We Need Medicare for All Now, but Socialists Must Fight For Much More

Yesterday, on the one year anniversary of the COVID-19 virus being confirmed in all 50 states, Representative Primila Jayapal, along with over 100 other House Democrats, re-introduced the Medicare for All bill she co-authored to Congress. Despite its passage facing an uphill battle, with virulent opposition from Republican lawmakers, and skepticism from President Biden and other centrist Democrats, the promise of the bill is more important than ever. The United States, once considered by the World Economic Forum to be the country best prepared for a pandemic such as COVID, has shown the true weakness of its health care system, as it leads the world in numbers of cases and deaths. While some countries have successfully limited transmission rates to almost zero, the US frequently broke records with hundreds of thousands of new cases and thousands of deaths every day. The US has 25% of the world’s confirmed COVID cases and 20% of its deaths, despite making up less than 5% of the global population. There is more reason than ever to replace private insurance with a single-payer, Medicare for All system, and masses of people must rally around the bill to show Congress that we demand health care. However, to fully meet the health care needs of all working and poor people, socialists must go much further and raise the need for every aspect of the medical industry to be taken under public and democratic ownership, removing the corrupting influence of the profit motive from everything from hospitals to pharmaceuticals. 

Donald Trump’s extreme incompetence in handling the coronavirus is cited as one of the main reasons he lost the election in November, and certainly many of his administration’s decisions exacerbated the already dangerous situation. However, the health care system in the US was failing long before COVID came to reign. Before the outbreak of COVID millions of Americans were already un- or under-insured, and even the Affordable Care Act of the Obama era did little to address the huge gaps in coverage and economic barriers facing working-class Americans. With health care tied to employment, many people in the US who are un- or under-employed, or whose employers do not provide health care insurance, are unable to afford a plan through the market—which can be prohibitively expensive, to the point where paying a fine for not being insured is more affordable. Add to this the massive unemployment caused by the pandemic and you have millions of working-class people who do not have access to health care during a deadly global health disaster.

It is in this context that support for Medicare for All is reaching new heights. Despite massive rollbacks and deregulations of the health care industry by Trump, and the GOP’s relentless propaganda, M4A has consistently been supported by a majority of Democratic and Independent voters, and by an increasing number of Republicans. In the 2020 congressional races, every single Democrat who endorsed Medicare for All won their seat, while centrists floundered; and even a Fox News poll indicated that as much as 72% of people favored a “government-run health care plan.” As Public Citizen points out, the inconsistent and biased language used by pollsters can affect the polls’ results significantly, but nonetheless there is a clear trend of support for Medicare for All and similar policies, and support may be even higher if one accounts for that potential confusion.

But health care is not just insurance. The brutality of the COVID-19 pandemic has highlighted the lack of resources in hospitals and medical providers, with frequent news of hospitals with no available beds, people being turned away due to lack of space, and of course the rampant “DIY” personal protective equipment many doctors, nurses and hospital staff had to make do with. The ensuing rush to find a vaccine has been an indictment of Big Pharma as well. Not only was vaccine production stymied by pharmaceutical companies looking for exclusive patent rights, but it turned out that Moderna already had the vaccine ready in January 2020, before the virus had reached the US in full force, but languished in trial, production and distribution. Even if every person in the US were fully insured last year, these failures would still have come to pass. Clearly, the health care system in the US is very, very sick.

Looking at Other Countries’ Systems

Every other so-called “advanced” economy in the world, including the other countries in the G7 and most other countries in the Organisation for Economic Co-operation and Development, has a higher level of socialized health care than the US, though to varying degrees. Despite their differences, all of these countries won universal health care through strong labor parties coming to power and alongside mass movements that threatened the power of the ruling class. Only through these powerful popular movements did the capitalist class capitulate to demands for public health care as a way to cut across the growing class consciousness of the workers. This is a critical lesson for us in the US.

Though it varies from country to country, generally countries with “socialized” health care have public government-run insurance programs, may have publically owned state-run hospitals and clinics, and administration may be centrally run or may be devolved to regional or local governments. But they all have somewhat less emphasis on private enterprises and stricter controls on health profiteering. Countries that are often pointed to as examples of how socialized health care works are Canada, the UK, and Scandanavian countries, but all of these countries have some mix of private and public health care. The UK had historically been the most socialized, with every UK resident being automatically covered by a public insurance scheme, most hospitals and doctor offices run by the National Health Service (NHS), and funding sourced primarily from general taxation with very little cost-sharing, though decades of austerity have severely curtailed the effectiveness of the NHS and there has been a swell of re-privatisation. Scandanavian countries such as Sweden are similar but generally have higher cost-sharing, and care is administered by local and municipal governments rather than a national system. Canada has a decentralized Medicare system with each province and territory operating its own plan, and hospitals and practitioners are generally privately-run businesses.

It is worth noting that all of these countries pay significantly less per capita on health care than we do in the United States, and all are rated higher by the WHO, which measures health care system efficiency based on three factors: the overall health of the population, the responsiveness of the system in adapting to the need of the population, and equity in financing (meaning poor people don’t pay proportionally more for care than rich people). In fact, the United States pays the most for health care out of any country, but is ranked #37 in the world, and is ranked #12 out of the 12 wealthiest countries in the world when it comes to life expectancy. It begs the question, just what are we paying for? Well, as in so many industries in the US, mostly we are paying for executives’ giant salaries. But the incredible inefficiency of our private insurance based, multi-payer system also generates much higher administration costs. Americans pay higher copays, deductibles, balance billing, and costs for prescription drugs than any other country — all of which primarily goes to line the pockets of hospital owners, private practitioners, and insurance and pharmaceutical executives while the general health of people in the US plummets. It is abundantly clear that paying more does not equal better care.

So, what is Medicare for All? 

Despite the misleading language used by pollsters and the media when discussing Medicare for All, there is clearly growing support for the notion of the government ensuring adequate health care to its citizens. Though it is often described pejoratively and misleadingly in the corporate media, M4A is in fact most similar to Canada’s system: a single-payer insurer plan that would not alter the structure of how health care is provided in the US, but would significantly increase access and availability, as well as simplifying administration. Under Medicare for All, every person in the US would automatically be eligible to receive comprehensive health insurance through the system. This means that instead of getting insurance through an employer or having to purchase a plan through the market, every person residing in the US would have access to necessary medicine, free at the point of service, with providers billing Medicare instead of the user paying. Providers and hospitals would still be largely private businesses, and private insurance would also continue to exist to provide additional medical care not covered by M4A. Medicare for All would be a huge step in the right direction for the US, as it would drastically reduce the amount of uninsured people and guarantee basic health care for all residents, and it’s an important reform that socialists should fight for and support. It would greatly benefit BIPOC communities who are disproportionately more likely to be un- or under-insured, and strengthen working-class power by removing the health insurance bargaining chip from employers during contract negotiations. It would cut across the profiteering of health care industries, and significantly reduce the amount of money we spend on health care every year.

But revolutionary socialists must recognize the limitations of Medicare for All. If and when we win M4A, it must be recognized for what it is—a massive improvement for the majority of the working class—but also for what it is not—a perfect solution to the health care problems of this country. Medicare for All would not see the dissolution of private insurance, and hospitals and care providers would still be private enterprises. Medicare may be able to negotiate drug prices, but it would not fundamentally change the way that pharmaceutical companies operate. Even with M4A in place the profit motive would still exist in our health care system in private hospitals, providers, and Big Pharma, and thus we could expect to see a constant erosion of these reforms back to more and more private enterprise models, despite not being in the public’s best interest.

We Cannot Stop Fighting

Even in the countries with the highest level of socialized health care, important reforms are perpetually under attack under capitalism. Capitalists and their allies in government will always look for ways to turn a public industry back into private profit. The British NHS has famously been subjected to decades of austerity and privatisation by the Tory governments and is now utterly failing to control the pandemic. Marketisation of health care in the UK has not led to better, more efficient service, lower prices, or shorter wait times.

Just as it took decades of agitation and organization by worker’s parties and labor movements to win universal health care in the UK, Canada, Sweden and more, so too will it take a mass movement of working and poor people to fight for and win not only Medicare for All but a fully socialized health care system in the US. Clearly we cannot rely on the promises of reform touted by Democrats to maintain their progressive and Left-leaning voter base, which are no better than bargaining chips to be discarded at the first sign of conservative pushback. We need a mass movement of Americans, led by socialists and organized labor, to demand that our health be prioritized over private profit. These important reforms will only be passed if the ruling class is sufficiently pressured to acquiesce, but it is critical also to recognize that any reform made while still under a capitalist system is tenuous at best and will undoubtedly be subject to rollbacks and under-funding by the ruling class.In the highly polarized political climate of the US—stoked on one hand by fear-mongering and red-baiting by big business and their media and governmental allies, and the other by the devastating economic fallout affecting the majority of Americans—there are a few all-too common arguments for why socialized medicine couldn’t work. Some detractors say that socialized health care only works in small countries with homogenous populations and strict immigration controls, or say that it is inefficient and causes long wait times. Yet large countries like Germany and diverse countries like Canada manage to provide health care to all people who live there. And in reality, as we see in the UK, the inefficiencies of other countries’ health care systems are tied to capitalist austerity measures, under funding, and re-privatisation. The biggest challenge facing socialized health care in the US is not the size or diversity of our populace; it is the vice-grip that the capitalist class maintains on our health care system. It is unacceptable that people in the US should suffer shorter lives and poorer health than every other “developed” country, and pay more for the pleasure. Enacting Medicare for All would be a huge step in the right direction—providing basic health care that so many lack, and weakening the hold of the insurance industries. But only fully socializing health care—abolishing private insurance and taking hospitals, clinics and pharmaceutical companies into democratic public ownership—can break the monopolies of the pharmaceutical industry, end health care profiteering by private hospitals, and provide the best possible care for all denizens, as well as supporting our health care workers. Only through a socialist revolution of society can we hope to keep the gains we’ve won.