Bernie’s Medicare-for-All Is Great–But the Real Work is in Blue States

It’s midnight here on the West Coast, my power is out due to a scheduled outage until 9amPST that I forgot about, my laptop has only 30 minutes of battery, and I’m running my Internet on my mobile hotspot, so this post won’t be long or detailed–but I wanted to get the post up and the thought out for the East Coast morning crowd. So apologizes for the brevity and lack of links, but here goes:

Bernie Sanders is coming out with a Medicare-for-All proposal in the wake of the shipwreck that is Trumpcare. That is precisely the right idea and the right message. Rather than sit on the laurels of a victory sustained largely by the immense cruelty of the farthest reaches of the Republican caucuses, it’s best for Democrats to acknowledge that while Obamacare did improve the American healthcare system, it remains deeply broken. Sanders–whose popularity remains extremely high with the American public–is leading the party in the right direction on the issue.

However, at a national level this is purely a message bill. There’s an infinitesimal chance that Trump could realize that the best way to fulfill his populist pledges on healthcare is to move drastically to the left, leave the Freedom Caucus and Paul Ryan behind, and work with Democrats and moderate Republicans to install a public option, lower the age of Medicare eligibility, and get rid of some of the more gimmicky taxes in Obamacare for a “compromise” package. If Trump were smart, that’s what he would do. His base will follow him to the ends of the earth and will eat up the idea of a public option if he sells it to them, no matter how loudly Rush Limbaugh, Stuart Varney and the Koch Brothers may shriek. But it’s extremely unlikely. Rather, Medicare-for-All is likely to just be a message bill at the national level–a signal to voters that the Democratic Party is ready to move forward to really fix the American healthcare system if given a chance.

The real work toward single-payer healthcare is in the states. Back in the late 2000s, there was an aggressive push in many blue states for state-based single-payer systems. Many states came very close to implementing them. But the momentum was ironically thwarted federally by the passage of the Affordable Care Act. Democrats in blue states sidelined single-payer in order to help make the Affordable Care Act’s exchanges work, and so the movement toward Canadian-style healthcare in the United States fizzled out for years.

But even with its failure, Trump’s determination to sabotage Obamacare combines with the precarious ecosystem of the insurance exchanges–not because of problems with Obamacare itself, but because many insurers simply don’t see enough profit in them to continue cooperating. The Affordable Care Act will still be a boon if the exchanges fails because of the Medicaid expansion and the regulations on insurers (in addition to the redistributive taxes), but the uncertain future of the exchanges highlights the need for action toward state-based public options and single-payer alternatives.

The influx of Sanders-style progressives into the local and states Democratic parties is combining with the re-engaged activism of many long-frustrated single-payer advocates to reignite the flames of state-based single-payer systems. Watch for a raft of resolutions and actual legislation toward that end from blue states around the country in the coming months. That’s where the real work will be.

David Atkins

David Atkins is a writer, activist and research professional living in Santa Barbara. He is a contributor to the Washington Monthly's Political Animal and president of The Pollux Group, a qualitative research firm.