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Democrats must stop playing defense on health care

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

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.

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.


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Comments (17)

  1. Submitted by Pat Terry on 07/21/2017 - 09:38 am.

    Some problems here

    You can introduce all the legislation you want, but it’s going to be 4 years (at a minimum) before it’s even possible to pass any of this. If Trump makes a couple more Supreme Court appointments, we are probably looking at least 20 years before this is possible because single-payer won’t pass constitutional muster with that kind of court. I’d like to have single payer right now too, but tens of millions will lose coverage if the current, admittedly flawed system goes away.

    You also underestimate the support for single payer. People like it until they find out how much it costs. That is why it was overwhelmingly defeated in Colorado. Bernie Sanders doesn’t like to talk about it, but it was tried and failed in Vermont. It’s why the poorly-written California bill is worthless – you will need to amend the constitution to raise taxes to pay for it, and that will never pass.

    • Submitted by Paul Udstrand on 07/21/2017 - 12:34 pm.


      Medicare and Medicaid are existing programs, they’ve already survived court challenges. The authority to levy taxes to pay for government service is clearly established and even THIS supreme court is unlikely to challenge that fact.

      The most likely scenario with Trump is that he’ll resign within the next two years, or shortly thereafter when Republicans get stomped in the midterms. Even if Trump lasts 4 years, no way he runs again. If Pence ends up in the office, he’ll have the same problem after the midterms, and while he’ll never sign MFA, Democrats can have it ready to go as soon as a Democrat takes office in 2020.

      We’ve been waiting for four decades, what’s another 4 years?

      The problem is as it has always been, obstructionist neoliberal Democrats, NOT Republicans. The only question is whether or not Democrats will finally abandon their bizarre fantasies about “centrism” and become a liberal party again. MFA is perfectly doable, and feasible, and it’s the best option on every level… but it’s a liberal initiative, and we know that the Democratic Party tends to reject liberal initiatives as a matter of course.

      • Submitted by Pat Terry on 07/21/2017 - 01:04 pm.


        Judges often follow past precedent, but are no means bound by it. Gorsuch’s early work suggests he is far and away the most conservative member of the court and doesn’t seem to be bound by facts, much less precedent. Replace Kennedy, or even worse, Ginsberg and/or Breyer, and you are going to see a lot of things you thought were settled get unsettled. A new govenment expansion like single payer doesn’t have a prayer.

        The fantasy is pretending this country is not fundamentally conservative and instead secretly socialist and that the dreaded neoliberals are holding us back.

        • Submitted by Paul Udstrand on 07/21/2017 - 03:25 pm.


          Is pretending that a political party that thinks the nation is fundamentally conservative is a liberal party. We already have one Republican Party, we don’t need another one.

  2. Submitted by Paul Udstrand on 07/21/2017 - 09:40 am.

    Heck yeah.

    Way way way past time Democrats come up with an agenda that looks beyond the status quo and the mediocrity and stagnation of “centrism”. And not just with healthcare.

  3. Submitted by Steve Titterud on 07/21/2017 - 01:22 pm.

    Wonderful idea, Dead On Arrival.

    First, to threaten massive social welfare benefits as part of proposing Medicare For All (MFA), will destroy the campaign right out of the gate.

    The author’s idea that this is a bargaining tactic – i.e., you right-wingers better accept MFA or else we’ll turn America into a social welfare state – is suicidal. Maybe a tactic like this might have some traction in a union negotiation (see author’s background), but it will TOTALLY confuse the public, who are already having trouble separating fact from fiction. It’s a completely different matter to persuade the public than it is to talk tough in a union negotiation.

    Rather, the most important thing is to assemble the TRUE argument that MFA will cost the whole society LESS, whereas, as can be seen by another commenter here, it is widely believed even by neo-liberals that MFA will cost MORE than the current system. It ain’t true.

    However, it must be made clearly and simply evident that the current system costs all of us MORE by including ALL costs, such as the ultimate costs of deferred care, emergency room visits, lost lives, massive profits and whopping salaries of the private insurance industry, and on and on. In other words, show clearly, and with effective political language, the TRUE COSTS of both systems.

    MFA is a no-brainer, but the public is confused because the true facts are obfuscated.

    • Submitted by Paul Udstrand on 07/21/2017 - 03:52 pm.


      The economics of MFA have been severely and deliberately obscured. But again, that’s because we simply don’t have a liberal party in America.

      Remember when a bunch of NYT’s economists declared that Sanders’s MFA was unaffordable and then had to retract their conclusion because they forgot tax increases would be offset by the elimination of insurance premiums? In fact MFA would save the average family around $5k a year, it would reduce over-all costs by 15-20% in the short term, reverse increases until the new baseline is reached, and then continue to control and reduce costs indefinitely.

      As for corporations we just need to point out the fact that we’re propping up health industry profits at the expense of all the other industries and economic sectors. That’s capital that would otherwise flow into disposable spending, expansions, dividends, and re-investments elsewhere in the economy, to the tune of around a trillion dollars a year. Why would business owners and large corporations fight to keep administering health plans for their employees at their own expense?

      I’m not sure about the bargaining chip idea either. You don’t put agendas on the table as bargaining chips, you put agendas on the table because you plan to pursue them… as agendas. I think MFA should be the first agenda, it’s easy to sell, easy to implement, and would be wildly popular once enacted. The beauty of MFA is it’s comparative simplicity. Once it’s up and running you could try to build off of that success and go to work on the other agenda items the author mentions.

      • Submitted by Steve Titterud on 07/22/2017 - 12:11 pm.

        Your paragraphs 2 and 3 are all that’s needed

        …in a political campaign in the public information space, assuming it’s possible to stay on message.

        There will no doubt be a desperate conservative opposition, but then again, there might very well be a handful of conservatives who would break tanks in favor of the obvious public benefit. We have recently seen how difficult it is to herd conservative cats.

        Once MFA is established, it will be impossible to remove, akin to the political stability of Social Security.

        A truthful accounting of ALL costs in both systems will outweigh ideology, and in fact may swing a few ideologues. Only a few, but that might be all it takes.

  4. Submitted by Connie Sullivan on 07/21/2017 - 05:36 pm.

    This guy’s proposals are misguided because he tries to put too many proposals together in one fell swoop. His goals are good, but there’s little realism in the ways he wants to attack (I use that word intentionally) the current system. That’s where Bernie Sanders gets it wrong too: Pie in the Sky just won’t work.

    Let’s fix Obamacare first. Work with moderate Republicans to fix what the GOP has removed of the necessary supports for the insurance industry, reinstate and strengthen the individual mandate, shore up the exchanges. Give reluctant states another chance to expand their Medicaid coverage (free, for states, if they can get past GOP ideology to the health of their working poor citizens). Lower eligibility age for Medicare, which is one of the best programs the US has ever had, after Social Security!

    Legislate permission for states to do a pubic option for the exchanges.

    Bit by bit, we can improve health care for Americans.

  5. Submitted by Paul Udstrand on 07/22/2017 - 08:26 am.


    I think people who couldn’t imagine Clinton losing to Donald Trump need to stop pretending they posses the nations expertise on reality. This delusion of political omniscience Democrats have been cultivating since the guy who engineered Dukakis’s loss to Bush lead Democrats into the “third way” is simply toxic. You don’t let people with limited imaginations who are hobbled by centrist tunnel vision dictate the boundaries of reality and political possibility. You don’t let the people who led us to the most bizarre and catastrophic loss in American Political history dictate possibilities. THAT’S how you end up with Donald Trump in the White House.

    The days of Democrats being dragged into liberal agendas and initiatives kicking and screaming simply must come to an end. MFA IS the fix for Obamacare. States already have the option of setting up their own single payer systems, CA and MN Democrats are already working on that. Public options should have been built in to begin with. Poll after poll is showing majority support for MFA among Americans in general, and growing support even among Republican voters. 52% of Republican voters now say they think the government should guarantee health care.

    In case you haven’t noticed, “fixing” Obamacare is the Republican agenda… we already HAVE a Republican Party, we don’t need another one, we don’t need the Democrats to be a second conservative Party we need a liberal Party.

  6. Submitted by Howard Miller on 07/22/2017 - 10:25 am.

    are Democrats done retreating from the PPACA finally?

    It was frustrating beyond belief when the PPACA was being debated in Congress and at town halls how loud Republicans were, and how invisible Democrats were. Since the law passed, it seems that Democrats spent more time running away from the law than pointing out how much good it was doing for so many Americans. And they’ve been clobbered in election after election, at both state and federal levels

    Mr. Nealis is correct. Democrats have to put forward a positive vision for health care for Americans, and for our economic security more generally. It is not sustainable that nearly all new income growth goes to the top few percent, while the great number of Americans stagnate economically. It is not reasonable to cut Medicaid and hand the savings to the already rich among Americans. It is not wise to push people away from health care, as a sicker population is less productive, and suffers more.

    It will be a refreshing change if Democrats stand loudly and proudly for a positive American future, one that emphasizes our common economic concerns and interests, and present that future in every US state and territory before November 2018.

  7. Submitted by Connie Sullivan on 07/23/2017 - 12:34 pm.

    It’s such a shame that people like Mr. Miller weren’t paying any attention to Hillary Clinton’s actual campaign last year. They just hated on her, for being a woman, for being married to Bill, for being so damn smart.

    She had answers and policy solutions that she had deeply studied and consulted with experts in many fields. She had a positive vision, which people refuse to consider.

    We are here inventing the wheel that we threw out when our ignorant and lazy current President was elected by a minority of American voters.

    • Submitted by Paul Udstrand on 07/24/2017 - 08:46 am.

      Hillary’s own campaign people…

      Eventually gave up trying to create a coherent campaign message so it wasn’t about whether or not people were paying attention, it was a failure to provide anything to pay attention to. I paid attention, I studied her website and her proposals, and they were all typical moderate Republican/neoliberal proposals like those Clinton has been championing for most of her life; and just didn’t sell, nor should it. Clinton’s campaign was about preserving the status quo, and that’s not what voters wanted.

      Some people still haven’t figured out the difference between Hillary worship and feminism, or liberalism, and it doesn’t appear they ever will figure it out. We still have to move forward.

      And yes, we all knew that Hillary was a deeply unpopular person, for whatever reasons, good and bad, right and wrong… but putting a deeply unpopular person at the top of your national ticket is sheer lunacy. It was the most catastrophic expression of self indulgence in American political history.

      Whatever… here’s the thing. Are the Democrats responsible for the most catastrophic expression of self indulgence in US history still in charge of the party or not? And it’s important to remember these self assigned experts of political reality have been delivering losses for decades. Are these the gatekeepers of reality and possibility? These people lost congress when Clinton was in office. These are the people who lost to George W. Bush not just once, but twice. And by the way, these are also the ones who told us Obama couldn’t possible win with a message of “Hope and Change”. Now we have Trump in the White House they’re still trying to pretend that they’re the reservoir of wisdom and reality but that’s just privilege masquerading as wisdom. Incrementalism and “centrism” aren’t the post ideological realities neo-liberals claim they are. Incrementalism and “centrism” are just comfort zones for the affluent and privileged who don’t NEED anything changed. The problem is their comfort zone is toxic to the rest of the nation so again, the question is: “Who’s in charge of the Democratic Party?”

  8. Submitted by Bob Petersen on 07/24/2017 - 07:57 am.


    No one hated Hilary for being a woman or smart or whatever you are projecting here. She was not elected because people simply rejected what she has done, how she went about her business, and did not prove to them that she would be a good president.

  9. Submitted by Bob Petersen on 07/24/2017 - 08:06 am.

    Single Payer Does Not Work

    Every other nation that has single payer is rife with limitations on who you can see and who you can see for your ills. Rationing is very real and, because of how the system works, waiting time to see doctors is very high. And the costs are staggering. These other countries have instituted private medical systems where you pay more for better healthcare.
    Progressives seem to think that the one size fits all programs actually work when it they actually hurt the ‘have nots’ more than they are trying to help. Everyone is jumping out of the social medical market. Why? Because it is not worth it.
    Our country is in enough debt – some states and municipalities are looking or have declared bankruptcy because of staggering public union money due to their programs. Interesting that this author of this single payer system article is a union activist.

    • Submitted by Paul Udstrand on 07/24/2017 - 10:26 am.

      Single payer works… bigly

      “Every other nation that has single payer is rife with limitations on who you can see and who you can see for your ills.”

      On every single metric from availability to cost single payer systems work better than ours, that’s a documented fact. American’s face greater limitations regarding care and access than any other population in a developed nation on the planet. If we expanded Medicare and Medicaid to cover everyone, and all health care, we’d have one of the best systems in the world.

      Any health care anyone provides anywhere in the country would be available to everyone. Regardless of your employment status, location, age, or income, you’d be fully covered for everything from routine check-ups to catastrophic illness or injury. You wouldn’t need pre-approval and you wouldn’t have to worry about going outside the “network” of providers because all providers everywhere would be your new network.

      Any medication your doctor prescribes would be available for small co-pay that would be easily affordable for everyone. The number of lawsuits associated with health care would drop dramatically because most of those lawsuits arise from crushing medical debts or expenses that would simply no longer exist. Likewise the number of personal bankruptcies driven by medical debt (up to 60% of all American bankruptcies) would disappear completely.

      You’re current “premiums” would be replaced by lower payroll deductions (a saving of $5,000 for the average family) and the over-all cost of health care and it’s share of the GDP would drop dramatically. As a the nations only payers, medicare and medicaid would have the leverage to control and reduce costs on everything from colonoscopy’s to epi-pens which currently cost anywhere from 100% – 1000% or more than they do anywhere else in the world.

      Employers would no longer need accountants or staff to manage health plans, or collect premiums, they would simply be out of the health care business. Administrative costs previous devoted to health care management could be deployed elsewhere from investment to higher wages. Billions of dollars currently spent on separate negotiations among hundreds of different payers and providers and all the associated administrative costs driven by claims and disputed claims would be eliminated.

      Likewise the personal savings and freedom of care would add billions of dollars of disposable income for ordinary Americans. People would be free to experiment with business, change jobs, etc. without fear of losing health care or the catastrophic financial ruin of a medical catastrophe or doubling or tripling their health cost by falling into a cobra plan.

      Expanding Medicare and Medicaid to cover everyone would be child’s play compared do the current system or any of the proposed “fixes” for the ACA. MFA would have been much easier to roll out than was the ACA. The health care exchanges and websites associated with Obamacare were far more complex and expensive than MFA would be. With MFA you determine your roll out date and on that date… it’s live, everyone is enrolled, no one has to go to a website or do anything done, your covered. Medicare already exists, it would just need to be expanded to cover everyone, and ramping it up is just a matter of scale. You could do it in stages but frankly it would probably be more economical and efficient to simply roll it out for everyone all at once. Doing it in stages or increment could actually just add unnecessary complexity to the roll out.

      If this all sounds like a dream world akin to a fantasy land where unicorns fly in the sky and cotton candy grows on trees…. it’s not. People in many developed countries have been living with this kind of health care for decades. The only reason we haven’t done this in the US is because: a) Our politicians are more interested in servicing the wealthy elite who profit from the existing system. and: b) Complacent liberals refuse to wander out of their “centrist” comfort zones and challenge their own neoliberal assumptions.

  10. Submitted by Bill Willy on 07/24/2017 - 04:04 pm.

    “It’s the (health care) economy, stupid!”

    Steve Titterud said, “the most important thing is to assemble the TRUE argument that MFA will cost the whole society LESS, whereas, as can be seen by another commenter here, it is widely believed even by neo-liberals that MFA will cost MORE than the current system. It ain’t true.”

    That, to me, is a great, basic, important point. It reminds me of Bill Clinton’s campaign reminder (to themselves) that, “It’s the economy, stupid!”

    Anyone who actually looks at the health care access, outcomes and cost facts — whether they think of themselves as a Republican, Democrat, Independent, conservative, liberal, progressive or whatever — will see that adopting almost ANY of the type of health care systems the rest of the industrialized world uses will save


    a relative LOT of money (and provide everyone with better health care than most are getting now).

    Without going into all the whys and wherefores, anyone who looks up the facts and does the arithmetic will see it boils down to something along these lines:

    If we, in the U.S. as a whole, could get our spending down to the GDP level of the UK or Canada WE (you, me, almost everybody else in the country) would save $1.6 trillion PER YEAR.

    If we, in Minnesota, could do that, we would save about $26 billion PER YEAR.

    Just this year we saw MN conservatives use all their political skill and energy to, among other dubious things, succeed in what they’re considering a massive tax cut success that will save MN taxpayers a whopping $650 MILLION (or so). It led to hog wild conservative celebrations, fist and chest bumps, hive-fives all around and lots of (weird) little victory dances.

    Compare that to saving those same taxpayers $26 BILLION per year, FOREVER.

    It’s SO basic, SO simple and would be SO beneficial to ALL Minnesotans . . . and it would be SO good for our economy in terms of people having SO much more money ($4,000, $5,000, $6,000) to spend on the products and services they need and want . . . that people — ANY people, but “conservative” people in particular — fighting tooth and nail to NOT allow that to happen has GOT to be one of the STUPIDEST things I’ve ever seen and keep having to watch.

    ESPECIALLY for anyone who thinks of or has the nerve to call themselves a “conservative.”

    Hello? You think saving MN taxpayers $650 million per year is a fantastic thing, but saving those same taxpayers $26 BILLION PER YEAR is something to be prevented at all costs?

    Again: Hello?

    In terms of “keeping it simple” and boiled down to the point where busy and distracted Minnesotans (and others) MIGHT be able to hear and relate to it (the argument Steve mentioned), do a simple survey:

    Ask MN voters if they think it would be better for them to save $650 million per year or $26 billion per year and see how the percentages come out.

    Every MN politician should do the basic research on this issue and, once they see it’s actually factual and true, START RUNNING ON IT.

    Kurt Daudt or Matt Dean or who knows who is going to run for Governor on the Republican side?


    Ask them what they think we should do about the hot and highly relevant issue of health care and watch them start dancing around and blabbing their usual negative “Obamacare, MNSure, Democrat’s fault,” mumbo jumbo.

    Ask them how their plan (if they come close to having one they can begin to explain) will improve Minnesota’s health care situation and how much money their plan will save voters.

    And when they get done sounding like they might not really know what they’re talking about (because none of them do) just say . . .

    “I’m not sure what you just said but it doesn’t matter . . . All Minnesota voters need to know is OUR health care plan will save them $20 to $25 billion — or $3,000, $4,000 or more — each and every year . . . AND we’ll ALL get better health care results than we’ve EVER gotten.”

    (Or something like that)

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