Why We Fight for Medicare for All

Medicare for All is one of the central demands that we organize around in the Democratic Socialists of America. This is the case to keep it at the forefront of our politics.


If you like this piece, read more about where we stand and sign up to get our occasional email bulletins!

In 2016, Bernie Sanders stormed into the American political mainstream, articulating a powerful message of class struggle that resonated with millions of people: Millionaires and billionaires have fundamentally different interests from the rest of us, and their growing wealth is the reason we can’t stop runaway inequality or secure basic social services.

The key demand that anchored Bernie’s campaign was Medicare for All — and its growing popularity in the last two years is one of Bernie’s most important and lasting contributions.

But not everyone is on board. The backlash from the insurance industry, pharmaceutical companies, and the capitalist class as a whole has been negative and swift. The American ruling class and its representatives have lined up against single-payer healthcare. And the center-left of the Democratic Party has tried to appease the growing movement with half-measures and symbolic statements of support — statements that are discredited by the enormous donations they rake in from insurance lobbyists.

This backlash should not surprise us. By moving a large part of national GDP from private hands to public control, Medicare for All would deliver a serious blow to the wealth of the ruling class. It would also undermine the ruling class’s power in important ways. If access to healthcare were not tied to employment, as it is for most Americans, the power of employers over their employees would be greatly reduced. Unions would not need to bargain over healthcare costs and coverage, allowing unionized workers to focus on stronger demands.

For socialists serious about transforming the world, one of the key appeals of a Medicare for All program is precisely this — it would expropriate the wealth and power of capitalists and put it in the hands of workers.

But the significance of the demand for a single payer system does not just come from the effects of the policy after it has been implemented. The campaign itself offers socialists the best opportunity we’ve had in several decades to engage in mass politics.

The experience of healthcare insecurity is one that is both widely and deeply felt among American working and middle-class people. Nearly everyone who’s not a millionaire worries at some point about losing insurance, not being able to pay for a medical procedure, or needing to stay in a shitty job or in an abusive relationship in order to keep access to health insurance. Because it offers a solution to these worries, a demand like Medicare for All has the potential to galvanize millions of people and act as a stepping stone towards socialist politics.

As the fastest growing and largest socialist organization in a generation, the Democratic Socialists of America must take seriously its responsibility to bring a socialist analysis to popular campaigns for mass demands. We believe that the fight for Medicare for All has the potential to significantly shift American politics, and we believe that DSA should be central to making that shift happen.

Heal the Sick, Tax the Rich: M4A and Class Struggle

As the growing popularity of Medicare for All demonstrates, people are tired of incremental changes like Obamacare, and rear-guard battles to save it. On the other hand, the Bernie campaign, and single payer in particular, took off because they raised our expectations by advocating for a demand that would actually improve the lives of working people.

It is our task as socialists to raise expectations by agitating against the widely-shared difficulties of daily life and campaigning for demands that address them. We need to articulate a politics that can improve the day-to-day lives of hundreds of millions of people.

As socialists, we start doing this by explaining that companies will never put the needs of regular people over their desire to make profit. We explain that for-profit insurance will never guarantee healthcare for all people and we directly link the misery created by a private insurance system to the profits of insurance CEOs. They are rich because the insurance system is so dysfunctional. By emphasizing the conflict between for-profit insurance companies and the health of ordinary people, socialists are able to advance a class-struggle perspective in American politics.

As a point of entry for advancing class politics, organizing for Medicare for All is important for four reasons.

First, this kind of agitation around healthcare helps people to start thinking of themselves as part of a class, with a common interest and common enemies — the CEOs and big investors, the hospital groups, and the political elite who serve them because of campaign donations, lucrative contracts and careers, or simple ruling class solidarity.

Second, it allows us to unite people around material interests. It doesn’t matter whether you are in a red state or blue state, city, suburb, or rural area, a democratic socialist, liberal, or even a Republican — today, even 51% of Republicans support moving to a single-payer healthcare system! When socialists talk to our neighbors, coworkers, and family about Medicare for All, we identify the conflict at the heart of the American healthcare system — and of capitalism itself. They profit from our work, from our homes, and from our (lack of) healthcare. Their interests are opposed to ours.

Third, we don’t have to look far to see the impact struggles around healthcare are making in actual class conflicts today. Such fights have played an important role in labor upsurges across the country. For example, the West Virginia teachers’ strike, which was sparked by proposed cuts to the public employee insurance plan. Access to year-round healthcare benefits is a key demand of hotel workers, striking right now. And AFSCME 3299, which represents 24,000 workers in the University of California system — one of the largest employers in California, has gone on strike twice this year after facing employer threats to increase workers’ healthcare costs.

Finally, a campaign for Medicare for All advances class struggle by popularizing the concept of de-commodification. Fighting for and winning single payer will help demonstrate the principle that basic human needs should not be commodities sold in order to create profit for the few. A mass movement of American workers, united around a politics of de-commodification, opens the door to further demands for a broader anti-austerity agenda: mass investment in social housing, green jobs, and the nationalization of major industries.

Building DSA’s Capacity

By organizing around Medicare for All, socialists in DSA can make a major contribution to building our organizational capacity, both at the chapter and national levels.

Through our volunteer campaign committee — which includes a network of regional organizers and teams for communications and policy — we’ve held trainings, produced videos and articles, helped chapters pass city council resolutions, and created an organizing guide to help members across the country learn fundamental organizing skills.

The impact has been tremendous. Since the national campaign launched nearly a year ago, DSA members have knocked tens of thousands of doors in over 100 chapters across the country. And new organizing committees and developing chapters have used the campaign to develop organizational structures that allow them to build up their chapters beyond the Medicare-for-All campaign itself. The campaign has provided a structure for DSA members to teach each other how to organize public events, set meeting agendas, follow up with new members, keep data, cut canvassing walk-lists, pressure elected officials, develop public speaking skills, and talk to their neighbors about capitalism. The national campaign has also brought together DSA activists from across the country, forming relationships that will allow us to take on greater and greater struggles going forward.

DSA chapters have used Medicare-for-All canvasses, town halls, and protests to introduce themselves to their neighbors and establish themselves as a presence in their areas. Some have used it to advance specific local campaigns, such as state single payer bills in New York and California and a paid sick leave ordinance in Austin.

The Medicare for All campaign has also opened up opportunities to collaborate with unions and organizations engaged in on-the-ground struggles against for-profit healthcare, exploitative bosses, and reactionary politicians. National Nurses United (NNU), one of the most militant and rapidly-growing unions in the United States, has identified Medicare for All as its top political campaign. Aligning with strong unions, like NNU, over shared priorities is crucial for DSA as we continue to establish ourselves as a political force.

If we care about using a Medicare for All campaign to build our organization’s capacity, it’s essential that we have national infrastructure to support it. Smaller and newer chapters should not have to reinvent the wheel, and DSA as a whole owes it to our members to provide ready-made materials and campaign infrastructure so that people can get to work advancing class struggle where they live.

Bringing Socialist Politics into the Mainstream

As its popularity grows, Medicare for All is becoming a standard by which working people can evaluate the commitment of politicians and unions to represent their interests. During the 2018 midterm elections and in preparation for 2020, socialists need to use Medicare for All as a tool to expose the conflicts within the base of the Democratic Party and clearly re-insert a socialist vision into the mainstream American politics.

The race between Jovanka Beckles and Buffy Wicks in Assembly District 15 in California provides us with an example of how Medicare for All can be used as a litmus test to differentiate class struggle candidates from centrist and even progressive Democrats. Beckles is a DSA-endorsed candidate, a long time Richmond City Council member, and member of the Richmond Progressive Alliance. She is a proud democratic socialist and her platform offers a clear articulation of what socialists running for office should demand — including strong support for single payer.

Beckles is running against Buffy Wicks, an Obama White House staffer and Hillary Clinton campaign field manager who moved to the district in 2016. In her platform, Wicks touches on healthcare, stating that California can provide single-payer healthcare to its residents but that it will require tough choices on budgets and taxation. In comparison, Jovanka Beckles says unambiguously that with the largest economy in the U.S. and the fifth wealthiest economy in the world, California has the resources to pay for a single-payer program. She commits not only to fighting for Medicare for All but speaking out against politicians that take corporate donations that restrict them from doing the same.

Looking into 2019 and 2020 we can imagine what a national race, drawn along similar lines, will look like. Bernie Sanders, free of corporate control and standing with the working class to demand a Medicare for All system that covers all Americans with no co-pays or deductibles against Cory Booker, Kamala Harris, and Elizabeth Warren — who will run on the promise of single payer or a public option while they take money from private insurance companies and the ruling class. In such a race, Medicare for All unmasks centrist Democratic politicians as defenders of the ruling class.

The DSA Medicare for All Campaign

Medicare for All is not a cure for all of the problems in America today. And DSA, both at the national and the chapter level, should not turn itself into a single-issue campaign organization. We believe that socialists should be actively working on revitalizing the labor movement from below, fighting to protect reproductive rights, opposing racist violence, engaging in political education, and agitating for socialist politics in elections.

But politics requires prioritization. As a socialist organization, we should analyze the political landscape, identify potential openings for mass action, and from there prioritize our limited time and resources as strategically as we can.

The struggle around healthcare has been at the forefront of American politics for over a decade now. And with growing public support for Medicare for All and the huge opportunities inherent in this fight to build support for class politics and socialism, the reason why we put this demand at the forefront of our organizing should now be clear.

We’ve made a lot of progress in the past year in terms of building our organization and solidifying Medicare for All’s political relevance. But we don’t want to stop there. DSA can make Medicare for All the most pressing issue in American politics in the lead-up to the 2020 presidential elections — and to advance socialist politics we must do so. A mass campaign for single-payer can expose the contradictions within the Democratic Party between its corporate leadership and affluent base of professionals on the one hand, and the millions of working and lower-middle class people who reluctantly vote for “the lesser evil” on the other.

If we want socialism to move decisively into the mainstream of American politics, we need to think big. In our current moment, Medicare for All is far and away the best opportunity that the socialist movement has to spread the message of class struggle and de-commodification to millions of working class Americans.

Megan Svoboda is on the Steering Committee of DSA's Bernie 2020 campaign and an activist in East Bay DSA. She is running to be on DSA's National Political Committee and is a member of the Bread & Roses caucus.