Medicare For All takes shape

The idea of Medicare For All as a way of creating a pathway to a single-payer universal health care system, that was deemed to be wildly socialistic and unrealistic when first proposed by Bernie Sanders, has now become a platform that any Democratic candidate for president has to pay at least lip service to, because the idea has been embraced by majorities of people.

Now the next step has been reached because actual legislation has been proposed to implement it and this will force people to take an actual stand on it. The crafting of the legislation is led by new congresswoman Premila Jayapal, part of the new breed of progressives who was elected to congress in the 2016 elections. She is a Seattle-based activist no stranger to advancing progressive causes, having served on the Mayoral Advisory Committee that negotiated Seattle’s $15 minimum wage. That measure was harshly attacked by conservatives and the business industry as the death of business in the city, as they would pack up and leave and would thus increase unemployment. That did not happen, even though conservatives seized upon a single flawed study that seemed to support their case before it was repudiated.

Ryan Grim examines the people and groups behind this legislation that it is even more ambitious than what Sanders initially proposed. This is because unlike with previous health legislation, including Obamacare that was largely crafted behind closed doors by lobbyists for the health and insurance industries, those behind this legislation represent, you know, ordinary people. How radical is that?

THE MEDICARE FOR ALL legislation unveiled Wednesday by Rep. Pramila Jayapal, a Democrat from Washington state, was written with the help of a broad swath of lobbyists and special interest groups, if perhaps not the kind associated with typical health policy legislation on Capitol Hill.

The key outside groups involved in the drafting included nurses, doctors, disability rights activists, and advocates for the elderly, as well as public interest organizations such as Public Citizen and the Center for Popular Democracy.

Along with Consortium for Citizens with Disabilities, the main groups involved in drafting the legislation were National Nurses United, a major nurses union that has long been on the forefront of the fight for single payer; Physicians for a National Health Program; the Center for Popular Democracy, where Barkan works and which organizes poor and marginalized communities; Public Citizen; and Social Security Works, which represents more than a million progressive seniors who support expanding the Medicare coverage they have to the rest of the population.

Meanwhile, the insurance and pharmaceutical industries played little to no role in the drafting process — an anomaly on Capitol Hill. Their marginalization in the process represents a major departure from the approach taken with the Affordable Care Act and reflects the type of bill being drafted: one less concerned about the profits, or even survival, of interest groups like insurers and more concerned with delivering care to the largest amount of people in the most cost-effective way.

NOTICEABLY ABSENT FROM the central drafting room was the Center for American Progress, the leading center-left think tank, which reflects a reticence by many in the progressive policy community to embrace something as sweeping as Medicare for All. The Center for American Progress, instead, has pushed what it calls “Medicare Extra for All,“ an expanded version of a public option that people could buy into. “The American people and Congress are further out ahead and more visionary than a lot of advocates,” said Jennifer Flynn, director of mobilization and advocacy for the Center for Popular Democracy, who was closely involved in the drafting of the Jayapal legislation.

So what will be new under this proposed legislation?

The result is legislation that, within one year of its passage, would provide improved Medicare coverage for everyone 19 and under, as well as everyone 55 and over. Within two years, it would cover everyone between the ages of 19 and 55, as well.

The legislation, which is being introduced with more than 100 co-sponsors, is the most far-reaching since a Senate version sponsored by Sen. Bernie Sanders, I-Vt., and includes benefits that are more generous. It also moves to full implementation in two years — as compared to four years under Sanders’s plan — a recognition by Democrats that the opposition party will push to repeal it if they come into power, but doing so will be more difficult once the benefits have gone into effect.

The effort includes related legislation that would change the way long-term care is covered. Under the current system, Medicaid is the last resort, which effectively means that the sick and dying must impoverish themselves in order to qualify. The new bill would end that practice and allow people to die with dignity at home.

That measure was written with the help of disability rights activists, led by the Consortium for Citizens with Disabilities. “She wrote it with our community holding the pen. Over months, disability rights activists went back and forth on the language. We are included. Not just as a sidebar or footnote,” said Ady Barkan, an activist dying of ALS, who collaborated with the Consortium for Citizens with Disabilities and others on the bill.

The goal for advocates is to convince a skeptical public that quality health care for all can become a reality. If it’s seen as a real option on the table, Flynn said, it will be unstoppable. “Look, if we are able to get out that we can have health care for all — and all means all. And it’s free. No copays, no out-of-pocket deductibles, no bills — there isn’t a human who won’t want it,” Flynn said. “But we have an uphill battle to convince people that’s a real thing.”

Of course, it’s a real thing. Pretty much every developed country has universal health care. It is only in America that such an idea is considered unrealistic.


  1. file thirteen says

    Meanwhile over in Britain, the NHS are desperately trying to stop the rot

    Theresa May has acknowledged that the 2012 act, which is widely considered to be the most damaging ever to afflict the NHS, is hindering a drive by the health service in England to provide better care by integrating key services.

    Good luck with that while the Tories are in power though.

  2. anat says

    Pramila Jayapal was voted into Congress in 2016 after having served in the Washington state legislature. The Seattle city council member you are thinking of is Kshama Sawant.

  3. Mano Singham says

    anat @#2,

    All these South Asians look alike to me!

    Seriously, thanks for pointing out the error. I have rewritten that paragraph.

  4. lanir says

    I saw this interview about the bill a couple days ago:

    The page has a transcript in case the video doesn’t work for some people.

    A lot of the questions did focus on asking Rep. Jayapal to respond to criticism as opposed to just exploring the concept neutrally but I think she still made a pretty good case for the bill. And I think gave a window into how those opposed to the idea will try to attack it.

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