The world will change tomorrow when Donald Trump becomes president -- and so, too, must the movement for social justice. It is this reality that prompted Mariame Kaba, who for years has been organizing on issues such as the criminal punishment system and domestic violence, to shift gears in the lead-up to the inauguration.
"I have been thinking about how to organize in this current moment, and figure out ways to build the power to resist on various fronts," she said in a Truthout interview. "I was thinking of an issue that can reach a broad range of people, regardless of where they stand ideologically, racially [or] economically."
This search led her to the issue of health reform and the need for a public system that guarantees care to everyone. The result will be tomorrow's Medicare for All National Day of Action, a nationwide online event to be held on Inauguration Day. While Trump is giving his oath of office, thousands of activists across the country will be working online (using the hashtag #medicare4all) to push for the reform: contacting Congress, making memes and forming relationships with other like-minded people.
Participants are encouraged to make use of the official website, Facebook page, Twitter feed and pre-made graphics that can be shared on social media -- all devoted to what Kaba calls a "virtual" day of action. "I wanted those who are unable to go down to Washington, DC, where there will be lots of resistance activities, to have a chance to participate," she said.
The long-term goal, Kaba elaborates, is bigger than just health care reform. She sees the fight for Medicare for All as having the potential to play a central role in building a mass movement against the inequities of capitalism more broadly. "This is ultimately what the struggle is against, and we need to start talking in those terms," she said, adding that those in power "want to take away your health care and give a tax break to people who are already rich. People can understand redistribution upward."
We Are All Patients: the Broad Appeal of Medicare for All
There is no shortage of issues that activists can organize around. Trump's victory has further exposed the world to environmental, media and immigration crises, to name just a few. But the fight for a real health care system, organizers believe, has unique potential to be the hub of a wider movement.
"We have all been patients at one point or another," said Dr. Carol Paris, the current president of Physicians for a National Health Program (PNHP) in an interview with Truthout. "So, yes, reforming the delivery of health care is something we all need ... what many people have now is just an insurance card and the illusion of care."
Indeed, health care policy is a major concern for workers seeing their paychecks shrink due to the rising cost of health care, as well as the 30 million Americans who remain uninsured despite progress on access from the Affordable Care Act (ACA). It is also a problem for those who have health insurance but are still exposed to massive debt and potential bankruptcy. This exposure causes millions of insured Americans to forego care they need.
The lack of a universal health system has also led to serious racial disparities, the Harvard Business Review observed in 2015, with Black Americans having a shorter life span and worse outcomes than whites on a number of ailments, including "heart disease, diabetes, and cancer, as well as higher risks for HIV infection, homicide, and infant mortality." The seriousness of the crisis cannot be understated. A 2012 study by consumer advocacy group Families USA concluded that 26,000 people die each year due to a lack of insurance.
Paris has a long history as a health care activist, extending long past her current role as a physician who is president of an organization that provides much of the seminal research on the subject. In May 2009, she was one of the "Baucus 8," who stepped up at the US Senate Finance Committee hearing on health care reform chaired by Sen. Max Baucus to ask why there wasn't a single advocate for single-payer health care on a 41-person panel. Baucus had all eight peaceful protesters, including Dr. Paris, arrested.
The Nashville-based doctor was arrested again -- which can be seen on video at PNHP.org -- two days after President Obama said in his 2010 State of the Union that he would listen to anyone with a "better approach" to reform. "Well, we had a serious set of proposals and tried to let him know," she said of her arrest, which occurred in Baltimore outside a conference featuring the president. They attempted to give him a letter that urged him to consider Medicare for All to save thousands "of American lives each year, not to mention the prevention of unnecessary suffering."
"It is important not just to rely on research and data but to organize, to protest and to fight for single-payer," Paris said to Truthout on the role of activism and organizing. "We have worked with many organizations [that] aren't solely focused on health care, such as labor groups, who know to get economic justice, creating a Medicare for All system would be an important step."
The Coming National Debate on Health Reform
While health care is always an important issue, it is going to be front and center in the national debate as Trump and the new GOP Congress seek to rapidly repeal (and supposedly replace) the ACA. This will be a messy, complex process and could cost more than 20 million people their health insurance, according to the Congressional Budget Office. But it will provide a chance for advocates to spread their message.
"In a back-handed way, [the GOP efforts to repeal the ACA] will provide advocates a chance to get our message across," Paris told Truthout on the phone while watching Bernie Sanders speak at the confirmation hearing for Tom Price, Trump's appointment for head of Health and Human Services.
"It is going to be up to activists and independent media [outlets] to give legitimacy to Medicare for All as a reasonable, cost-effective alternative to the status quo," Paris added.
Democrats are promising to fight the repeal and possibly minimize some of the consequences of the GOP's approach. Even if the repeal could somehow be stopped, however, the fight for Medicare for All remains the ultimate goal for many progressive activists. "Our job today is to defend the Affordable Care Act," Bernie Sanders recently said on Twitter. "Our job tomorrow is to create a single-payer system."
Certainly, Sanders has his detractors, including many in the Democratic Party, some of them beneficiaries of large donations from Pharma and the private insurance industry. This bipartisan opposition to Medicare for All is a reality that organizers say the movement must tackle head on.
"Politicians from both parties say it is politically impossible," Paris said. "But what does that mean? It means that our representatives won't vote for it. It means many won't risk alienating their donors at the pharmaceutical and health industries, who fund their campaigns."
Education and Class Consciousness
Certainly, education must be central to building a movement, which is why organizers' use of the term "Medicare for All," over "single-payer" is deliberate. While policy wonks are familiar with the term single-payer, it is still a phrase that confuses many people. "Most people know what Medicare is," Kaba said.
Amazingly, despite a narrow debate in the media and in Washington that villainizes or ignores the policy, the public is still broadly supportive of Medicare for All (when the question is asked in those terms), and has been for years. In December of 2015, a Kaiser poll showed 58 percent of the public supported the policy, including 81 percent of Democrats. But polls using the term "single-payer" do not fare as well as ones using the term "Medicare for All."
"Medicare for All has the potential for extremely broad appeal because it would help the vast majority of Americans, including many with quite conservative views," said PNHP founders David Himmelstein and Steffie Woolhander, in an email to Truthout.
A lack of understanding single-payer and how it is financed has been an obstacle for the movement in the recent past. "If you find that you have to keep explaining what your proposal is, you haven't done enough, and your opponents can and will destroy your efforts with a few soundbites," explained Dr. Don McCanne, of PNHP, in response to a failed health reform effort in Colorado that was supported by single-payer activists.
And with a rigid ideological adherence to market-based solutions in the media and in Washington, many Americans are not aware that the United States is an outlier in its lack of a public health care system: The only member of the Organization of Economic Cooperation and Development (a coalition of wealthy nations) without universal care.
An explanation of how outside the norm the US is in terms of providing a safety net -- the US ranks 25 out of 34 OECD nations on social spending -- can provide a stunning contrast to those who are trying to understand how American capitalism functions, raising class consciousness.
The Sanders presidential campaign, as Truthout observed in August, did help to educate the public about these differences. At times, Sander's message broke into the dominant media narrative, which typically ignores or wrongly dismisses Medicare for All as impossible, radical or unaffordable. Some recent coverage is laughably bad. Last Friday's David Brooks column in The New York Times made the ridiculous claim that the Republican Party has granted "the Democratic point that health care is a right."
But despite these falsehoods being so pervasive in the media, the fruits of a growing class awareness are evident in the rising number of people challenging Democrats' reluctance to make real changes on the health care front. Last week, a public outcry erupted when 13 Senate Democrats voted against an amendment by Sanders to allow drugs to be imported from Canada, lowering prices for Americans. Sen. Cory Booker, a high-profile Senator who is rumored to have presidential ambitions, was among the group that sided with Republicans to kill the amendment. In the aftermath of Sanders' presidential campaign, a vocal and aggressive group of progressives were paying attention to the amendment, and when they saw that Booker received big money from Big Pharma, they connected the dots between campaign finance, Congress and health policy. The result was a flood of indignation toward Booker on social media.
There has been pushback from the establishment, mocking the critiques leveled by the "Sanders Wing" toward the Democratic Party. The surge of opposition to Booker's vote, however, is promising. It demonstrates not only how many Americans are aware of how private capital can influence health policy, but also how the internet can serve as an effective tool for vocal protest of the congressional machinations that too often happen behind closed doors. The fallout from Booker's vote is something that Democrats will remember, especially as they plan for the need to connect with progressives in future elections.
What Lies Ahead
After the Medicare for All National Day of Action is over, the work of organizing, educating and agitating will continue. Kaba has plans to create curriculum -- a sort of Medicare for All 101 -- on the website in the weeks following the inauguration.
Organizers are also encouraging activists to get involved at the local level. There are organizations advocating for Medicare for All across the country. Physicians for a National Health Plan, for instance, has chapters in 43 states. Healthcare-Now has chapters in 38 states and is seeking to start chapters where none exist. Single-payer actions are also being organized by a variety of other organizations across the country.
We are in the process of entering a scary new world. But if activists and organizers can keep one another engaged and active, there is a chance that this moment will also be an important occasion for social justice -- and the fight for a humane health care system could have impacts for generations to come.