Mailbag: Stephanie’s Last Episode

Medicare for All

We answer your questions about why we don’t have Medicare for All yet, interfacing with groups fighting for incremental reforms like Medicaid expansion, and more. Show Notes Starting with an easy one, many people asked: Why don’t we have Medicare for All yet? A few reasons: first, our political system is very different from most of the other countries that already have single payer. In the U.S. to make significant change, one party needs to control the Presidency, the House, and the Senate, and then the issue needs to have a big enough margin to overcome any dissent within the party (cough - Manchin, Sinema - cough). Systemic racism is also at play in preventing passage of Medicare for All. One of our favorite books (“National Health Insurance in the United States and Canada: Race, Territory, and the Roots of Difference” by Gerard Boychuk) highlights the role of systemic racism and Jim Crow in blocking any national health reform from passing. Lastly, while there have been attempts to create a national healthcare system since the 1940s, we suffer from the lack of a broad-based powerful social movement to pass some form of national healthcare. While public opinion is in support of Medicare for All, that's just not enough. We need to build more power to overcome the obstacles of existing structures of power and to deliver consequences to politicians who don't stand with us. (Not mincing any words, Stephanie sums it up: politicians are cowards.) Are things going to have to get worse -- MUCH worse-- for M4A to pass? If you had to project, how long will it take? Unfortunately, we live in a country that refused to change gun laws after the Sandy Hook massacre. We still haven't convinced politicians they will lose their jobs if they don't do the will of the people. Can it get worse than a global pandemic that shuts down the economy? The healthcare system has failed huge swaths of Americans, including fairly well-off people, business owners. We just need to do more organizing. Why doesn't the Single Payer movement do more targeted ads promoting the amazing benefits of single payer, refuting false claims from the anti-M4A PAC and telling the public about the huge amounts of contributions that many Congressional reps take from the industry? Ads are effective. We know this because the anti-M4A PACs do a lot of advertising. (Bill, IL) It's a question of how we best use our scarce resources within the M4A movement. With $50,000, do we think we’ll gain more power and leverage as a movement by running ads, or by hiring a local organizer for the next year? We have huge grassroots capacity, but not deep pockets. Our opposition has nearly bottomless bank accounts but doesn’t have grassroots capacity. They use advertising because that - along with hiring lobbyists - is the only tactic available to them. (It's also easier for them to defend the status quo than it is for us to make huge change.) When we reach the end game stages - at a state level or nationally - this calculation will change, and ads will likely become important for M4A. I live in one of the southern states that refuses to accept federal dollars to expand Medicaid. So lots of time and energy goes into efforts to make Medicaid Expansion happen along, now with pressure to include vision, hearing, dental in the Build Back Better bill (which may have disappeared by the time you read this). Please address how advocates for Medicaid Expansion and Build Back Better can be turned into "we won't stop here" advocates that will continue to be engaged until we have Medicare for All. Advocates for Medicaid Expansion are choosing to fight for Medicaid expansion because it’s something that could be implemented, more or less, tomorrow, and make an immediate difference in people’s lives. Stephanie lived in the South and Medicaid would have made a huge difference in her life as a service industry worker with no chance of getting healthcare.