Nonprofit, nonpartisan journalism. Supported by readers.


Community Voices features opinion pieces from a wide variety of authors and perspectives. (Submission Guidelines)

Democrats must stop playing defense on health care

To lead now means going on the offensive for single-payer national health insurance as envisioned in House Bill 676, the Expanded and Improved Medicare for All Act.

Democrats have a historic opportunity to lead.
REUTERS/Aaron Bernstein

The Democrats’ defensive strategy on health care leaves them tailing behind public opinion. To lead now means going on the offensive for single-payer national health insurance as envisioned in House Bill 676, the Expanded and Improved Medicare for All Act. A majority of Americans are on board, yet just two Democratic senators, Bernie Sanders and Elizabeth Warren.

Wayne Nealis

Just defeating the GOP legislation is not a solution. Working to patch the shortcomings of Obamacare is a short-term thinking. The current stalemate presents an opportunity to launch an offensive. I suggest some version of the following political strategy.

The first step is to acknowledge that any solution that relies on the private insurance market, Obamacare included, will not lower costs or cover everyone. Americans just rejected two GOP plans promising the market will do so. It won’t. The massive bureaucracy of the private insurance market and its lavish expenditures on advertising will under any private system continue to waste billions of dollars. On the other hand, Medicare has a 52-year track record that demonstrates single-payer works at a fraction of private insurers overhead.

Announce a goal

Next, announce a goal of fully implemented national health insurance within 5 years of passage. Legislation that will provide comprehensive, medical, dental and eye care for all. No hassles, no worries, better care and for less cost to the nation. Encourage Democratic candidates to commit to single payer in 2018 elections and beyond. Candidates who decline should be challenged and retired.

Article continues after advertisement

Immediately author separate legislation that would lower Medicare eligibility to age 55 within one year of passage. A one page bill will do. A slight majority of voters over 55 voted for Trump. Implementing such an easily administered program will garner support for single-payer, raise expectations and prove it works.

Propose a two-year extension of ACA provisions, including Medicaid and Medicare administrative rules to buy time for discussion and debate the next steps. No cuts. Polls indicate his idea should receive broad public support. Cover funding shortfalls by a temporary increase in taxes on the wealthy.

Assure workers in the private health care insurance industry they will be taken care of as the nation transitions to single-payer. They will not be made jobless. Those not needed for single-payer administration will be retrained and given stipends and free educational benefits modeled after the spirit of the GI bills. No one will be left behind.

No more half-measures

Introduce legislation to implement the Bernie Sanders campaign’s social benefit program — free post-secondary education, 12 weeks of paid parental or medical leave and a minimum of 10 days of paid vacation and seven sick days. Sanders acknowledged these are far below that of peer nations, but would be a start. American workers have the least social benefits among industrial nations. It is time to catch up. This tactic will raise the ante at the bargaining table with corporations and the wealthy that oppose single-payer health care. The underlying message – we are serious. No more half-measures on health care.

And lastly, propose that single payer be implemented in steps to allow time to transition insurers out of business and put systems and policies in place. The public’s experience with the rollout of ACA means some confidence building measures are in order.

Articulate a transition plan

Articulate a clear transition scenario. For example, Medicare will be structured and prepared to administer single payer within five years of passage. At year three, the Medicare system would cover those 50 to 55 to ensure systems and policies are working. At year five, single-payer goes into effect.  All in, all pay a fair share, no worries, no hassle, quality health care. Health-care coverage starts when you are born.

Many Trump voters believed he was going to get everyone health care. Clearly, Trump and the GOP will not. If Democrats want to win over these voters, get them health care. White working-class voters who voted for Trump will overwhelmingly support such an approach. Union members are on board. Offense will capture the public’s attention. It will engage Sanders’ supporters and youth to get behind a real solution to the nation’s health-care crisis.

Organizing to stop the GOP legislation is defense and offers nothing to solve the crisis. Make a commitment to single-payer health care. This is the historic opportunity to lead. Playing defense is a losing game. It is time, past time, to go on the offensive.

Wayne Nealis is a writer and long-time single payer activist and former union activist living in Minneapolis.


If you’re interested in joining the discussion, add your voice to the Comment section below — or consider writing a letter or a longer-form Community Voices commentary. (For more information about Community Voices, see our Submission Guidelines.)