America still has a moral compass. Let’s prove it with Medicare for All.
The progressive policy platform today is gaining support, from local office to the Democratic presidential primary. Medicare for All (M4A) is emerging as a pillar of this movement, a bold endeavor to restructure the delivery of healthcare throughout the country. If enacted, every American would receive healthcare free at the point of service, as is the case in most of the developed world. The question that remains is whether such a major change stands a chance in our political climate. Given that our last president just took his shot at reform with the Affordable Care Act (ACA), it’s worth comparing the political strategy employed at the time to progressive tactics today. The differing approaches show us how M4A can succeed where the ACA failed.
I’m going to posit from the outset that the push for healthcare reform requires a moral clarity not necessarily relevant in all political challenges. Generally speaking, compromise is a virtue in politics, but when legislating a moral imperative, it can be counterproductive. Senator Dirksen’s words in 1964 regarding the push for civil rights impart the correct mindset for our current case: “There is another reason why we dare not temporize with the issue which is before us. It is essentially moral in character. It must be resolved. It will not go away. Its time has come.” M4A speaks to a moral imperative as historic as any other: our system needlessly leaves so many to die from lack of insurance or go bankrupt from its cost, and people are less willing than ever to put up with it. Leaders aiming to turn M4A into law will have to be strategic and smart, but their efforts must embrace a Dirksen-esque mindset, accepting no half-measures or promises for later action.
The ACA, in hindsight, was blighted by a willingness to do just that. Its foundations were negotiated away, namely the public option and increases in Medicare funding (left up to the states to accept, which many did not), both of which would have positively affected health outcomes. Think about what this might have looked like for civil rights legislation in the 1960s. Perhaps a state-by-state opt-in for desegregating public spaces? A means-tested poll tax, instead of eliminating it outright? The political class of the era might have congratulated themselves for their more agreeable solution, but the crux of the problem would have largely gone unaddressed. And so it is with the ACA, whose passage hasn’t changed that medical cost is still the leading cause of bankruptcy, that thirty million Americans are still uninsured, or that these last kill tens of thousands a year. These are the results when an ambitious project lacks the conviction of its own pursuit.
Another culprit in the ACA’s failure is a total lack of popular mobilization, whose need is apparent in historical precedents. Civil rights leaders building public consciousness needed LBJ’s ability to whip votes in Congress, and vice versa, to get legislation passed. Decades prior, FDR’s famous words to union leaders spoke to the same dynamic: “I agree with you, I want to do it, now make me do it.” The resolute, moral perspective I’ve argued for above is useless as an atomized, personal emotion. It’s only powerful in the political sphere as a connecting force between activated leaders and citizens. It’s a feeling and attitude not unlike faith… Or perhaps hope?... Where have I heard that before?…
Barack Obama seemed attuned to this notion with his famous “Hope and Change” rhetoric that touched so many of his supporters, myself included. As a candidate in 2008, he embraced a popular mobilization strategy when his campaign formed a network, Organizing for America (OfA), so his supporters could communicate and strategize grassroots advocacy in his behalf. People believed in Obama and were ready to back him, but once he was in office this platform was never called into action, not even for his most important priorities. There were a variety of forces that worked against OfA, but what is certain is that without grassroots support, Obama’s attempts at reform were entirely toothless, and his overtures to Republicans left him looking helpless. We can only wonder what might have been accomplished, on multiple fronts, with the popular pressure Obama so clearly needed.
Progressives are instead embracing popular mobilization, not waiting for control of the White House to use it. Just recently, with support from worker movements, Senator Bernie Sanders pressured Amazon into raising its minimum wage to $15 an hour (not wanting to be the odd man out, Amazon has now joined in the fight to raise it at the federal level). He also leveraged his campaign mailing list from 2016 to warn against impending ICE raids last summer, notifying citizens and immigrants of their rights and what actions they could take. Sanders has vowed to continue this strategy in the Oval Office, acting as an “organizer in chief” to mobilize popular sentiment for his policy goals. It’s an approach that has worked in the past. Major leaps forward – like the right to directly elect Senators, universal suffrage, civil rights – were passed into law not only by ardent and longstanding supporters of those causes; the remaining support came from those who were instead influenced by a consensus growing around them that was simply too great to oppose. With this in mind, Sanders’ grassroots strategy emerges as the smarter way forward, reflecting an ambitious yet grounded understanding of American political change. It’s exactly what action driven by belief looks like.
Progressive priorities will flourish or die on the basis of how much they leverage popular sentiment. As for M4A specifically, the trend is certainly promising. The issue was considered fringe just a few years ago, yet is now decidedly favored by Democrats, and at times has even polled above 50% with Republicans since the last election. This is not to diminish the opposition: Republican institutions that cried tyranny over the minor ACA reforms will play the same tune again, and the healthcare lobby has already blanketed the airwaves in early primary states to put voters off to further action. What remains is to continue cultivating active support and stalwart leadership that can outdo their efforts. Now that we have a candidate in Sanders who has made this a cornerstone of his campaign, there’s never been a stronger impetus to for anyone who supports M4A to contribute their own personal efforts. The moral clarity of the issue is on our side: “It must be resolved. It will not go away. Its time has come.”
