Medicare for All is what the new left theorist Andre Gorz termed a “non-reformist” or “revolutionary” reform.  Although it may seem like a contradiction to pair revolution and reform, it isn’t necessarily. Typical reforms make people’s lives better in the short term but fail to challenge the basic capitalist structure or position us to fight it. Non-reformist reforms do both.  They not only fulfill an immediate need, but also change the public’s thinking about capitalist social, political, and economic structures, enabling people to imagine and work toward an alternative to the current capitalist structure.

Medicare for All would create a fully comprehensive public single-payer system, and in doing so would change basic structures by dismantling an entire industry. Thus through the fight for publicly financed universal health care, we can demonstrate the value of socialized services generally. Medicare for All is an ideal vehicle for this message because healthcare touches everyone from cradle to grave and because most people in the U.S. are adversely affected by healthcare’s astronomical costs.

Boston Democratic Socialists of America (BDSA) recently adopted the fight for single-payer universal health care as a chapter-wide priority; most recently, our work has focused on H.R. 1384, a bill Representative Pramila Jayapal introduced in Congress this February to create a  single-payer national insurance program. The fight for universal care is such a sea change in how the US finances healthcare that it requires many groups to collaborate in order to create a mass movement that cannot be denied. In that sense, the growing Medicare for All coalition can be thought of as a “popular front” working together against the powerful medical-industrial complex (e.g., private insurance, the pharmaceutical industry, and large health provider organizations). Below, we describe how BDSA’s health working group has sought to create just such a powerful coalition with other national and local groups.

Why is this fight so important? The US healthcare system is fundamentally broken. We have the highest healthcare costs per capita in the world, and yet we fail to cover millions. Even those with insurance are vulnerable, as far too many are under-insured, leading to high levels of medical debt and bankruptcy—two things that are unheard-of in most other similarly wealthy nations. We also have relatively poor health outcomes compared to other comparable nations. There is a simple explanation for all of this.  We are the only wealthy nation that treats healthcare as a commodity rather than a basic human right. Creating a universal single-payer system such as Medicare for All can solve all of these problems. But fighting for Medicare for All is important for a socialist organization for other reasons as well. Not only will it materially improve the lives of millions of people; it is the type of reform that can provide a gateway to understanding and implementing socialism.

Coalition work advocating for H.R. 1384. As sensible as adopting a single-payer system would be, reforming this system is not a trivial undertaking. Although many effective public models exist around the world, none were created in a place where a large and entrenched private system already existed as it does in the US. Give this situation, it is impossible for a single organization to take this project on alone, and we need to work in coalition with a broad range of groups.

Consequently, BDSA has been working in coalition with multiple organizations to advocate for H.R. 1384. Our coalition partners are National Nurses United, a labor union, Healthcare Now, a national non-profit dedicated to achieving a single-payer healthcare system, and Our Revolution Cambridge, a local affiliate of a national multi-issue grassroots political action group. For this work, we co-hosted barnstorms to organize a grassroots campaign consisting of phonebanks and canvasses.  In total, the coalition organized two barnstorms with over ninety participants, and organized a grassroots campaign of over forty phonebanks and canvasses following from that.

This work targeted two Massachusetts representatives, Joseph Kennedy and Richard Neal.  We selected Kennedy for two reasons. First, he is a member of one of the Congressional committees through which H.R. 1384 must pass before it can reach the floor. Second, he is in a relatively progressive district, and we therefore considered him low-hanging fruit. We were successful in pressuring Kennedy to sign on as an original co-sponsor of the bill. Even though his district is not as progressive as Kennedy’s, we selected Richard Neal because he chairs another committee through which the bill must pass to reach the floor. Neal has not yet signed on, but we organized thousands of phone calls to constituents educating them about Medicare for All and inspiring them to make hundreds of calls to Neal’s office.

BDSA is continuing its collaboration with Healthcare Now and Our Revolution Cambridge to create a local Boston Coalition for Medicare for All building on our existing work. We hope to influence the coalition as it grows so that it is focused not just on nationalization of health care payment, but also on reforming the health care system more generally such that it is de-commodified entirely—nationalization of health care provision.

Coalition work on drug pricing. BDSA has been working in coalition with the Right Care Alliance (RCA), a nonprofit political action group comprised primarily of patients and healthcare providers. Although RCA is not a multi-issue group like BDSA or OR-Cambridge, their stated mission is broader than that of Healthcare Now; they advocate for healthcare equality and placing patients over profits, rather than for a specific set of legislation. RCA’s past actions have focused mostly on drug pricing. Currently, they are holding a series of political educational talks discussing the state of healthcare and the future of the US healthcare system to help shape their vision for the future. DSA members are attending these talks and participating in the conversation. Many members of the RCA are not explicitly socialist, and some initially considered some of our ideas to be unrealistic. However, as the conversation has progressed within the group and in the wider political realm, many have come to see that a single-payer (i.e., nationalized or socialized) healthcare payment system is the most effective way to guarantee access for patients. We are already seeing how our coalition work is convincing people of the value of socialist solutions.

We have participated in several direct-action protests with the RCA, and are planning more.  One of these, which occurred in November of 2018, took place at the offices of Sanofi, one of the world’s leading producers of insulin. The three main producers of insulin, Sanofi, Eli Lilly, and Novo Nordisk, have allowed the prices of this life-sustaining medicine to skyrocket up to one thousand dollars per month. The protesters were led by the parents of two young people who had died because they could not afford insulin. The parents brought vials of their children’s ashes to present to the company’s executives as a testament to the loss they had sustained due to high drug prices. Instead of meeting with these grieving parents, the company shut down for the day, sent all of its workers home, and ensured that the entrances were blocked by police officers when we arrived.

Nevertheless, the rally continued, and the parents and several current patients spoke movingly to the crowd. We considered the action a success, as it garnered significant attention from news and social media, including a video on Twitter that received two million views. Because of actions like this, we have seen serious dialogues about drug pricing begin in the halls of Congress.

Value of and challenges to our coalition work. Many of our coalition partners within the health justice movement are issue-specific and thus do not have BDSA’s broad political vision. For example, for some, improved and expanded Medicare for All is the end goal. Others may share a broader vision but not necessarily an explicitly socialist one, as in the case of Our Revolution. For now, BDSA can work with them to achieve non-reformist reforms such as nationalizing our health payment system. When we eventually achieve that goal, we may need to split off from some of these groups to push for the nationalization of healthcare delivery as well. We hope to educate our partners so that they will travel further along this journey with us. But above all else, we see this work as part of a broader political project. It is important to keep in mind our long-term goals—complete de-commodification of the healthcare system—and our broad vision—socialism. This means not becoming co-opted by short-term victories, as powerful as some of them may be.  And while in the short term we need to be respectful of others’ views to sustain the coalition, we should educate them about our longer-term goals and broader vision, as we have successfully been doing with the RCA and hopefully will be within the Medicare for All Coalition.

An additional challenge for our coalition work is that many of our partner organizations are either nonprofits or unions.  These groups tend to adopt far more top-down decision-making processes than do grassroots organizations such as BDSA or OR. Thus, at times we may have to decide whether we will go along with or modify actions that are not what we would have chosen through our usual democratic process.

Despite these challenges, working in coalition on such a massive undertaking as reforming our healthcare system has great rewards. Coalition work enables us to share resources and learn from others in the coalition, drawing on expertise we may not have in-house. Most significantly, being part of a larger movement makes us more powerful and more resilient in the fight against capitalism. Finally, our coalition work on revolutionary reforms has already created small victories, demonstrating to us and our partners that overturning the capitalist economy and creating a juster system is possible.

Written by Louise Parker and anonymous. To learn more about Boston DSA, visit their website and follow them on Twitter.