The Sabotage of Single Payer Healthcare
A Warning from the “Golden State” About the Corporate State
By Scott Tucker – Larry Gross
September 7, 2025
The United States: Failing In a Class by Itself
How did this wealthy nation drift into the twenty-first century with such a backward and class-divided healthcare system? The United States certainly has world-class centers of medical research and teaching, but it also has “the highest rate of maternal death among its economic peer nations,” according to “State of Maternal Health 2025,” a report from The Century Foundation published in April of this year. Moreover, the same report notes that “the black maternal death rate is more than twice that of other races and ethnicities,” and that “maternity care is becoming more scarce as health care systems close their obstetric units or hospitals close altogether.”
Among wealthy industrial nations, repeated surveys confirm that the United States has the most expensive healthcare system with the lowest health outcomes overall. The greatest disparities track along lines of class, race and sex, and these divisions remain among the “pre-existing conditions” that burden the body politic. A single-payer healthcare system would deliver better care and cost less, which is also confirmed by studies that compare systems of national healthcare.
“Mirror, Mirror: A Portrait of the Failing U.S. Health System” is a report from the Commonwealth Fund comparing healthcare performance in ten wealthy industrialized nations, published on September 19, 2024. This is the main conclusion of this report:
The U.S. continues to be in a class by itself in the underperformance of its health care sector. While the other nine countries differ in the details of their systems and in their performance on domains, unlike the U.S., they all have found a way to meet their residents’ most basic health care needs, including universal coverage… [In] the aggregate, the nine nations we examined are more alike than different with respect to their higher and lower performance in various domains. But there is one glaring exception—the U.S. Especially concerning is the U.S. record on health outcomes, particularly in relation to how much the U.S. spends on healthcare. The ability to keep people healthy is a crucial indicator of a nation’s capacity to achieve equitable growth. In fulfilling this fundamental obligation, the U.S. continues to fail.
Though corporate cheerleaders often claim that the United States has the best healthcare in the world, that claim is founded on the belief that a “free market” in healthcare can do no serious wrong. They hate Big Government except when they really, really love it. They denounce regulation of their favored business sectors, except when they demand the kind of systematic privatization of hospitals and health programs that can only be delivered by corporate thievery and concentrated state power.
Under the second Trump administration, the Republican Party now dominates both the Senate and House of Representatives in Congress. Plainly, the Republicans are committed not only to a general policy of obstruction regarding legislative reforms, but also to the demolition of regulatory agencies and even of institutions that gather social data for better analysis and planning in public policies. However, it would be both comforting and false to imagine that the evident danger on the far right should exempt the Democratic Party from criticism.
The Democratic Party made a long retreat from the field of class-conscious public policies, and the Republican Party steadily advanced over the same terrain. The Democratic Party is not even a party of basic social democracy, and is a collaborator in the bipartisan consensus of war and empire. The career politicians of the Democratic Party are not prepared to confront present dangers. Outright fascism is always a potential mutation of the corporate state.
Flawed Reforms, Bipartisan Regression
Thirty years span the important legislative reforms of the New Deal in the 1930s and of the Great Society in the 1960s. Those reforms were not simply gifts from the gods, but demonstrate that “power concedes nothing without a demand,” in the words of Frederick Douglass in 1857. The class struggles of the twentieth century made the reforms of the New Deal and the Great Society both socially possible and politically imperative. The strength of organized labor was acknowledged by career politicians of the capitalist parties, but these reforms were also as close as this country ever came to adopting social democracy in public policies.
After World War Two, the Labour Party in Britain gained power and instituted the National Health Service (NHS). Canada likewise had a social democratic party that pioneered universal health care in the province of Saskatchewan, which was then adopted over time by the whole country. The United States lacked a programmatic party of labor, and the American Medical Association (AMA) red-baited the advocates of a national healthcare system. The AMA campaigned against Medicare and Medicaid as “socialized medicine,” as did conservative politicians who warned of a bureaucratic slide into socialism and communism.
Just as Social Security, instituted in 1935 under President Franklin Roosevelt’s New Deal, excluded agricultural and domestic workers who were then the majority of black workers, so the advent of Medicare and Medicaid in 1965 under President Lyndon Johnson preserved class divisions within a legal reform. The original Medicaid program was designated as Title XIX of the Social Security Act, and is a joint federal and state program offering health coverage to low-income persons, seniors, and parents in need. These healthcare reforms did not guarantee full coverage to the entire population.
Medicare, which is funded by a tax on earnings, primarily serves persons aged 65 and over, and those with specific disabilities, regardless of income. Medicaid, in contrast, is a means-tested program primarily for low-income persons and families, and it has more difficult eligibility rules and more uncertain benefit packages administered by the states. Though both Medicare and Medicaid have significant support across party lines, Medicaid is more often perceived as a “welfare” program.
The public policy of single-payer healthcare is often presented with the more familiar title of Improved Medicare for All. Bernie Sanders followed this general rule during his presidential campaigns in 2016 and 2020. In her own campaign in 2016, Hillary Clinton dismissed Sanders’ advocacy of a single-payer program, saying it “will never, ever happen,” and she only suggested improving the Affordable Care Act (ACA).
The good reasons for a familiar outward-facing message of Improved Medicare for All include strong popular support for Medicare and Medicaid, even across party lines, and the aim of guiding public policies along stepping-stones rather than quicksand. The hope of healthcare reformers is that a familiar reform can be defended while a more unfamiliar reform can be extended.
Good intentions, however, come up against efforts to divert newly eligible seniors into deceptively named Medicare Advantage plans, instead of traditional Medicare. Public dissatisfaction with Medicare Advantage plans has grown, as the allure of lower deductibles and minimal dental and vision benefits is tarnished by their high rates of denial of critical coverage. Medicare Advantage plans incentivize “cherry-picking” of healthy patients, and “lemon-dropping” of less healthy and costlier patients. We cannot simply and only blame the Republican Party for the destructive impact of profit-dominated healthcare corporations. The morphing of traditional Medicare into Medicare (Dis)Advantage has been a resolutely bipartisan project, though with more dissenters among Democrats.
Trump’s “Big Beautiful Bill” gave new tax cuts for the rich while cutting back medical care and insurance for the poor. The leading career politicians of the Democratic Party quite rightly point out the regressive policies of the Republicans, but their claim to be the progressive party of opposition is a fiction. Otherwise, the Democrats would have worked in earnest for social democracy in healthcare, housing and education, and Trump would not have gained an increasing sector of working-class voters.
An assumption among many progressives is that the Republican Party must be the prime beneficiary of corporate donations in state legislatures and in Congress, and in general that is true. Though the lobbying and donations can vary considerably depending on election years and legislative agendas. On June 10, 2025, public health writer Wendell Potter reported on Health Care Uncovered that health insurers gambled overwhelmingly on Harris and the Democrats in 2024, though of course they place bets on both parties of big business:
Well, the reality is that insurers have fared exceedingly well when Democrats have been in charge of things in D.C. over the past decade and a half, and, as you’ll see below, executives and employees of the biggest insurance companies spent heavily during the past election cycle to try to keep them in charge. You may be surprised to see just how much Big Insurance favored Democrats, especially in the presidential race. It wasn’t even close.
We Vote, They Rule
The single-payer healthcare movement in this country is now at an impasse. Why? Not because the single payer movement lacks policy scholars and committed activists, but because our political strategies have been spinning on the same legislative merry-go-round for decades. Not simply because the Republican Party now controls the White House and both chambers of Congress, but also because the Democratic Party remains a collaborator in the defense of the corporate state. Not, finally, because the democratic left (generously defined, inside and outside the Democratic Party) is shy in proclaiming that healthcare is a human right, but because even socialists are burdened by habitual pieties, including “the left wing of the possible.”
That phrase, created by Michael Harrington, a founder of the Democratic Socialists of America (DSA), became a motto for many socialists determined to make a long march through the Democratic Party. A specific medicine against sectarianism became a general formula for opportunism. The actual history of DSA in relation to radical healthcare movements has been inconsistent overall, and sometimes even regressive, as we will see in the case of California.
The single truly signature piece of legislation under the Obama administration was the Affordable Care Act (ACA), sometimes known as Obamacare. Unsurprisingly, the main response to attacks on the ACA and Medicaid among old guard and “centrist” Democrats has been a reflexively defensive campaign. They do not take this opportunity to wage an offensive campaign all along the healthcare front. How could they do so? That would mean taking the fight to the enemy, namely, the deeply entrenched corporate cartels of Big Med, Big Pharma, and Big Insurance. Insurance companies invest in Democratic politicians, and they expect returns in favorable laws and policies. Some Democratic politicians, including Gov. Newsom of California, even campaign in favor of single payer healthcare, but resolutely change the subject once they have gained office.
The ACA, in its original version, required the expansion of Medicaid in all states, but in 2012 the Supreme Court ruled in NFIB v. Sebelius that state participation was optional. In 2025, ten states have not adopted Medicaid expansion under the ACA. The ACA proved to be no stronger than a sandcastle facing a rising tide of reaction, and such incremental gains are now going under the waves.
Republicans control the House and Senate in Congress, and Democrats urge voters to donate more and vote harder. Democrats once again change the subject away from their own policy failures. The bipartisan consensus in favor of war and empire has made the military budget rise without any clear public accounting year after year, while public goods and services go begging. In this way, the Republican and Democratic parties keep each other in business, and Congress remains the front office of the ruling class.
The contradictions of capitalism include the collision of heavily advertised morality and heavily subsidized corporate power. Raising the ground floor of healthcare, housing and education will require fair taxation and public funding for social goods and services. The most elementary moral code would include this precept: Reduce the sum of suffering and increase the sum of well-being. The most elementary social democratic reforms will require a political revolution against the bipartisan corporate state.
Bernie Sanders sometimes calls for political revolution, but he is a nominal Independent who caucuses with the career politicians of the Democratic Party. Independent political action against the duopoly in Congress requires class-conscious resistance in our workplaces and neighborhoods, and not only on election days.
The class system today in the U.S. is even more extremely divided than in the era of Robber Barons, and some analysts accordingly call current wealth inequalities “The Second Gilded Age.” American for Tax Fairness reported that roughly 800 billionaires in the U.S. hold a portion of the nation’s wealth exceeding the wealth of the bottom half of the population. USAFacts collects data from government sources, including the Census Bureau and the Federal Reserve, and in 2023 they reported that the top 1% of American households owned 30% of net worth. And the rate of their enrichment accelerates. The advice to “call your representatives” often has only marginal influence, since the rich can buy damn near anything, including career politicians.
In a study published by Perspectives on Politics in 2014, “Testing Theories of American Politics: Elites, Interest Groups, and Average Citizens,” two political scientists, Martin Gilens and Benjamin I. Page concluded:
In the United States, our findings indicate, the majority does not rule—at least not in the causal sense of actually determining policy outcomes. When a majority of citizens disagrees with economic elites or with organized interests, they generally lose. Moreover, because of the strong status quo bias built into the U.S. political system, even when fairly large majorities of Americans favor policy change, they generally do not get it.
The Policy of Single-Payer Healthcare
The key to single-payer healthcare would be to take private profit out of public healthcare and insulate this essential public good from the demands of shareholder greed. Yes, public goods and services such as quality healthcare for all do require public funding. Graduated income taxes that make the rich pay their fair share into public funds for social solidarity are by no means only a demand of socialists, as any survey of U.S. tax rates in the previous century will prove. In any class-divided society, the rich always have the option to buy whatever they please, including private healthcare.
The public policy of single-payer healthcare is often presented with the more familiar title of Improved Medicare for All. The good reasons for doing so include strong popular support for Medicare and Medicaid, even across party lines, and the aim of guiding public policies along stepping-stones rather than quicksand. The aim of the single-payer healthcare movement is to defend and improve a familiar reform, while working to extend this reform into a truly universal and comprehensive healthcare system. For this and other reasons, including the deliberate evasions of private insurance companies, single-payer policy must be defined and explained to the widest public.
In an article, “What ‘failed’ in Vermont was not single payer,” published by the Minnesota chapter of Physicians for a National Health Program (PNHP-MN) on May 1, 2015, healthcare analyst Kip Sullivan wrote:
The practice of dividing health care systems into single-payers and multiple-payers began three decades ago and is now widespread. Like all durable typologies, the single-versus-multiple-payer typology is widely used because it serves a useful purpose. The traditional Medicare program indisputably falls onto the single-payer side of that typology. No rational person would place it on the multiple-payer side… Having a clear definition of what single payer is and is not will be essential to clear communication. If we let opponents or proponents of single payer turn the label into mush, our job will be much more difficult.
Sullivan offered what may be the briefest and clearest definition of single payer policy when he was interviewed by the editor of Corporate Crime Reporter in 2019:
Single payer has four elements. First– one payer, not multiple risk-bearing entities called insurance companies or health maintenance organizations (HMOs) or accountable care organizations (ACOs). One payer. All the risk lies with that one government payer. Second, budgets for hospitals and nursing homes. Third, uniform fee schedules for individual providers—doctors. Four, price controls for drug companies. Those are the four elements you need.
As noted at the website of Health Care for Us (HC4US.org):
Single payer is patient centered… The uniquely American health insurance system is a business designed to extract profit by maximizing cost and minimizing care, to reward owners and shareholders with ever-increasing financial gain. Multi-payer is profit-centered.
The Movement for a National Health Program
In 1986, two socialist physicians, Steffie Woolhandler and David Himmelstein, founded Physicians for a National Health Program [PNHP], which now has over 22,000 members and has consistently been in the forefront of pushing for a single-payer healthcare system in the United States. The founders were inspired by the success of the movement that achieved the creation of Canada’s National Health Insurance system, and they were alarmed by the limits of the current Medicare system. Under the Reagan administration privatization had started with the 1985 Medicare HMO program; and providers siphoned billions, taking advantage of the payment system that had been adopted from private insurers. In addition, of course, Medicare and Medicaid only covered a portion of the population and many millions were without health insurance in a landscape dominated by employer-dependent insurance plans.
PNHP was singularly focused on advocating for a true single payer policy and this has remained its primary goal. However, the struggle has never been simple and the opposition from the ever-growing insurance/medical/pharmaceutical complex has ensured an uneven playing field.
The issue of healthcare became steadily more prominent through the 1980s and it played a significant role in Bill Clinton’s 1992 victory. One of Clinton’s first moves was the establishment of a National Task Force on Health Care Reform, putting his wife Hilary in charge. The Task Force was mandated to come up with a comprehensive plan to provide universal healthcare for all Americans, which was to be a cornerstone of the administration’s first term agenda. Clinton’s Task Force and the resulting proposals evoked a firestorm of opposition from Republicans but also from many Democrats, and it was subjected to a successful legal challenge over its secret, closed door meetings.
Her chief health reform policy concern was to preserve Health Management Organizations (HMOs), which served the private interests of insurance companies and not public health. Later, these HMOs were rebranded as Accountable Care Organizations (ACOs), a distinction without a difference, but with the distinct purpose of causing further distraction and confusion among the public.
The Task Force never produced a bill that the Senate leadership could put to a vote, and it was successfully tarred with the charge of Big Government and excessive red tape. The Health Insurance Association of America created a TV ad campaign featuring “Harry and Louise” – a middle class couple worried about governmental bureaucratic intrusion – that helped feed into the Republican “Revolution” of 1994 when the GOP captured both houses of Congress and ended any chance of national healthcare reform until the election of Barack Obama in 2008.
Obama, like Clinton, put healthcare reform at the center of his campaign, and he took up the issue early in his first term. Like Hilary Clinton’s 1993 effort, Obama never considered excluding private health insurance companies from his proposals and, in fact, offered them a substantial pool of new clients whose healthcare would be subsidized by the federal government. The Affordable Care Act [ACA] – or Obamacare – was modeled on the Massachusetts healthcare reform law enacted by Governor Romney – thus labelled Romneycare – in 2006, although this act of political plagiarism from a Republican governor did not shield the ACA or Obama from continual criticism from the GOP. Repealing Obamacare has been a central feature of Republican politics ever since. In 2009, former Alaska governor and failed Vice Presidential candidate Sarah Palin took a provision in the ACA allowing Medicare payment for doctors to spend time discussing end-of-life issues with patients, and proclaimed that under Obamacare governmental “death panels” would be coming for the elderly and the infirm. Donald Trump made the repeal of Obamacare a central part of his 2016 campaign and it was ironic that the decisive vote to save the ACA was cast by Obama’s 2008 opponent, John McCain.
While the ACA did accomplish many important goals of healthcare reform, such as forbidding the use of “pre-existing conditions” to deny insurance coverage, mandating coverage of numerous preventive care measures, and providing insurance to millions of citizens previously without employment-based insurance, it falls far short of the benefits that would be achieved with a true single-payer system. The ACA builds the for-profit health insurance corporations into the system, actually expanding their reach by mandating that everyone be enrolled in an insurance plan and subsidizing those otherwise unable to pay. Thus, ACA-mandated care continues to incur inflated administrative costs, in contrast with Medicare and Medicaid, as well as the incessant demand to increase shareholder profits as a fiduciary responsibility of health insurance management.
In 2016, Bernie Sanders ran for the Democratic Party’s presidential nomination, in a race that Hilary Clinton won. Sanders’ campaign had two main issues: economic inequality that benefited the “1%” at the expense of the “99%” – attacking the billionaires – and calling for universal healthcare under the label of Improved Medicare for All. Sanders’s strength as a candidate surprised and scared the political establishment and it put single player healthcare squarely back in the center of the political arena.
While Hillary Clinton maintained the familiar disdain of the Democratic Party leadership for single-player healthcare – in a debate with Sanders she reiterated that “it will never, ever happen” – the issue lit a spark with the public and helped fan the flames of enthusiasm that Sanders inspired. Thousands of previously disengaged citizens were drawn to the Sanders campaign, which also drew from the veterans of the recent Occupy movement, and healthcare reform was among the most powerful lures.
Although an “independent” member of the Senate, Sanders identifies as a democratic socialist, and one of the more surprising aspects of the campaign was the revelation that the label of “socialist” was no longer a political kiss of death; certainly not for the younger folks who “felt the Bern” and flocked to his rallies. In the aftermath of the 2016 campaign, many of those who had been drawn into activism joined the Democratic Socialists of America, swelling its membership from around 5000 to over 90,000.
Michigan Democrat John Conyers began introducing an Expanded and Improved Medicare for All Act in Congress in 2003 and in 2017 Bernie Sanders introduced a parallel Medicare for All Act in the Senate. However, neither the Conyers or the Sanders bill included all of the elements of a true single-payer policy. More recently, the House bill, now with Pramiya Jayapal and Debbie Dingell as the prime sponsors, incorporates all of the key components, and Sanders has signed onto the Jayapal-Dingell-Sanders bill introduced in April 0f 2025.
Each succeeding version of these “Improved Medicare for All” single-payer bills has garnered more sponsors in the House and the Senate, but has not had any serious chance of passing either house. Biden made his opposition to single-payer healthcare explicit, promising to veto a bill if it ever did pass, and no one expects anything but further attacks on the existing Medicare and Medicaid systems from a Republican Congress and administration.
When we campaign for single-payer healthcare, of course, our message must cross all party lines. Whenever an “inside / outside strategy” is discussed, however, there is often a presumption that socialists should maintain an electoral orientation toward the Democratic Party. An actual inside / outside strategy is nonsense unless the democratic left is generously defined to include socialists who organize against the bipartisan corporate state. Then there is no need to pretend that anyone can predict the future, and in good faith we can discuss possible coalitions centered on class conscious public policies.
National vs One-State Strategies
In recent years, a split has opened in the movement for single payer between those who believe that the focus must remain on achieving national healthcare reform — such as “Improved Medicare for All” – and those arguing that real progress will only be possible at the state level for the foreseeable future. These two positions have resulted in the creation of two new organizations that overlap with PNHP but that have adopted often irreconcilable strategies.
The proponents of pursuing only federal level reforms are represented by the organization National Single Payer whose five-member steering committee includes Ana Malinow, a former president of PNHP. NSP’s fifth Principle [out of 13] states, “We believe that neither a state by state nor an incrementalist strategy is an effective approach to winning national single payer.”
However, a basic flaw in their argument is revealed by the fourth principle: “We maintain hope based on our nation’s history of building dynamic movements to abolish slavery, expand voting rights, establish unions, and take on corporate power.” NSP’s position is precisely contrary to the actual history of most “dynamic movements” for systemic reforms in this country. The struggles against slavery and for women’s suffrage, labor rights, civil rights, reproductive rights, LGBT rights, all scored significant victories in individual states long before national legislative reforms were achieved. In fact, as with the Canadian campaign for a national health system that began with the province of Saskatchewan, single-state victories have been the inspiration and model for much national legislation.
While it is true that some New Deal and Great Society legislation initiated national reforms that had no precise state level models, most importantly Social Security and Medicare/Medicaid, it is impossible to imagine any recent or foreseeable Congress adopting single-payer legislation. Obama’s Affordable Care Act barely passed and only survived in 2017 by one vote. Further, we must keep in mind that, while no one expects the GOP to ever favor single payer, the leadership of the Democratic Party has explicitly rejected single payer. As a candidate, Biden promised to veto any single-payer bill that might arrive at his desk, and his colleagues in the party have been singing from the same hymnbook.
On the other side of the split are the activists who believe that an effective strategy to achieve single payer healthcare should focus at the state level, while not denying the ultimate goal of a national system. The organization One Payer States was founded in 2009, proclaiming:
We endorse efforts on both a state and national level and support organizations, officials, and candidates that are working with urgency to make Universal Healthcare a reality. Our focus is on those that are struggling and vulnerable, not the privileged few who may be inconvenienced. We do not support delay tactics, incremental approaches, or any effort that assumes the for-profit model can stay in place for necessary care. We believe the only way to true social justice, cost relief, and personal freedom is through a one-payer system.
At present, OPS lists active movements or infrastructure for state-based one-payer or universal health care bills in 23 states. Among these are the “obvious” candidates, such as California, Hawaii, New York, Massachusetts, Minnesota, Oregon, Vermont, Washington, but also some less likely ones, including Montana, Ohio, Pennsylvania, and Utah. Certainly, these states vary considerably in the degree to which their single-payer efforts are pursuing realistic goals or merely establishing an important principle and laying the groundwork for future political campaigns.
The California Legislative Merry-Go-Round
By any reasonable calculation California should be among the states most likely to give rise to a powerful movement for single payer healthcare. After all, California has a notable history of leading the fight for many progressive causes, such as environmental regulation, labor laws, gun control, among others. This social history of reform, and not simply the sunny climate, earned for California the reputation of being the “Golden State.” Career politicians in the Democratic Party, however, have been especially expert in partisan priestcraft, and in making a gilded idol of “progressive California.”
Efforts to enact single payer legislation in California began in the early 1990s and there was a failed single payer ballot initiative [Prop 186] in 1994. By the late 1990s, there was a consistently visible movement for single payer that has resulted in a series of bills introduced in nearly every legislative cycle since 1998. Yet California does not have a single-payer healthcare system, and the legislative merry-go-round continues. Reflexively, Gavin Newsom proclaimed his support for single-payer healthcare when he campaigned for governor, and when he needed photo ops with the California Nurses Association. Now, Gov. Newsom dodges the issue, and simply gives excuses consistent with “campaigning in poetry and governing in prose.”
The story of the successive legislative battles in Sacramento is long and convoluted, and there is no reason for the present purposes to recount this complex history. Following evidence on the public record, the smoking pistol is that Democratic politicians grandstand in favor of Medicare for All and single payer when the Republicans are in power, and in a position to block or derail significant legislation. In all these years, between 1998 and 2025, the California legislature has considered a series of single-payer bills. Only twice, in 2006 and 2008, did a single-payer bill pass both houses, and in both of these instances the Republican Governor, Arnold Schwarzenegger, had promised to veto the bill and did so.
In 2010, Schwarzenegger was succeeded by Jerry Brown, a Democrat, followed in 2018 by Gavin Newsom, another Democrat. By 2012, the Democrats had achieved a supermajority in the legislature, and thus could enact bills without any Republican support. Thus, the fate of the efforts to enact progressive reforms is entirely in the hands of Democratic Party politicians, and it has been their priority to ensure that a single-payer bill does not land on the governor’s desk.
Nurses are the labor backbone of the single-payer movement in the United States, and they deserve credit for being among the strongest advocates for single-payer healthcare. This is especially true of the members and leaders of the California Nurses Association (CNA), which was led by longtime labor organizer RoseAnn DeMoro for 32 years, from 1986 to March 2018. CNA pioneered the first state law mandating minimum nurse-to-patient ratios in the United States, a moral and material advance for public healthcare. For nearly a decade, nurses gained broad support from patients and the public, while hospital executives lobbied to defeat the law. In 1999, Assembly Bill 394 was passed in California and took full effect in 2004. Following this success, the CNA cofounded National Nurses United (NNU) in 2005, and the nurses still work to advance nurse-to-patient ratios in other states and in federal law.
Since 2005, CNA has been the principal sponsoring organization for single-payer legislation in California. When Jerry Brown became governor, it might have been expected that the way was open for single-payer legislation, but Brown, like Democratic governors before him, was not a supporter. In a fateful miscalculation, the CNA leadership chose the path of persuasion rather than the confrontational tactics they had employed against Governor Schwarzenegger. In 2018, as she retired from her leadership role in CNA, DeMoro acknowledged that “not convincing Jerry to do single-payer” – even though Brown supported single-payer care when he ran for president in 1992 – is “my greatest failure.”
In 2018, Gavin Newsom ran for governor on a platform that included clear and strong support for single-payer healthcare, assuring CNA, “If we can’t get it done next year, you have my firm and absolute commitment as your next Governor that I will lead the effort to get it done. We will have universal healthcare in the state of California.” CNA sponsored a bus that toured the state with a picture of Newsom’s face and these words: “Nurses Trust Newsom. He shares our values and fights for our patients.” However, what happened next was a repeat of the all-too-familiar pattern of Democratic politicians who run on issues of real reform, but run away from them once they gain public office.
Gavin Newsom is now in his second and last term as governor and quite obviously preparing to enter the 2028 Democratic presidential contest. Given the fiscal power of the health insurance complex and their firm control over the Democratic party establishment, it is entirely unsurprising that Newsom has abandoned that “firm and absolute commitment.” In fact, he has worked in earnest to ensure that a single-payer bill never lands on his desk. The most recent ride on the legislative merry-go-round followed the familiar pattern, so a review of those events is in order.
Sabotaging CalCare
In early 2022, Newsom introduced his budget while the state assembly began to move a single-payer bill created by CNA and sponsored by Assembly Member Ash Kalra, called CalCare. When asked about it, Newsom got testy and replied, “I have not had the opportunity to review that plan, and no one has presented it to me.” Though Newsom said that single payer was still “the ideal system,” he added: “The difference here is when you are in a position of responsibility, you’ve gotta apply, you’ve gotta manifest, the ideal. This is hard work. It’s one thing to say, it’s another to do. And with respect, there are many pathways to achieve that goal.”
We do not need leaders of DSA to play riffs on Newsom’s deadbeat excuses, or to explain why it is such hard work for Newsom to do what he says. As for “many pathways” to achieve the goal of single-payer, a long-time member of DSA named Michael Lighty has been loyally serving the career politicians of the Democratic Party in changing the subject from an actual single-payer program to a legislative campaign of false advertising.
While many players have had a hand in sabotaging single payer legislation in California, Michael Lighty truly deserves to be seen as the Zelig of healthcare sabotage. An early member and one-time national director of DSA, he worked from 1994 to 2018 for the California Nurses Association / National Nurses United (CNA/NNU), where he served as Director of Public Policy. He was active in the Sanders campaigns of 2016 and 2020, serving as Healthcare Constituency Director for the 2020 Sanders campaign.
The history of labor unions is not simply a story of solidarity, which is unsurprising when workers organize on the terrain of the corporate economy. In union drives for membership, union leaders sometimes trade charges of raiding across lines of union jurisdiction, and some of these conflicts end up in court. In the early years of this century CNA/NNU had a hostile relationship with SEIU, competing for members, before they made a surprising alliance in 2009. This alliance was at the expense of the smaller (despite its name) National Union of Healthcare Workers (NUHW) that split off from SEIU’s Union of Healthcare Workers (UHW). By 2013 CNA/NNU ended its detente with SEIU and made a new alliance with NUHW, but that relationship soon soured, ending up in court in 2016. By 2018 NUHW, which has a membership of around 17,000 in California, mostly Kaiser non-nursing employees, and CNA, with a membership of over 100,000 (part of NNU’s membership of 250,000), had become enemies.
In 2018 Lighty left CNA/NNU, under unclear circumstances and has since been affiliated with the NUHW as President of Healthy California Now (HCN). NUHW is the prime sponsor of HCN, that describes itself as “a statewide, non-partisan coalition of community, consumer, labor, health, disability, LGBTQ, business, and political organizations committed to building and broadening the movement to guarantee health care for all Californians.” It is entirely unclear what degree of commitment and investment these organizations have to HCN beyond putting their names on a list of affiliates, thus allowing Lighty to present himself as “representing over 6 million Californians, and hundreds of community-based organizations”. Lighty and HCN have created an empire out of Potemkin villages.
However, HCN is not a true single-payer coalition. HCN’s signature effort in 2023 was the successful campaign to pass a bill introduced by State Senator Scott Weiner, SB770, that was intended to distract, delay and divert the campaign for CalCare, which is a true single-payer bill.
The opening language of SB770 signaled its linguistic obfuscation:
Prior state law established the Healthy California for All Commission for the purpose of developing a plan towards the goal of achieving a health care delivery system in California that provides coverage and access through a unified health care financing system for all Californians, including, among other options, a single-payer financing system.
Note the introduction of the slippery term “unified health care financing” and the crucial qualification, “including, among other options, a single-payer financing system.”
The primary function of SB770, in the eyes of CalCare proponents, was to give Democratic legislators excuses not to vote on the CalCare bill, AB2200, sponsored by CNA, that was introduced in January 2024. This goal was achieved by the familiar tactic of mandating the creation of a body to conduct discussions. In this case, SB770 mandated the creation of “a Waiver Development Workgroup (workgroup) to advise the Governor on topics related to federal negotiations,” regarding the granting of federal waivers that would be necessary in order to direct federal Medicare, Medicaid, and VA funding to a state single payer system.
However, according to federal law, Section 1332 of the Patient Protection and Affordable Care Act, which permits states to request such State Innovation Waivers, it is necessary to first pass a state policy bill before approaching the federal government to request waivers. In 2023, Carmen Comsti, CNA’s current Policy Director, reported that when Assembly Member Ash Kalra met with HHS in 2022 and provided them with a copy of the single payer bill he was introducing, he was told, “It’s nice you have a bill, but you have to pass the bill first, then come back to talk to us.”
Even more importantly, SB770 mandated a report to the legislature on these negotiations by June 1, 2024, meaning that the report would come after the deadline for a vote on AB2200/CalCare that is set by California’s strict legislative time-table. In other words, members of the legislature would now be able to argue that they could not vote on CalCare before receiving the Workgroup’s report.
Sidelining DSA and PNHP
Throughout the Spring and Summer of 2023, HCN and its allies pushed SB770, arguing disingenuously that it was “complementary” with CalCare, despite its use of “unified financing” and its timing that would undermine support for CalCare. These efforts were clearly visible in two instances that we witnessed firsthand, in the LA Chapter of DSA and in the California chapters of PNHP.
We must offer a disclosure to readers here: the account of the recent CalCare campaign is based on personal participation rather than only observation and second-hand accounts. Despite misgivings about working within the Democratic party — as the “left wing of the possible” – we joined DSA in 2022 to work with socialists on the public policy goal of single-payer healthcare.
Following the Sanders campaigns of 2016 and 2020 that put Improved Medicare for All at the center and demonstrated the wide and deep support for serious healthcare reform, the membership of the DSA swelled from around five thousand to over 90,000 members, making it the largest socialist organization in the country. The role of the Sanders campaign in recruiting new members to DSA was immediately evident in speaking to comrades in the LA Chapter, the second largest after New York, and hearing many of them recount their entry via volunteering for Sanders, as well as the grassroots organization Feel The Bern that connected local groups around the country united in their support for Sanders and the issues he promoted.
We attended the annual DSA-LA convention in July 2022 and were perturbed by the absence of any mention of healthcare among the priorities being considered for the next year. A few months later, we connected with the leaders of the Healthcare Justice Committee and began attending their meetings, which were focused on enlisting DSA in support of the emerging CalCare campaign. But when the Committee presented a proposal to the April 2023 DSA LA convention to make CalCare a priority, our resolution was defeated. Our proposal was not debated in any fair and open discussion, but it was attacked by members of the chapter Steering Committee, reading recognizable HCN talking points off their phones, and making clear to any uninformed members that the proposal was opposed by the chapter leadership. One of them stated, “we need to elect cadre to Sacramento” before a single payer bill could be considered. Another stated that they “would be in negotiations with the staffs of Newsom and Biden.”
Any mystery about why the DSA-LA chapter would reject a resolution in support of CalCare was cleared up when one of our members was informed that the Steering Committee had been in communication with Michael Lighty. It’s not difficult to imagine the scenario in which these relatively young and newly elected members of the chapter Steering Committee were mentored, though not enlightened, by someone with unimpeachable credentials. After all, Michael Lighty was a decades-long member and former national director of DSA, a veteran of the Sanders campaign, and a long-time Policy Director for CNA. While we might speculate about his motives in HCN’s creation of SB770 and his role in undermining CalCare, despite claiming that SB770 was “complementary” with single payer, it is easy to see how he was able to make the DSA leadership see things his way.
The subversion of DSA’s commitment to single-payer legislation didn’t end with the defeat of the Healthcare Justice Committee’s resolution. Although DSA-LA had a long-standing but inactive membership in HCN, an episode of political surrealism soon followed when Ryan Andrews (a member of DSA-LA’s Steering Committee) submitted a Resolution to the newly activated California DSA State Council, effectively placing California DSA under the direction of HCN. Although there had been no open debate and forum on health care policy within DSA-LA, and the Healthcare Justice Committee was not consulted despite their obvious relevance, the Resolution was duly passed by the California DSA body. Thus, the DSA-LA Steering Committee assisted Michael Lighty in converting the California DSA chapters into subsidiary stocks of the holding company of HCN. As the last clause spelled out without ambiguity: “Let it be further resolved that California DSA will offer material support for legislation endorsed by HCN after adopting and in accordance with a broader organization-wide framework for legislative endorsements.”
During several months of tense discussions between the Healthcare Justice Committee and the chapter steering committee our repeated requests for a public debate between proponents of CalCare and SB770 were ignored. Two members of the Steering Committee joined HJC Zoom meetings to discuss our concerns, but in both cases they admitted that they had not even read the five-page text of SB770. As one of them put it, “I’m a teacher, not a healthcare policy expert.” In September 2023, the entire membership of the Health Justice Committee resigned and issued two public statements recounting the events leading up to our decision:
- Socialist Health Care Organizers Exit DSA
- DSA Resignations Over Corrupt DSA Oakland Michael Lighty Who Fronts For Insurance Industry
In the nearly two years since then, the issue of healthcare and the fight for single-payer health care has been singularly absent from the webpages and publications of DSA-LA, DSA California and, indeed, the national DSA. Neither the 2023 nor the 2025 biennial National DSA Conferences featured healthcare in any visible role, and the issue is not listed among the organization’s priorities or working groups. One of the foundational issues that helped DSA become the largest socialist organization in the country has to all intents and purposes been shelved.
A History page on DSA’s website that was written in 2017 notes that in the 1990s, “We helped build the ‘single-payer’ or ‘Medicare for All’ movement as an alternative to the Clintons’ failed plan to expand coverage by the private insurance system.” In recounting the importance of the 2016 Sanders campaign, the history says, “Many in DSA had hoped that a Hillary Clinton victory would allow DSA to help lead an anti-neoliberal Democrat opposition pushing for Medicare for All, progressive taxation, stricter regulation of the financial sector, etc.” Later, the 2017-era document proudly proclaims that, “In blue states such as New York, New Jersey, New Mexico and California, DSAers are at the forefront of the fight for state-level Medicare for All legislation.” Clearly, this History page is overdue for an update.
Our second direct experience with HCN’s efforts to promote SB770 at the expense of CalCare occurred when a longtime single-payer activist alerted us to a conflict within the California chapters of PNHP. We were longtime members of PNHP, as non-voting allies – their membership category for non-medical professionals.
In addition to the numerous local chapters, there is a statewide body, PNHP-CA, that coordinates the combined efforts of the organization. In the Spring of 2023, the newly elected chair of PNHP, Dr. Nancy Greep, chair of the Santa Barbara chapter, was persuaded by Dr. Hank Abrons, chair of the Bay Area chapter, to endorse SB770, on the grounds that it was “complementary with CalCare.” When our comrade learned about this endorsement, she explained to Nancy Greep why SB770 was not, in fact, complementary, but rather a means to undermine CalCare. Subsequently, Nancy Greep asked the PNHP-CA Steering Committee, comprised of the chairs of the local chapters, to reconsider their endorsement of SB770. After a tense and often fractious Zoom meeting of the Steering Committee, which we attended along with other non-voting members, the endorsement was rescinded, and it was agreed that PNHP-CA’s affiliation with HCN would be reconsidered.
Following their loss in the PNHP-CA Steering Committee, Abrons and his fellow HCN/SB770 supporters raised objections to the process, and the vote, with the national leadership of PNHP. The complaints about the conflicts within PNHP-CA succeeded in persuading the national leadership, many of whom were longtime friends and colleagues of the HCN-allied faction, to put the statewide organization on “hiatus” – freezing Nancy Greep’s access to the statewide mailing list and effectively silencing PNHP-CA as a player in the current struggle over SB770 and CalCare.
However, despite being on “hiatus,” PNHP-CA is still listed on the HCN website as an “affiliate”, along with many other organizations whose degree of “affiliation” is open to question. The California Nurses Association is listed, despite the deep disagreement between CNA and HCN over SB770; as are numerous other organizations that we suspect accepted without much deliberation the assurances that HCN is truly “dedicated to establishing a single-payer system in California ,” and that SB770 was “complementary” with AB2200.
Killing CalCare
After passing the Senate and the Assembly Health and Appropriations Committees, SB770 was amended in ways that made its true goals even more undeniable. The Working Group was removed, and the bill now mandates that the Secretary of the CA Health & Human Services Agency “engage with” unspecified “stakeholders” on issues relating to health policy and Federal waivers – replicating the work of the recently completed Healthy California for All Commission. More importantly, the Secretary was instructed to report on a timeline that was guaranteed to undermine the timing of a vote on the CalCare bill that was introduced in February 2024.
In its original form, the report from this process was due June 1, 2024, which would provide cover for legislators to say they couldn’t vote for CalCare in May 2024, the deadline for AB2200 to pass out of the Assembly to advance, because they would have to wait for the SB 770-mandated reporting about waivers. But the amended version that passed the legislature made this strategy even more obvious by moving the date for the interim report to January 1, 2025, and the final report to November 1, 2025. In other words, the goal of delaying and diverting real legislative action was achieved and single-payer could now be kicked down the road for at least two more years.
As it turned out, however, SB770’s timeline was not needed, as fate provided an even easier way to assure that AB2200/CalCare never arrived on Governor Newsom’s desk. By the Spring of 2024, California was experiencing a familiar pattern of projected budget surplus turning into a deficit. As we know, a crisis is a terrible thing to waste, and a budget deficit is also a convenient opportunity to kill unwelcome programs and proposals.
The legislative process in California begins with the introduction of new bills in January and February that are then assigned to a relevant committee for consideration by the end of May. If a bill passes out of the committee, it is referred to the powerful Appropriations Committee, which reviews every bill with “any fiscal impact to the state government.” Given this broad mandate, the Appropriations Committee considers more bills than any other committee; in 2023-24 it considered 5,525 bills. Given the size of their workload, the committee operates in a unique fashion, placing a large portion of the bills that come before it into a “Suspense File” from which they may, or may not emerge. Bills that are left in the suspense file are effectively killed, without an actual vote.
In 2024, the new Speaker of the State Assembly, Robert Rivas, appointed as the chair of the Appropriations Committee, Assembly Member Buffy Wicks (D-Oakland). Wicks, now in her second term, came to the Assembly after considerable political experience, including stints in the Obama White House and the Obama and Hilary Clinton campaigns. She made a highly visible speech on the Assembly floor in 2020, when she brought her newborn baby with her because she was not allowed to vote-by-proxy. In April 2021, she recorded a moving interview with healthcare activist Ady Barkan, who was then confined to a wheelchair with ALS, and has since died. Wicks gave a passionate account of her support for single-payer healthcare:
To go from the system we have now to a single-payer system is not easy. And so I think it requires, and you’ll appreciate this as an organizer, a grassroots campaign focused on ensuring that I and all my colleagues, and the governor, hear from the people out in the community about why this is so important. That’s who should be demanding this. And that’s who is demanding it. That’s who should hold my feet to the fire when I’m pressing either the green button or the red button. I think we’re ready for it. We have Democratic control in the legislature, a democratic governor, Democrats in Washington, DC. Well, Democrats, it’s time for us to step up and do the right thing.
Indeed. However, Wicks, as an experienced and ambitious politician, knew what the Speaker and the Governor expected of her. The CalCare bill, AB2200, was placed in the suspense file, where it remained. Although numerous studies, including the official Healthy California For All Commission, concluded that a single payer system would save the state billions each year, while providing more care through universal coverage and comprehensive benefits, Appropriations chair Wicks used the deficit as an excuse to make the bill disappear into the suspense file. In an article headlined, “Single-payer healthcare meets its fate again in the face of California’s massive budget deficit,” the Los Angeles Times reported:
“We have an obligation to balance the budget in California,” said Assemblymember Buffy Wicks (D-Oakland), chair of the committee. “There were some tough choices to make.” Wicks said she was a co-author of a previous single-payer healthcare bill, but told reporters that lawmakers had to weigh the financial burdens that accompanied this sweeping proposal.
Thus, at least for the present, single-payer healthcare was killed in California by career politicians of the Democratic Party without the need for a vote, and no fingerprints were left at the crime scene.
CalCare Post-Mortem
When AB2200/CalCare was killed in the “suspense file,” the movement for single payer found itself once more at the bottom of the Sisyphean hill. Despite the refrain that it was time to pick themselves up, dust themselves off, and start pushing the rock up the hill again, it is really time for a candid appraisal of past campaigns and a realistic assessment of future strategies.
Let’s begin with the fact that the current single-payer healthcare campaign in California can succeed only when a policy bill is passed by the legislature and signed by the governor. The experience of so many trips on the legislative merry-go-round should have taught clear lessons about the perils of this endeavor.
First, in order for our elected representatives to vote for a bill that has any important consequences, they need to be persuaded, bribed, or scared. We can quickly dispense with persuasion, as we’ve learned that legislators will say what they think we want to hear and then do what serves their interests. When it comes to bribery — campaign contributions and refraining from funding a member’s opponents — the single payer movement is vastly out-matched by the health insurance complex. This leaves the option of scaring them, and that means enlisting the public at large, in large numbers, and in anger. Unfortunately, this is where the recent campaigns have failed.
The last few rounds of single-payer legislative campaigning have been led, as noted, by the California Nurses Association, initially under the leadership of former Executive Director RoseAnn DeMoro. In 2015, DeMoro appeared with then Lt. Governor Gavin Newsom, already preparing his 2018 campaign for governor, and applauded his unequivocal endorsement of single-payer healthcare: “I’m tired of politicians saying they support single payer but that it’s too soon, too expensive or someone else’s problem.” Once elected, and already planning his future foray into presidential campaigning, Newsom made sure that he was never faced with the dilemma of signing or vetoing a single-payer bill.
The strategy adopted by CNA in successive legislative campaigns has followed the same playbook: collect an increasing number of legislators to co-author and co-sponsor the bill when it’s introduced; marshal large numbers of citizens to sign petitions, and write or call their representatives; solicit formal endorsements from organizations – other unions, civic associations, etc. – to be listed as supporters; meet with members of the legislature and present them with analyses and arguments as well as petitions signed by their constituents. And, that, apparently, is about it.
What’s missing from this strategy is any broad awareness and engagement on the part of the public. There was no highly visible presence of the CalCare campaign in the public realm besides small-scale, local efforts such as tabling at farmers’ markets and public events, and some canvassing and circulation of petitions.
When AB2200/CalCare was introduced in February 2024, it might have been expected that the proponents would have used the opportunity to stage a visible public event that would draw media attention and engage public interest. Instead, this opportunity was ignored and the scant media coverage was framed in terms framed by the bill’s opponents: “Single-Payer Healthcare is a ‘tough, tough sell’ as California faces massive budget shortfall”. The article leads with the claim that single payer healthcare would be a budget-buster, despite the numerous studies – uncited in the article – showing that it would save the state billions.
The article also gives prominent mention to the recently passed SB770, thus depicting Newsom as “setting the stage for universal healthcare” and citing State Senator Weiner’s goal of achieving an “incremental step to address some of the logistical hurdles that had stymied earlier proposals for sweeping reform.” CNA’s support for single payer is noted, as is their emphasis on the distinction between single-payer and other systems that provide coverage “through both public and private systems.”
The failure to seize the opportunity provided by the introduction of AB2200, thus allowing the issue to be framed as a budget challenge, led one of us to write to two of the CNA staffers with whom the activists we were working with were communicating. Their response was not encouraging. They acknowledged disappointment in the coverage, noting that, “while our Comms Department handles a ton of issues for our union across the country on a daily basis, CalCare was certainly a priority over the last two weeks.” They went on to say, “We decided strategically to defer an in-person press conference for just a bit to allow time for more organizations to endorse the new bill first so they can participate… We’ll have more details to share on that soon.” As far as we can tell, this never happened.
Finally, there was this disconcerting conclusion: “In general, our goal this time is definitely to involve a stronger core coalition group on the bill; and the hope would be that some of the capacity on things like press, for example, could perhaps be delegated to other members of the group.”
Which brings us to one of the most serious criticisms of the strategy adopted by the CNA, which played this challenging game, holding its cards very close, exercising severe message control, while, apparently also hoping others would carry out crucial supporting roles. When one of us approached the CNA staffer assigned to work with LA-area activists, introducing himself as a journalist who was writing about CalCare, there was no response.
The apparent failure of CNA’s leadership to fully comprehend the importance of the media is, unfortunately, matched by Michael Lighty’s apparent skill at cultivating and leveraging the media.
No Friction, No Traction
In January of 2026, we can expect that CNA will once again sponsor the introduction of the CalCare single-payer bill by Representative Ash Kalra and, it is likely, a large number of co-sponsors. However, absent a radically different campaign we can also expect that this bill will suffer the same fate as its predecessors, even if the precise method of its execution remains to be seen.
The opponents arrayed against single-payer health care remain formidable. The profit-centered health insurance complex represents a significant portion of the state economy and at least as significant a portion of the campaign funds received by elected officials. California is the largest state in the country and is often described as the fourth or fifth largest economy in the world, raising the stakes of this state-level fight even higher. We are facing the power and wealth of a sector of the economy similar to the defense and energy sectors, and the leaders of the Democratic Party in California and beyond are well aware of the costs of alienating those interests.
As we have seen, as a candidate in 2017, Governor Newsom was about as explicit as he could be in support of single-payer, but ever since he was elected, he has been equally steadfast in ensuring that no single-payer bill landed on his desk. Now that he’s running for the presidential nomination, he’s no more likely to be a reliable ally, and we have no strong reason to expect much more from the candidates lining up to succeed him in next year’s election.
Further, knowing that the absence of a highly visible campaign to inform and engage the public in recent years was a fatal weakness does not in itself offer a solution. To succeed in arousing the public and wielding public anger as a weapon requires effective media-savvy tactics to compete with the formidable resources of those who currently dominate and shape the media coverage. A decade and more ago, CNA’s RoseAnn DeMoro was a frequent presence in the news, whether hounding Governor Schwarzenegger or arguing for single-payer. In recent years, however, the field of media discourse has been dominated by politicians and healthcare experts who are skilled at sabotaging single-payer efforts.
Most significant, for those who are fighting for a true single-payer healthcare system, is the opening sentence of SB770, Lighty and HCN’s paramount accomplishment: “Prior state law established the Healthy California for All Commission for the purpose of developing a plan towards the goal of achieving a health care delivery system in California that provides coverage and access through a unified health care financing system for all Californians, including, among other options, a single-payer financing system ” [emphasis added]. These three words constitute precisely the necessary loophole through which insurance companies will be able to crawl, undermining the fundamental requirement of a true single-payer system. The Democratic politicians in Sacramento are happy with “unified financing” as long as single-payer remains one “among other options.”
If the next CalCare campaign is to have any chance of succeeding, we need to counter the strategies of obfuscation and distraction that will be employed by the insurance interests and their political allies. A policy battle between the public and the health insurance corporations will be asymmetrical warfare and we need to assemble many more allies to confront their economic and political power.
While CNA will certainly be the primary sponsor of any new CalCare bill, they need to build a broad coalition of groups and organizations that are truly invested in rather than merely lending their names to a list of endorsers. What this means, concretely, is that CNA will have to yield some of the tightly held control that is has maintained in past campaigns, and invite other labor unions to join with it as partners, not merely as allies.
There certainly are challenges to the enlistment of many unions as fully engaged fighters for single-payer, as many of the more managerial unions are ambivalent about giving up their role in securing employment-based health care benefits for their members. Here, the membership is often ahead of their leaders, as was evidenced in 2020 when the members of the Culinary Workers Union in Nevada overwhelmingly voted for Bernie Sanders despite the union’s official support for Biden and disavowal of Medicare for All.
Beyond labor, there should be active engagement and investment by community, ethnic and faith organizations that can reach and mobilize their members. Business organizations should be engaged and persuaded of the important benefits they would accrue from having healthcare insurance taken off of their shoulders and, especially for small businesses, relieving their employees from the burden of healthcare costs.
When Luigi Mangione, allegedly, shot Brian Thompson, CEO of UnitedHealthCare, the tsunami of public support for Mangione revealed what should have been obvious: the public loathing for the insurance industry. When it was reported that the words “delay,” “deny,” and “depose” were on the ejected cartridges, the public readily recognized the rubber-stamp lingo used by insurance companies to avoid paying claims, and social media was flooded with solidarity for the shooter. Beyond Mangione, social media is full of testimonies from medical professionals and patients recounting their frustration and their anger at the profit-centered medical and health insurance system.
We are all patients in the end, and patients must be front and center in this struggle. The public is enraged and it’s time to get them engaged.
To undertake a campaign of this magnitude, taking on one of the most entrenched interest groups in the country, without a fully engaged and aggressive media campaign is tantamount to surrender. In order to enlist enough citizens in an effort to persuade and, more importantly, scare their elected representatives, it is necessary to utilize all available sectors of the public sphere. Legacy media may be fading but they’re still a critical piece on the board, especially with older voters who are less immersed in social media, more likely to vote, and more likely to understand the importance of health care reform. Legacy media, including the editorial and op ed pages of newspapers, help frame the issues and set the agenda for public discussion.
Social media have become a significant force in shaping public awareness and consciousness but they have not replaced the role of news and opinion media and, in fact, much of the content of opinion media consists of responding to and commenting on events that have been reported by legacy journalists.
We need to cultivate media contacts and professionals: editors and reporters of legacy media as well as social media journalists, commentators, and “influencers” and provide them with ideas, analyses, and concrete stories and angles. In effect, we need to make their work easier by offering them clear and easily digested soundbites and texts, helpfully framing and summarizing the issues and, at the same time, inoculating them against the frames and perspectives they might encounter from the other side. This message must reach the widest public: Single-Payer Costs Less and Covers More!
Public officials can attract the media’s attention simply by speaking in their official capacity. If the governor or the Assembly Speaker issues a statement about a pending bill, that is newsworthy by definition; although whether it receives coverage will depend on the perceived importance of the issue.
For those outside the circle of “official sources” – and this includes those who are fighting for radical change — it is often necessary to employ less conventional tactics to attract public attention.
Town Halls are by now a familiar venue in which elected officials meet with their constituents in order to account for their actions and hear from the public. While these are typically set up and hosted by the officials, we could set up Citizens’ Town Halls and invite the local Assembly Representatives and State Senators to attend, with the topic being the pending CalCare bill. The logical candidates for such public meetings would be the members of the Assembly or Senate Health Care committees, and the Appropriations Committee. High on the list should be Buffy Wicks, chair of the Assembly Appropriations Committee. Of course, it’s entirely possible, even likely, that these elected officials will decline to appear at such a Town Hall and face constituents demanding that they follow through on their professed support for single-payer healthcare. But then, the presence of an empty chair on the stage is also a potent way to attract media attention to the Town Hall. If well organized and prepared, such Town Halls should inform and engage the public via legacy and social media.
Beyond media events such as Town Halls – either staged by the CalCare forces or any regular ones hosted by elected officials – there are a range of non-violent direct action tactics that can be enlisted to raise public awareness and take the fight to the enemy.
Imagine a stage set up outside the office of a major health insurance company – in California that would certainly include Kaiser Permanente – on which we present a Patients Tribunal featuring testimonies from patients and medical professionals, recounting their experiences with the insurance system. These media events are likely to receive coverage in the news media and, even more, to be disseminated widely via social media. Following such a Tribunal, patients could pay a visit, invited or not, to the offices of the insurance company and, this, too, would attract media coverage.
A successful campaign for the passage of a single-payer bill will require many tactics employed by many players. It will require a fully visible campaign that counters the attempts by politicians and their allies to divert, delay, and distort the issues. It will require a broad-based coalition of unions, communities, and engaged citizens. It will require honest analysis and directed anger: homework and hell-raising. But it can be done, because in the end, we are many and they are few.
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