The centrists are finally talking about Medicare for All. Since they can’t deny the moral imperative of single payer, they’ve become obsessed with attacking its “political viability.” Yet, detached from the work of political persuasion, it seems these opinion-generators know little about how regular people actually think about Medicare for All.
Hillary Clinton this week dismissed single payer as being “the right goal” but politically impossible. J.P. Green of the Democratic Strategist opined that “Medicare for All in the Sanders-Warren sense is just not viable politically.” Ron Brownstein fretted in the Atlantic last month about the political challenge of a reform with such an “eye-popping” price tag, and the “anxieties” of Democratic health care experts on whether Warren’s plan (people like this avoid mentioning Bernie at all) could fly in the general election. David Leonhardt of the New York Times wrote a couple weeks ago of Warren’s plan, “The No. 1 reason to question her version of Medicare for All — in which private health insurance would be eliminated — is its political viability.” How will she “overcome people’s resistance to giving up their health insurance for a larger new program that yes, would require a tax increase”? Leonhardt could not imagine.
In their world, Medicare for All is on everyone’s mind, but is impossible. Turning away from the pundits, with their cramped political imaginations and scant experience of humans, offers a different view.
For quite a while now, DSA activists have been going knocking on doors, talking to people in their communities, and working to get them to support and fight for Medicare for All. (Some chapters have been working to get local congressional representatives to support the Bernie Sanders/Pramila Jayapal single-payer legislation; in many places, these efforts have been incorporated into a broader canvass for Bernie.) Such canvassing offers a different perspective from the polling so beloved by pundits, consultants, and other political professionals, in part because it assumes that people are open to new points of view.
What Medicare for All canvassers find is that most people haven’t even heard of M4A. Many haven’t heard of Bernie Sanders or his presidential campaign. But people tend to love the idea of M4A once it’s explained. “No one says, ‘I don’t want free health care,’” says Eric Vance, who canvassed for M4A with East Bay DSA and now is a field organizer with Healthy California Now, a coalition of groups working for single-payer health care. “There’s very little antagonism.”
What’s more, the questions people ask about Medicare for All aren’t the same ones the pundit class imagines, nor, in the context of an engaged conversation about their health care experiences, do their objections tend to be fatal.
One issue that troubles pundits little, yet comes up frequently in the field, is that people who have some experience of Medicaid or Medicare are often dissatisfied with these programs. Fainan Lakha, an organizer with DSA’s NYC Healthcare Working Group who spent much of the summer canvassing block parties in Bedford-Stuyvesant, Brooklyn, heard a lot of complaints about Medicaid: doctors can change, and the paperwork and billing can be burdensome. “Medicaid feels like a lot to manage” for many of the people she met, she says. Lakha found people were often convinced when she talked about how Medicare for All would be different from existing government programs: “no expiration, no bill, no paperwork, all you need to do is pick your doctor and show up.”
Similarly, Tara Rose, a DSA member, who has been canvassing mainly in working-class black neighborhoods in Winston-Salem, North Carolina finds that many elderly people aren’t thrilled with Medicare. “The only person who actually yelled at me when canvassing just kept yelling, ‘I hate Medicare! I hate Medicare! I wish I could go back to my old insurance,’” Rose laughs remembering this scene. “What was funny was he actually had a peace banner on his house!”
While this particular Medicare-hater wasn’t willing to listen to her perspective, most people are. Rose explains why the Sanders/Jayapal M4A is better than Medicare; when older people hear that it would cover dental, vision, and hearing aids, they’re likely to get on board.
Kate Schneider, canvassing in Austin, Texas, says she always begins by asking people about their experiences with the existing health care system. “So many people are ashamed of their experiences in the health care system. They see it as a sign of their individual failings,” she says. “And it’s not.” These conversations tend to lead easily into a discussion of the system’s injustices and how it might be changed. Sometimes, she says, people object that they have health insurance already, so this issue doesn’t affect them. “I would respond by talking about my own experiences,” Schneider says. “‘I have health insurance through my employer, but they changed the plan on me and now it’s not as good — has that ever happened to you?’ That gives them a different perspective.” She also finds that it can be persuasive to talk with people about how “health insurance companies profit by denying care.”
Now and then, someone asks how we will pay for it, and whether their taxes will go up, but those two questions aren’t as common, insistent, or as intractable as our pundit friends imagine, at least in the working-class communities DSA has been canvassing. A couple of canvassers interviewed for this article said questions about funding or taxes were rare. When such questions do come up, Fainan Lakha talks about how health insurance companies are “money down the drain”: we (and our employers) pay premiums to them that have nothing to do with providing care. Other canvassers talk about how under Medicare for All there will be no premiums, no co-pays, and no deductibles. Tara Rose tells people, “Yes, your taxes will go up, but you will save money.” She says, “something I love about DSA is we’re not afraid to talk about taxes — everyone else is.”
“What people want to know is, what will my experience of this system be?” says Lakha. “And that’s great because that means what’s at stake for them is what we want to be at stake — a better life for everyone.”
Vance says he tries to get people to think about “why don’t we have this, and can you imagine how different your life would be if we did?” Kate Schneider concurs: “We’re encouraging people to expand their political imagination.”
Tara Rose talked to a Republican woman whose husband was in the military. He wanted to leave the service, but didn’t want to lose the health care. Rose’s canvassing partner, a veteran, could empathize with the woman on the excellence of military health care, and how hard it is to give it up. “Wouldn’t it be great,” she asked, “if your husband didn’t have to stay in the military to get that great health care?” The woman signed their Medicare for All petition. But she did have one question: “I’m not signing up to be a socialist, am I?”
Well, actually . . .