Jimmy Dore Is Right About the Urgency of Medicare for All. But AOC Isn’t the Problem.

It’s good that we’re talking about the urgent need for Medicare for All. But democratic-socialist politicians like Alexandria Ocasio-Cortez aren’t the ones standing in the way of an American welfare state. Let’s figure out how to actually build working-class power and win change.

Rep. Alexandria Ocasio-Cortez (D-NY) on August 24, 2020 on Capitol Hill in Washington, DC. (Tom Brenner / Getty Images)

Isn’t it great to be living in the United States of America? A country where millions forgo vital medical care because they can’t afford it, where cancer is a leading cause of bankruptcy, and where millions have lost their jobs because of a deadly pandemic and hence lost their employer health insurance.

Medicare for All is not just a vital moral imperative, it makes political sense. A clear majority of the public supports it, including a surprising number of ordinary working-class people who identify as Republicans. It’s good politics as well as good policy, and it’s very good that Bernie Sanders and left-wing representatives like Alexandria Ocasio-Cortez have brought it into the center of the debate about health care policy.

But if we’re going to win this fight, we need to start from an understanding of how the Democratic and Republican establishments continue to stand in the way of such a basic reform and what it would take to overcome that resistance. We need to take Medicare for All from a popular idea that never actually goes anywhere to something that has at least a fighting chance of success. That’s why the debate that’s recently broken out on comedian and podcaster Jimmy Dore’s idea about how congressional Berniecrats could advance the proposal matters on a level much more important than different media personalities clashing on YouTube and Twitter.

Whatever you think of the merits of Dore’s case or of the way he’s advancing it, it’s vitally important that we foreground these discussions of strategy on the Left.

AOC vs. Pelosi vs. Dore

Nancy Pelosi won a caucus vote for reelection to the speakership that had all the suspense of a Soviet election. If the House-wide vote happens on the expected straight party lines, the narrow Democratic majority in the House will translate into a narrow victory for Pelosi as the speaker.

This is a miserable result for the Left. Pelosi openly opposes Medicare for All, derides the Green New Deal as “the green dream or whatever,” has a policy of institutionally punishing anyone who helps primary challengers (even as she herself endorses primary challenges from the right), takes an enormous amount of corporate money, and generally acts like the living embodiment of neoliberal centrism. Unpopular and uncharismatic, Pelosi’s perma-leadership is one of the most depressing things about today’s Democratic Party.

The most prominent voice of the tiny and informal social-democratic opposition faction within the Democratic caucus, freshman congresswoman Alexandria Ocasio-Cortez, has said that she would love to see Pelosi go, but she’s reluctant to vote against her until there’s a realistic chance that she can be replaced with someone more progressive instead of with an even worse speaker.

Is she right about this? It’s sadly very easy to imagine someone even worse replacing Pelosi, but if AOC and the rest of the Squad refused on principle to vote to empower someone like Pelosi, that might be usefully clarifying for casual news consumers who might be vaguely aware that Ocasio-Cortez and the others are “more extreme” than establishment Democrats like Pelosi but might not really have a sense of the ideological gulf between them. The long-term strategic benefits of clearer ideological differentiation might be worth the short-term price of a slightly worse speaker.

The question that’s dominated discussion on the Left this week, though, has been a slightly different proposal from Jimmy Dore. He has urged the Squad not to refuse to vote for Pelosi on general principle but that they threaten to refuse to vote for her as a bargaining tactic.

When LA Chargers running back Justin Jackson took up Dore’s cause on Twitter, AOC responded that House progressives have been using the leadership vote to bargain over issues like committee appointments and the vile PAYGO rule. But Dore’s specific demand is that instead of any of these issues, they focus on demanding a floor vote on Medicare for All. And supporters of Dore’s proposal like Krystal Ball have suggested that, given the dispute about whether AOC voted against the CARES Act, she doesn’t deserve the benefit of the doubt that she’s using whatever leverage she has against Pelosi in an effective way.

Dore has argued that there’s an urgent imperative to demand a floor vote now. “In two years,” he says, “the Democrats are going to get wiped out in the House. They will lose their majority and their speakership.” As such, this is the only time the Squad can force a Democratic speaker to hold such a vote. “If it loses,” he’s argued, “we can put a marker down” and identify those who vote against it, so voters will punish them in the future.

Rep. Alexandria Ocasio-Cortez speaks as Reps. Ayanna Pressley, Ilhan Omar, and Rashida Tlaib listen during a press conference at the US Capitol on July 15, 2019 in Washington, DC. (Alex Wroblewski / Getty Images)

Bernie Sanders’s former press secretary Briahna Joy Gray has endorsed Dore’s proposal. She believes it “would expose those Democratic House members who are thought to have cosponsored Medicare for All to burnish their progressive bonafides without ever intending to vote for the bill.” Once everyone was forced to put their cards on the table, “no” voters would “be forced to justify their position to primary challengers in 2022.”

Gray and Ball are far more measured, but Jimmy’s Dore’s response to AOC failing to sign onto this specific idea is telling his audience that AOC is a “sellout,” accusing her of “standing between” her constituents and health care, and screaming things into his camera like “you’re a liar” and “f— you and f— anyone who defends you!”

This is not productive in the least — and saying so isn’t “tone-policing.” I don’t care that Dore is angry about the lack of progress of health care; I’m angry, too. But I do worry about putting a wedge between the progressives in his audience and the strongest supporters of Medicare for All in Congress. That risks wildly disorientating us about the real forces blocking progress in the United States.

The Merits of the Case

Let’s put aside the issue of Dore’s way of pushing his proposal, though, and consider the merits of the idea itself. The first question is whether the Squad really has the leverage that Dore thinks they do to (successfully) demand bigger asks in exchange for their votes in the leadership race.

I have my doubts. But let’s assume for the sake of argument that this isn’t what would happen. The second question is whether a floor vote on Medicare for All at this stage would accomplish what Dore and Gray think it would. It’s true, for example, that the various votes that the Freedom Caucus forced the Republican leadership to allow were often symbolic victories for the Right. Even though Obama vetoed every bill to repeal Obamacare, and even though the effort fractured as soon as Trump was in office and something was actually at stake, the House and Senate victories for the repeal efforts probably added momentum that was useful to the hard right.

On the other side of the spectrum, the recent House vote to decriminalize marijuana was a symbolic victory for a good cause. An even more potentially consequential example was Bernie Sanders’s War Powers Resolution on Yemen, which passed the House and Senate but was vetoed by the supposedly “isolationist” President Trump. Could a Medicare for All vote be like those small wins?

One extremely important difference is that only 118 members of the House currently say they support Medicare for All. That’s about half of the slim Democratic majority in a 435-member institution. This means that, as everyone in the debate has acknowledged, there’s no chance whatsoever that a floor vote would mean that Medicare for All would win even the modest symbolic victory of winning the House before going nowhere in the likely GOP-dominated Senate.

What about Dore’s and Gray’s suggestion that some of the current 118 House cosponsors are insincere and that forcing them to “go on record” would show the Left which cosponsors are truly committed and which wouldn’t follow through when it really mattered? Their premise is surely plausible in at least some cases (Kamala Harris was a prominent Senate cosponsor!). But the conclusion hardly follows.

The vote would be three-to-one against if every cosponsor stuck to their guns. Everyone would know this going into the vote. There would be no suspense whatsoever — even if it wasn’t doomed to defeat by even worse odds in the Senate. So why on earth wouldn’t anyone unwilling to enrage the donor class by actually making Medicare for All a reality but willing to make the symbolic gesture of adding their name as a cosponsor not be exactly equally willing to make the equally easy symbolic gesture of casting an entirely meaningless vote?

Given the current dismal landscape, it’s far from clear why we should see “exposing” soft “yes” votes who might get cold feet if push really came to shove as any sort of priority. If anything, increasing the soft “yes” votes (as well, of course, as the more important task of winning primaries and thus increasing the hard “yes” votes) should be the priority right now. But if, as Dore, Gray, and others seem to believe, it is important to expose such members, a purely symbolic floor vote at this stage not only wouldn’t accomplish that goal but would have the opposite effect. As journalist Natalie Shure has pointed out, it would give them more cover.

Maybe the usefulness of putting members “on record” is in the other direction. Republicans and establishment Democrats would have to make their opposition official. Supporters of the Dore plan typically point out that this would be happening against a background of (a) an especially desperate need by constituents for health insurance not tied to employment and (b) widespread public support for Medicare for All.

There are two problems with this argument. First, Republicans and establishment Democrats are by and large already extremely open in their opposition to Medicare for All. In the last presidential election, Trump constantly accused Biden of supporting Medicare for All, and Biden constantly angrily denied the accusation.

Joe Biden and Nancy Pelosi at President Barack Obama’s first State of the Union address in Washington, DC in 2010. (Chip Somodevilla / Getty Images)

The issue of Medicare for All has loomed so large in the last five years of debates within the Democratic Party that there are relatively few Democratic officeholders who haven’t expressed some sort of opinion about it — and with 118 cosponsors in the House, just “not being a cosponsor” already makes where any given member stands pretty clear. But I suppose it’s just barely possible that a few Democrats who’ve never been asked why they aren’t cosponsors might be asked why they voted no (or skipped the vote).

The second and more important problem is that there’s no evidence that voters will punish anyone at their polls for how they acted in such a floor vote — especially one where there was no suspense about that result. In the last Democratic nomination battle, a candidate who openly opposed Medicare for All — and didn’t even hedge his bets with any sort of triangulating rhetoric about “Medicare for all who want it” — won the nomination even though exit polls in state after state that he won showed that most Democratic voters disagreed with him on the issue.

Indeed, on the campaign trail, Biden openly promised to veto Medicare for All in the unlikely event that it was passed by both the House and Senate.

The grim fact of the matter is that most voters think Medicare for All is a good idea, but most don’t take the idea that it could become a reality in the foreseeable future seriously enough to punish politicians who oppose it at either the primary or general election stage. It’s hard to see how a preordained three-to-one House loss would help them take it more seriously.

Theories of Change

In case the point gets lost in the discussion of the many, many problems with Dore’s idea and with his denunciations of AOC for not signing onto it, it’s worth emphasizing that a point of agreement between all sides in this intra-left debate is that it makes perfect sense to center Medicare for All right now. Out of all of the social-democratic demands popularized by Bernie and the Squad, Medicare for All has the broadest public support. And the movement definitely has an opportunity during the COVID-19 crisis to solidify some of that support and use it to politically differentiate ourselves from liberals. The pandemic has been in effect a giant PSA about the evils of the existing system of private and mostly employer-linked health insurance.

As such, the core of the Dore proposal that makes sense is that picking a fight — any fight — with the Democratic leadership that gets people talking about Medicare for All makes sense if only because it would raise public awareness about how the social-democratic faction in the Democratic caucus wants everyone to have health care and the leadership doesn’t. That’s useful in itself.

A single day of news coverage that a floor vote would net isn’t much of a payoff for such a fight, especially since most of that coverage would be about how badly it lost. And while Gray points out that the members of the Squad “are famously adept at making viral moments out of congressional hearing testimony,” it’s likely that the Democratic leadership would allow about fifteen minutes of floor debate and no such viral moments would be forthcoming.

Gray argues that the floor vote tactic couldn’t be ignored by the corporate media if the Squad “were to coordinate with the activists and protesters who helped to organize the historically large mass protests from this summer,” or if their play was backed up by “organized labor” through “the threat of a general strike,” and this is all true enough as far as it goes, but it’s a bit like saying that three people waving around signs in front of a city council meeting couldn’t be ignored if they coordinated with space aliens so that an intergalactic spaceship simultaneously landed on the roof of City Hall.

Even putting aside the fancifulness of thinking that a credible threat of a general strike is in the cards anytime soon in a country with 6.2 percent private-sector unionization and where those unions that do exist are mostly in a deep defensive crouch, the problem is that a political landscape in which there was any chance furious mass protests over the failure of Democratic politicians to support Medicare for All would be one in which a lot of the most important obstacles to Medicare for All becoming law had already been overcome.

But there are more grounded ways that the basic message about which side of the ideological divide within the Democratic Party wants everyone to get health care and which side is standing in the way of that could be sent. A sit-in on the floor of Congress like the one staged by mainstream Democrats over gun control, for example, would be a dramatic piece of political theater that could actually add to the movement’s momentum rather than sending the counterproductive message that Medicare for All doesn’t have a realistic chance of happening anytime soon.

A series of such gestures could both avoid the political costs of sending that message and keep the issue in the public eye far longer than a floor vote that would be over shortly after the new session starts. Unlike hoping for a general strike to materialize in time to back up a floor vote, this kind of thing is well within the realm of short-term political possibility.

Even so, we shouldn’t exaggerate the potential payoff of any of this. Political theater can be a useful educational tool, but it can’t be a substitute for the long, slow, and often dismally unsexy work of organizing and mobilizing citizens at the grass roots and actually winning elections. And a widespread failure to appreciate these distinctions is the biggest problem not only with the fixation of much of the online left on insisting on engaging in a purely symbolic parliamentary maneuver that might well do more harm than good but with Jimmy Dore’s belief that AOC is a “sellout” who is “standing between” her constituents and health care.

This controversy perfectly encapsulates both the powerlessness of a Left arguing about ways to somehow pressure or trick or cajole our thoroughly dominant centrist enemies into helping us accomplish our goals and the dangers of political voluntarism.

During the presidential election, most intra-left debate on electoral strategy seemed to be dominated by the argument between figures like Noam Chomsky who thought it was a good idea to vote for Biden “and then pressure him” and figures like Briahna Joy Gray and her Bad Faith podcast cohost Virgil Texas who thought it made more sense to strategically withhold the Left’s votes in exchange for concessions. On paper, these are polar opposite strategies, but in reality they’re variations on the same idea — that the Left can accomplish its goals not by defeating centrists and achieving power for ourselves but by somehow maneuvering to get centrists to accomplish those goals for us.

The same bad idea underlies the Dore plan — but the difference is that in this case we’re not being asked to try to extract policy concessions but just a procedural concession whose value, if any, would be as symbolic political theater. I have my doubts that a pure reminder of how far Medicare for All is from becoming a legislative reality would be the kind of theater the movement should want, but whatever you make of that issue the larger question is what to make of the disconnect between the extremely limited value that even the supporters of the plan think it would have and the idea that not signing onto this specific plan reveals AOC and other social-democratic politicians as “sellouts” unwilling to fight for Medicare for All.

This is an extreme manifestation of a voluntarist worldview according to which anything is possible regardless of the objective political terrain — so if some good political outcome doesn’t come to pass, we should suspect that leaders who said they wanted it are too institutionally compromised to really want it, or at least aren’t sufficiently committed to fighting for it. This is the ideology of those who thought that Evo Morales was a sellout because Bolivia didn’t expropriate its capitalist class and transform itself into a socialist republic. I also want to end capitalism but a lot more is blocking that goal than insufficient political will by left politicians. The same is true even of goals as modest as Medicare for All.

It’s true enough that there are moments when individual personalities do have an outsize role in shaping the course of history. If Lenin hadn’t returned to Petrograd in 1917, it’s plausible that the Soviet Union never would have come into existence. If a staunchly antiwar president had come into office instead of Barack Obama in 2008, much more of the Bush-era “war on terror” might have been reversed. But the reasonable case that can be made about these examples isn’t an instance of voluntarism because there are deeper structural and institutional factors at play. “Dual power” between the Provisional Government and Soviets of Workers’ Deputies already existed in Russia before Lenin got on his sealed train. Presidents have tremendous, almost emperor-like powers over foreign policy in the American system. A single freshman congresswoman in a caucus dominated by neoliberal centrists has very few chips with which to bargain for anything.

The reason that there is no chance whatsoever of Medicare for All becoming a reality in the coming congressional session isn’t that the few social democrats in that Congress are insufficiently committed. It’s that the insurance industry and the rest of the capitalist class thoroughly dominates the levers of power. There aren’t nearly enough Medicare for All supporters in office for the legislation to have a chance of passing, and despite the widespread popularity of the reform the grassroots movement for it isn’t nearly powerful enough to effectively pressure fence-sitters and overcome inevitable ruling-class resistance.

The good news is that both halves of that situation were much worse just a few years ago. Bernie Sanders’s two campaigns for president played a tremendous role in forcing Medicare for All into the center of debate about health care and grassroots organizing by Democratic Socialists of America, National Nurses United, Physicians for a National Health Program, and others has slowly but effectively built on that. As soft as some of these votes may be, the fact that there are 118 cosponsors in the House is a remarkable victory for a movement that’s been working tirelessly to end the abomination that is the American health care system.

“If barely half of House Democrats are willing to cosponsor Medicare for All even while it has the support of 88 percent of Democratic voters during a global pandemic,” Briahna Joy Gray asks in Current Affairs, “what are the odds the holdouts will be more amenable once the vaccine is distributed and life begins to normalize?” The answer is that they won’t come around in the future with or without any particular symbolic tactic being employed right now. They have to be defeated and replaced. That’s a matter of on-the-ground organizing, candidate recruitment, and so on — none of which will gain any sort of meaningful boost from bringing holdouts “on record” about something which the Democratic establishment could hardly be more “on record” about already.

Gray concludes by arguing that “[a]t the end of the day, the moral case for action requires no strategic justification,” but this is exactly wrong. It’s precisely because achieving Medicare for All is so morally urgent that it’s so important to think carefully about what strategies might actually get us there and which ones are unhelpful diversions.

The Left’s goals can’t be won with procedural tricks or exhorting individual leaders to fight harder. They have to be won by organizing the working class at the base of society and, hand in hand with that, building an electoral left that can, instead of using some dubious “leverage” against centrists for the sake of symbolism, defeat those centrists and take power for itself.

The problem is a political landscape in which a ghoul-like Pelosi could become speaker in the first place, and in which if she was replaced, it would likely be with something worse, not with one of our tiny handful of actual allies in Congress not doing a good enough job of “playing hardball” with Pelosi.

Voluntarism is dangerous for the same reason that it’s dangerous to go swimming in a riptide and tell yourself that you won’t drown if you only paddle hard enough. We need to understand why we’re losing if we ever want to win.