Mailbag: Stephanie’s Last Episode

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. And growing up in the South – where people who are low income don’t have access to the public services like those available in the North primes you to accept that you are on your own, the government isn’t there to help you. The bare bones safety net in Southern states is meant to drive people into hopelessness and despair, and no one is going to fight for Medicare for All if they live on a planet so different than the one that guarantees healthcare for all. 

  1. What messaging do you suggest:
    1. Include Medicaid expansion in your single-payer messaging, acknowledging the real need that can be implemented right away.  
    2. Tie public health insurance to a more fair and equitable healthcare system. We’re not asking for an expansion of the exchange plans, we’re asking for the publicly-funded Medicaid program because the more public funding and oversight there is, the more equitable the system will be 
    3. DON’T be so militant that your message is dismissive of incremental efforts like Medicaid expansion or adding hearing, dental, and vision to Medicare. People are fighting for their lives. We don’t have the votes to pass M4A now, so it’s especially important to show up for existing campaigns for fights that bring us closer to M4A and will save lives.
  2. What tactics would you recommend to have us reach our goal?
    1. I think it’s important that we show up for Medicaid Expansion fights.
    2. Work on lobbying legislators on both expansion and M4A. 

Medicare is a 80/20 plan and requires a person to purchase a supplement to pay the 20% which many cannot afford. Is the 20% going to be eliminated under M4A? Since Medicare Advantage plans do not follow standard Medicare with the same coverage how will that be handled? Why can’t we have the single payer that would apply to all the States with identical coverage. (Mary, FL)

YES, deductibles would be eliminated under the Medicare for All bill, and so would Medicare Advantage plans – this would be a truly national plan with the same comprehensive coverage for every state. The current bills don’t totally eliminate cost sharing, but are better than most existing universal healthcare plans in other countries.

What is the purpose of the Medicare deductible each year? It only makes seniors delay seeing a doctor. I don’t see the advantage of a deductible to the system and there is no advantage to seniors. Is there a benefit to the deductible? If so WHO does it benefit and in what way?  

Passage of Medicare – during the 1960s – was fraught with explicit racial tension about who was going to get what, and of course how desegregation would affect black and white patients. And the consequences of this conversation are still with us today – and its actually the reason Medicare was split into 2 parts: “Part A,” the part that covers hospital care, requires no premium. “Part B,” the part that covers physician care outside of a hospital, does require a premium. Part B was designed this way in 1965 so that physicians’ offices in the South could claim that it was a voluntary insurance program – something that you buy into, and not a direct government payment – and continue to racially segregate their offices and refuse black patients. Basically this was meant to accommodate racist doctors in 1965. 

Why doesn’t Medicare pay for long-term care? That is something that a lot of us will need at some point. Moreover, those who need long term care are usually past the point of being able to work to earn the money themselves to pay for it.

The answer once again is systemic racism. Covering long-term care (LTC) under Medicare would have meant desegregation of nursing homes. By covering LTC under Medicaid, it allowed Southern states to continue the segregation of nursing homes much longer, since Medicaid is administered by the states instead of the federal government. Nursing homes were eventually desegregated – at least on paper – but we are now left with a LTC system with truly awful consequences. People who need LTC but can’t afford it are forced to impoverish themselves to qualify for LTC under Medicaid.

A listener asks Stephanie, as she leaves Healthcare-NOW,  what are the most important lessons you’ve learned about Medicare for All, about organizing, etc.?

  1. Organizing is truly local: relationships, building community and planting roots.
  2. You need both community and a strong strategy to make an effective, enduring grassroots organization.
  3. You need benchmarks along the way to make sure you’re making progress toward your long term goal.

What are you going to miss about working at Healthcare-NOW? (Karry, MA)

Working with people all over the country and getting a bird’s eye view of what’s happening nationally.

You’ll have to listen to the podcast to find out how Stephanie manages to connect single payer healthcare to Squid Game. We’ll miss you Stephanie!

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