On July 13, the Senate Republican leadership announced its revised proposal to “repeal and replace” the Affordable Care Act (ACA). The new plan tweaked the first two Republican health-care-overhaul bills but retained their substantial cuts to Medicaid funding and to the already-meager subsidies ACA gave low-income workers to help defray the costs of private health-care plans.
Luckily, it now appears that the Senate will not pass even this version of the bill. To explain why, the media has focused on divisions within the Republican Party, in particular between the remnants of the libertarian Tea Party and the more mainstream congresspeople facing tough reelection campaigns. The Republicans’ failure, however, also reflects the deep division within the American capitalist class over federal health-care policy.
On one side, the Chamber of Commerce supports Mitch McConnell’s new bill, arguing that it will repeal taxes and mandates on employers, give employers greater flexibility in reshaping employment-based health insurance, and lower the cost of individual insurance policies by granting state governments greater autonomy. However, organizations representing hospitals and health insurers continue to defend the ACA, which provides them with huge tax subsidies. Both the Coalition to Protect America’s Health Care, an organization consisting of the largest hospital chains, and American Health Insurance Plans, the insurance industry’s main lobby, have condemned the Republican bill.
The divisions within both the Republican congressional delegation and the capitalist class may force party leaders to negotiate with Democrats to change — rather than replace — the ACA.
No matter what happens, poor and working people will pay the price. Any Republican-written proposal will include deep cuts to Medicaid, upon which the poor and disabled rely. Millions will lose insurance after their subsidies disappear.
More likely, we will see minor changes to the Affordable Care Act, which still leaves 28.2 million people — 8.8 percent of the population — uninsured. The exchanges in many states will continue to implode, forcing millions to pay more for less and less coverage, while private insurance companies rake in profits from the premiums paid by working- and middle-class taxpayers.
The American socialist and labor left has been arguing for an alternative to the Republicans’ slash-and-burn proposal as well as the Democrats’ public handouts to private companies — a single-payer or “Medicare-for-All” system that would effectively abolish the private health-insurance industry.
As Jacobin’s Dustin Guastella recently argued, the debate on national health policy represents an important opportunity for the Left to give single payer popular resonance.
Activists have planned effective local demonstrations in opposition to Trump/McConnellcare and in support of Medicare for All — including sit-ins by disabled folks and their allies at numerous Republican congresspeople’s offices. However, we need a march on Washington. Unlike local actions, a national mobilization would give our movement national presence.
A Medicare-for-All march could accomplish two tasks. First, it could put the movement back on the national agenda, drawing media attention and helping to cohere wider support for the demand.
Second, a national demonstration would help local activists connect with the broader movement. We should plan local actions corresponding to the national march — especially for those who cannot come to Washington — but the current moment demands that we make our struggle nationally visible.
As Guastella argued, we cannot rely on the forces of official liberalism, especially the neoliberal Democratic Party establishment, to initiate and organize such a demonstration. The sabotage of the California Medicare-for-All bill confirmed what most of the Left understands: both parties fundamentally oppose our vision of egalitarian social transformation.
The socialist left, in coalition with the labor left — particularly National Nurses United — has already organized local actions across the country. These same forces, alongside organizations like Physicians for a National Health Program, should launch a coalition for a national march on Washington in support of a Medicare-for-All bill.
Such an organization can draw in former Bernie Sanders supporters, labor activists, and other social movement organizers. It could realistically mobilize at least fifty thousand participants within a matter of months.
The growth of socialist organizations since Trump’s election gives the Left the opportunity to change the national conversation for the first time in decades. Health care represents an important entry point. We can’t miss this chance to begin shifting the debate in our direction.