on numerous ways the public health crisis has made the need for such a system clearer than ever.

Committee Chair Carolyn Maloney (D-N.Y.) will be joined Tuesday by Rep. Cori Bush (D-Mo.) in leading the hearing, which will be the third congressional ever to focus on Medicare for All.

Several progressive lawmakers, including Reps. Alexandria Ocasio-Cortez (D-N.Y.), Rashida Tlaib (D-Mich.), and Jamaal Bowman (D-N.Y.), are also members of the committee.

Medicare for All advocate Ady Barkan, who suffers from ALS, is set to testify at the hearing, along other witnesses including with emergency physician Dr. Uché Blackstock and economist Jeffrey D. Sachs.

The hearing will focus partially on how universal healthcare coverage, with all types of medical care free at the point of service as it is in other wealthy nations, would help close health disparity gaps for people with disabilities, people of color, low-income and poor people, and other marginalized groups.

According to a report released just before the pandemic by Physicians for a National Health Plan (PNHP), Hispanic and Black Americans have significantly higher uninsured rates, at 19% and 11%, respectively, than white Americans, 8% of whom are uninsured.

Black Americans are also twice as likely as white people to die of diabetes, 22% more likely to die of heart disease, and 71% more likely to die of cervical cancer.

In the country’s healthcare system established for all veterans, though, Black men are significantly less likely to develop heart disease, while high-quality health coverage erases nearly half the racial disparities for women with breast cancer.

“This policy will save lives, I want to make that clear,” Bush told The Nation on Thursday. “I hope this hearing will be one more step forward in our commitment to ensuring everyone in this country, and particularly our Black, brown, and Indigenous communities, have the medical care they need to thrive.”

In addition to showing how quickly a for-profit healthcare system—in which medical coverage is tied to employment for more than half the country—can leave millions without care, progressives have said since the pandemic began that the crisis demonstrated the need for Medicare for All in other ways.

As Common Dreams reported in 2020, for-profit health insurers have illegally hit Americans with surprise medical bills for Covid-19 testing and treatment, with some being billed for thousands of dollars for services advertised as free—and necessary for public health.

“Americans deserve a healthcare system that guarantees health and medical services to all. Congress must implement a system that prioritizes people over profits, humanity over greed, and compassion over exploitation,” Bush told The Nation.

The announcement of the hearing comes two weeks after House Democrats pulled $15.6 billion in pandemic response funding from an omnibus spending bill, a move that forced the federal government to end coverage of Covid-19 tests and treatment for uninsured Americans.

Meanwhile, the Biden administration is moving ahead with a scheme to privatize the existing Medicare program, continuing an experiment first pushed by former Republican President Donald Trump.

In the Senate this week, Sen. Bernie Sanders (I-Vt.) announced that he soon plans to reintroduce a Medicare for All proposal. Next week’s hearing will consider a shift to the Medicare for All proposal put forward in the House by Rep. Pramila Jayapal (D-Wash.).

Marking the twelfth anniversary of the Affordable Care Act, Social Security Works executive director Alex Lawson said Wednesday, “It is more clear than ever that we need improved and expanded Medicare for All.”

Common Dreams, March 24, 2022, https://www.commondreams.org/news/2022/03/24/house-democrats-hold-first-medicare-all-hearing-pandemic