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The Democratic Strategist

Political Strategy for a Permanent Democratic Majority

M4A Movement at the Crossroads

Natalie Shure has a sobering read, “Before Forcing the Vote on Medicare for All, We Must Build Power: Overcoming the ruthless opposition of the health care industry will take a mass movement” at The Nation. Among Shure’s insights:

“With Pelosi’s reelection in January, the best path forward for Medicare for All remains uncertain. While President Joe Biden staunchly opposes it, the razor-thin Democratic majorities in the House and Senate, as well as Democratic supermajorities in several states, could still present opportunities to advance the cause. Even if #ForceTheVote never materialized as initially conceived, many advocates continue to push for a floor vote as soon as possible. But the unfortunate truth is that the Medicare for All movement lacks the power to make such a vote effective.”

Bam! She’s not saying the M4A idea lacks popular support. She is saying that the movement for it is still too weak. The polling data is favorable overall, depending on the way the polling questions are phrased. (A public option is much more popular than eliminating health insurance companies). But the on-the-ground organizing needs work. Shure continues,

“More than a year into the coronavirus pandemic, the case for single-payer has never been clearer: Millions of Americans have lost their employer-provided insurance; inadequate access to care has driven up the Covid-19 death count; and hospitals have found themselves underwater without revenue from elective procedures. The pandemic has given us an intimate look at our country’s unequal health outcomes, which Medicare for All would do more to address than any other systemic reform. But moral necessity isn’t enough to win against a $3.8 trillion health care industry that accounts for nearly 20 percent of the US economy and would be fundamentally upended if Medicare for All were to become a reality. With the health care sector already accounting for some of the top political spenders in Washington, there’s virtually no limit to the amount it would expend to topple reforms far more incremental than Medicare for All. Overcoming the ruthless opposition of the health care industry will take a mass movement willing to hit the streets, engage in direct action, and even go on strike to demand single-payer. Until Medicare for All has that kind of movement power behind it, it will easily be defeated by capital—a lesson we’ve learned repeatedly from health care reform battles in the past. And while it has popular support, polling between 40 and 70 percent, the same was true of national health insurance in the 1940s, until a major doctor-and-insurance-backed lobbying effort made the prospect of “socialized medicine” utterly toxic.”

The pandemic provides an important lesson for those who are willing to learn, that health insurance companies and state boundaries are both pretty useless in a global public health crisis. That part is not a tough sell. But Shure warns of the danger if premature congressional action:

From that perspective, the idea of putting politicians on the record regarding Medicare for All has no obvious value. For one thing, similar insight can already be gleaned from a list of the bill’s House and Senate cosponsors. But more important, given the current power disparity between the Medicare for All movement and the colossus it confronts, the unavoidable fact is that most of the elected officials who say they’re in favor of single-payer health care will never be true ride-or-die supporters until we can generate enough force to make the idea of bending to our will more compelling than bending to Big Health Care’s.

Rather than “bending to our will,” an effective social change movement wins over voters by persuasion and persistence. But Shure is right that building this coalition is the essential precondition that has to come before congressional floor votes, or even committee votes. Chase Iron Eyes makes the argument for pressing the case in congress in “We Can’t Miss the Next Chance to Force the Vote on Medicare for All: The tactic helps pinpoint which Democrats value donors over working people,” also in The Nation. He argues that “Forcing the vote lets the public see where our politicians stand. It feeds into other organizing and makes clear to elected officials that the people are watching them. It also helps the public pinpoint which Democrats value donors over working people.”

Meanwhile, Democratic leaders, inclding President Biden, Majority Leader Shumer and Speaker Pelosi all favor building on the Affordable Care Act over Medicare for All, and that’s what is going to happen — until the movement for Medicare for All reaches maturity.

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