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My View from the Front Lines of the Single Payer Movement

May 5th, 2017 / Andrew Dana Hudson

Yesterday Congress passed a bill that would unravel much of the Affordable Care Act, lurching American healthcare towards a new era. It’s a dark moment for many of us who have worked to implement the ACA and improve the lot of the vulnerable and the uninsured. While many are pinning their hopes on moderate Senate Republicans who may block the bill, I have my eye on a very different bill currently making its way through the California state legislature.

Last week the California Senate Health Committee put its stamp on SB562, the Healthy California Act. The Healthy California Act would create a single payer system in our state. The dream of health reform advocates since it was first proposed 100 years ago, single payer is a system where the state pays private providers to care for everyone. SB562 would cut out the middlemen that take 30 cents out of every healthcare dollar and eliminate the premiums, copays and deductibles that force so many to forego care they can’t afford. It will finally affirm that healthcare is not a privilege but a human right, making sure that every Californian gets the care they need—including mental, dental and vision—regardless of wealth, immigration status or pre-existing conditions.

This win came thanks to the tireless organizing efforts of the nurses’ union and community activists, thousands of whom travelled to Sacramento last week for the hearing. I was among them, traveling by bus with 30 fellow members of the East Bay Democratic Socialists of America (DSA). We gathered with the nurses to hear activists like Michael Lighty and the two sponsors of the bill, Sen. Ricardo Lara and Sen. Toni Atkins. Then we marched on the capitol in a sea of red t-shirts to push the committee to advance the bill.

It was incredible to see the diversity of the people who showed up: nurses, doctors, educators, union organizers, immigrant-rights advocates, disability activists, small-business owners, and patients of all backgrounds. When so many people in healthcare are feeling put on the defensive, that march proved that there are huge and passionate communities who believe now is a moment when we can make positive, transformative change.

Single payer may be a common sense policy (universal healthcare is embraced in some variation by every other industrialized country in the world), but winning it in California won’t be easy. Twice under Gov. Schwarzenegger the CA legislature passed a single payer bill, only to see it shot down by the Republican. Now that a Democrat who ran for president on single payer is governor—though Gov. Brown has expressed skepticism about the costs the plan—the calculus has changed.

Already insurance lobbyists are starting to dial up the pressure on lawmakers, and concern trolls are coming out of the woodwork to demand an end to “moralizing” about universal healthcare. Health Committee approval was a big win, but there are even bigger fights ahead if the bill is going to get through Appropriations, through the Senate and Assembly, and signed by Jerry Brown. Prepare for television ads and astroturfing campaigns focus-group-tuned to produce anxiety: “SB562: Not the right time, not right for California.” They’ll call it a job-killer and a budget-buster—anything to distract from the fact that for-profit insurance puts patients in impossible situations as a matter of policy.

Three million Californians remain uninsured, and millions more risk medical bankruptcy if they get hurt or fall ill. The patchwork of provider networks create barriers to care, and the profit-seeking bureaucracy of private insurance creates incentives that put shareholder earnings ahead of patient needs and outcomes—no matter how compassionate the individuals running those companies may be. These are moral issues that everyone who serves the safety net encounters every day.

While the state has made great gains through implementing the ACA, the looming gutting of healthcare reform means we can’t sit idly by. Now the nurses who showed up at the capitol say it’s time for California to lead, to be proactive about imagining and enacting a new healthcare system that centers equality, freedom and solidarity over corporate greed and free market fantasies. A single payer system in California could cascade across the country (as provincial universal healthcare programs did in Canada), finally achieving the dream of an America where the poor are not asked to die for the health of the rich.

The experience I’ve had organizing for the Healthy California Act has been one of the most energizing things I’ve done in either politics or healthcare. While canvassing and phone banking, I’ve heard stories of people denied the care they needed, lost in a maze of contradictory paperwork, and trapped in dead-end jobs because they couldn’t afford to lose their coverage. Even with all the progress that’s been made, Californians still see the system as broken.

And it has been broken for so long that many of us, particularly in the safety net, have decided to simply put our heads down and try to help the patients that make it to our door. But if you are jaded by the decades of failures and backsliding in the battle to fix the Frankenstein’s monster of American healthcare, let me tell you: this time is different.

There is a vigor and urgency to this movement that even activists who have devoted their lives to single payer say they’ve never seen before. I’m hopeful that this is the start of a groundswell of people power we need to push past the big money interests that uphold our current system. Every month the DSA and others are reaching more people in our communities, and each of those people who talks to their friends and coworkers or comes out to the next canvass amplifies our movement. Single payer is the intersectional cause that can define California as a beacon of progress in this dark political moment—and it’s a fight that we can win.