At this point, to still be debating whether we need single payer health care is like continuing to have a “debate” about human-caused climate change. Actual facts and evidence are on one side, while the other has only bad faith arguments about “choice” and cost—literally industry-created talking points invented with the purpose of misleading the public and hiding the truth from voters.
Asking “how will we pay for it” is not a serious question, and hand wringing about the budget is faux concern when single-payer costs LESS than our current system (the previous link is to more than two dozen independent analyses); LESS than a public option. This is not a real debate. We have twice the GDP per capita that Italy does, yet that county guarantees health care to all its citizens as “a fundamental individual right and collective interest” through its national health service, created in 1978 and recently described by NBC News as “one of the best public health systems in the Western world.”
The evidence is in. Every nation, without exception, that has some form of universal, publicly funded health care program rather than our for-profit model, pays less—much less—than we do on health care, while saving lives. It is hardly surprising that cutting out unnecessary profit-making middlemen, eliminating the paperwork created by our multi-payer system (that paperwork alone adds in costs totaling over $800 billion a year) and increasing the negotiation power of the government would dramatically lower costs. Study after study shows this to be the case. There is no serious debate over whether moving to a single-payer system would cut costs—the only question is, how much.
There is also no debate about whether Democratic voters support Medicare For All; exit polling has made this clear. On Super Tuesday, most of the voters in every primary state said they preferred a government-run system that covers everyone. Exit polling on Super Tuesday II also showed significant majorities supporting such a system, even in Mississippi (62% supporting “a single government health insurance plan for all”), where Biden won the popular vote overwhelmingly.
That the Democratic electorate prefers a Medicare For All type system should not be surprising given the inequities and irrationality of our current system that is organized to create profits for private companies, not deliver health care to people. The current crisis caused by the coronavirus pandemic has only further underscored the insanity of this system. Doctors are taking to Twitter to vent their frustrations with private insurance companies getting in their way as they battle on the front lines of the pandemic:
Meanwhile, patients hospitalized due to the coronavirus who are fortunate enough to win that battle are being left with life-ruining medical bills—something unheard of in literally every other country in the world.
More and more uninsured Americans will be facing similar catastrophic bills as businesses close their doors and companies lay off workers. We are already seeing an unprecedented rise in unemployment claims, with millions more people likely to be thrown out of work in the next few weeks. A recent study showed that Medicare For All, in addition to guaranteeing health care for all, would be a boon to the economy, creating jobs and helping small businesses. If one thing has been made clear in this time of uncertainty and upheaval, it should be this: tying health care to employment makes absolutely no sense, from a moral, economic, or public health perspective.
The failings of our current system are glaringly obvious, even in normal times, to anyone who has ever lived in a country with guaranteed, universal health care.
But now, in the midst of this crisis, our system’s failings could prove disastrous. Public health experts are noting that countries with single-payer are proving more nimble in their responses, and succeeding in providing the widespread, free or low-cost testing that is critical to controlling the spread of the pandemic, where our fractured, for-profit system has failed.
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In light of these realties, it is clear what the health care policy position of the Democratic Party, and our nominee, should be. As Seattle-based physician and author Alice Rothchild wrote recently:
The Democratic Party needs to solve the critical, fundamental political and moral question: How can we guarantee that no one is locked out of the health-care system due to cost while providing quality care to all? More than 2,500 physicians have signed an open letter supporting Medicare for All. Our patients desperately need an end to the inhumanity of our health-care system exposed once again by this devastating pandemic.
So why does Joe Biden continue to refuse to support a desperately-needed reform that is favored by a majority in the Democratic Party—not mention the position that would immediately solidify his support among the party’s progressive base? What does he have to lose?
The answer is—large dollar donations from the for-profit health care and pharmaceutical industries.
According to the Center For American Politics, the pharmaceutical industry has been supporting Biden in a big way, giving far more money ($1.34 million) to his campaign than to that of any other candidate for president (including Trump, who is probably already a safe bet to oppose Medicare For All). One of his bundlers is a board member on several pharmaceutical companies—David Scheer, who has raised at least $25,000 for the campaign. This spending is separate from the pro-Biden super PAC, Unite The Country, which has spent nearly $12 million supporting Biden. According to an article in The American Prospect, the super PAC
is led by multiple individuals with ties to the pharmaceutical industry. Among its leaders is longtime Biden friend Larry Rasky, the founder, chairman and CEO of Rasky Partners, a lobbying firm whose pharmaceutical clients have included Eli Lilly. Another member of the super PAC’s professional team, Amanda Loveday, is an associate director of NP Strategy, a public relations shop launched by corporate law firm Nexsen Pruet, which has clients in the healthcare and pharmaceutical industries.
One of the campaign’s top aides, Steve Richetti (formerly Biden’s Chief of Staff when he was VP) is himself a former longtime lobbyist who once ran Blue Cross Blue Shield’s “political department” and who personally represented drug companies, including Eli Lilly and Sanofi, two of the three major insulin manufacturers in the US. All of these former clients of the longtime lobbyist are staunch opponents of Medicare For All. The lobbying firm Richetti founded with his brother continues to operate.
I’m sure that Joe Biden is a fundamentally decent person, one who went to Washington with intentions of doing good. If he were not, it would make no sense to talk about the corrupting influence of money in politics. Barack Obama explained this dynamic eloquently in his 2006 memoir, The Audacity of Hope, in which he described the experience of becoming a United States senator:
I can’t assume that the money chase didn’t alter me in some ways. ...
Increasingly I found myself spending time with people of means — law firm partners and investment bankers, hedge fund managers and venture capitalists. As a rule, they were smart, interesting people, knowledgeable about public policy, liberal in their politics, expecting nothing more than a hearing of their opinions in exchange for their checks. But they reflected, almost uniformly, the perspectives of their class: the top 1 percent or so of the income scale that can afford to write a $2,000 check to a political candidate...
The longer you are a senator, the narrower the scope of your interactions. You may fight it, with town hall meetings and listening tours and stops by the old neighborhood. But your schedule dictates that you move in a different orbit from most of the people you represent.
And perhaps as the next race approaches, a voice within tells you that you don’t want to have to go through all the misery of raising all that money in small increments all over again. You realize that you no longer have the cachet you did as the upstart, the fresh face; you haven’t changed Washington, and you’ve made a lot of people unhappy with difficult votes. The path of least resistance — of fund-raisers organized by the special interests, the corporate PACs, and the top lobbying shops — starts to look awfully tempting, and if the opinions of these insiders don’t quite jibe with those you once held, you learn to rationalize the changes as a matter of realism, of compromise, of learning the ropes. The problems of ordinary people, the voices of the Rust Belt town or the dwindling heartland, become a distant echo rather than a palpable reality, abstractions to be managed rather than battles to be fought.
Right now, we have not just a battle to be fought, but a war to be won. Now is the time for Joe Biden to show Democratic voters, and the rest of the 99%, whose side he is on.