Medicare for All is a Fight to Democratize the Economy
Monday, December 31, 2018
PAUL JAY: Welcome to the Real News Network. I’m Paul Jay. We’re in Burlington, Vermont at the Sanders Institute Gathering. One of the main themes of this conference, and sure to be one of the main themes of the run-up to the 2020 elections, is healthcare, and the demand or call for Medicare for All. One of the people who is very involved in this campaign, Kelly Coogan-Gehr, is the Assistant Director of Public and Community Advocacy at National Nurses United. She served as Education Director for NNU and the Director of the Washington State Labor Center, and as a labor representative for healthcare workers. Kelly currently helps operationalize NNU’s national Medicare for All campaign. Thanks for joining us.
KELLY COOGAN-GEHR: Thank you.
PAUL JAY: You opened the panel yesterday, which was on healthcare—which is, as I say, one of the, according to polling, the number one issue that everyone was concerned about in the midterm elections, and sure to be at the top of the agenda for 2020. The campaign for Medicare for All, which everyone who watches us knows what that’s about, it’s a reform that’s very important. People are very involved in it. But even if you win it, it on itself doesn’t transform what’s happening in this country. You tied this together in your panel in an interesting way, where you talked about this is a way to get people engaged in the whole question of democratization.
KELLY COOGAN-GEHR: That’s right. That’s right.
PAUL JAY: What were you getting at?
KELLY COOGAN-GEHR: One of the things I said in those opening remarks was that, yes, everybody knows that Medicare for All guarantees healthcare to all Americans. Yes, most unions understand that by de-linking healthcare from employment status it increases the industrial power of working people, Medicare for All would. But what we are seeing with the fact that right now 18% of our gross domestic product is spent on healthcare, by 2026 it will be over 20% of our gross domestic product, that’s an entire fifth of our economy. So essentially what Medicare for All would do is bring back to the people a fifth of our economy, is essentially democratize an entire fifth of our economy that’s now essentially extraordinarily privatized, and not only that, but profiting off of the suffering and pain of most Americans.
PAUL JAY: The link between the campaign and the bigger picture is partly about this economic democratization of a sector of the economy. But in Canada, we kind of have that. I say we because I grew up in Canada. That in itself doesn’t get there either because you can’t say Canada’s fundamentally different, in terms of its politics, than the United States. We have a premier in Ontario who’s pretty Trump-like, Rob Ford.
KELLY COOGAN-GEHR: That’s right. If I could just interrupt real quick. I mean, I think that one of the reasons why people are craving a mechanism that—to say it socializes medicine is not quite correct. I mean, the government would be the single payer of the healthcare system. But we are in a proto-fascist moment right now. I mean, as you just said, the deep economic discontent and frustration that economic neoliberalism has created amongst the working class is being articulated in these horribly racist ways and these sexist ways. So, I think that the left is understanding that we need a broader movement, and that broader movement is in healthcare justice, to really mobilize people around fighting for their economy. Not just for their healthcare, but for their economy.
In Canada, and the same goes for NHS, privatization is just absolutely rearing its ugly head. That’s why our nurses here in the United States are really in support of the National PharmaCare campaign that’s happening in Canada right now because pharmaceutical pricing is the third worst in the world. One in five families can’t—and this is in Canada—can’t afford drugs. The only way that a Canadian can actually get a prescription covered and paid for is if they’re admitted into the hospital. So you have Canadians for arbitrary reasons trying to get admitted into hospitals just so that they can be prescribed medications. So, it’s not a perfect system. And because we live in a capitalist society, we are always going to be fighting against the encroachment of privatization. There’s always gonna be various entry points for privatization.
We see with the NHS that that’s what in terms of the public-private partnerships that are happening right now with the private finance initiative. This is what’s happening, is that essentially the private sector, through austerity measures, is trying to come in. The government starves the system. It makes the system inefficient, understaffed, and then the private sector comes in as this knight in shining armor trying to save the public system from itself, when it’s really the austerity measures that created the problem in the first place. So, any time … I mean, that’s what capital does. Capital finds the rifts and the cracks and it finds a way to get inside them. So, of course winning Medicare for All isn’t gonna be the end all, be all.
This is one of the things that National Nurses United has been saying for years, is that the core issue is not just democratizing our healthcare system. It’s also addressing underlying problems of healthcare restructuring, which bring Taylorism into the healthcare workplace by trying to make work practices more efficient.
PAUL JAY: Taylor’s the guy that did the time clock on the automobile assembly line.
KELLY COOGAN-GEHR: That’s right. And trying to find ways to de-skill and displace through health information technology.
PAUL JAY: Well, I think you’re making a really important point. I don’t hear it being made very often. Bernie in his talk yesterday was talking about it’s not just about concentrated wealth. Concentrated wealth is concentrated political power. But he didn’t go, to my mind, the next step, which is what do you do about that concentrated wealth and concentrated power? I don’t see how you counter that without building out the public sector. The most, fifth of the economy, if you turn that into public sector, you start to take away some of that power.
KELLY COOGAN-GEHR: That’s exactly right. I also think that the way to counter it, and this is why NNU has turned to this methodology of big organizing, the way to counter it is actually to build a social movement that scales very quickly. I know that, for those folks who heard the panel, they heard that we don’t counter ourselves to the Saul Alinsky model, but we build on the Alinsky model, so the-
PAUL JAY: Explain what that means for people who don’t know.
KELLY COOGAN-GEHR: Basically it’s, and no one thinks that this would ever be replaced, but the idea of the significance of the one-on-one personal conversation, the one-on-one organizing conversation, the one-on-one relationship to build trust. From there, workers become empowered, and ideally over time they set up organizations that represent their interests, and essentially get them a seat at the table. But we have seen for the past half century what getting us a seat at the table has looked like, and particularly in healthcare. You go back to the 1950s. Yeah, union contracts guaranteed workers healthcare for life. We had 33% union density. That’s not the case anymore. I mean, work is too precarious. Union density is too low. No one can count on a job for life. But we gave up some of our biggest weapons, the primary one of those being the strike, to have a labor management partner relationship where we would be guaranteed certain benefits for life, and one of those was healthcare. In that, we lost a great deal of power.
So, we are saying right now that we need to build on this Alinsky model, because it’s not scaling up quickly enough. What we want to do through that is use the technologies that mediate our every day lives to help us literally reach hundreds of thousands of people in a matter of weeks.
PAUL JAY: The movement’s obviously having quite a bit of success. This Medicare for All is becoming a common term. A lot of people running for office are campaigning on it, and some winning on it, to the extent Karl Rove just the other day wrote an op ed in The Wall Street Journal, I think it was, talking about how to fight this growing socialism.
KELLY COOGAN-GEHR: Which is such a sign of our success.
PAUL JAY: Well, the fact that Karl Rove’s against it is a no-brainer, and it is a sign of success that he has to write an op ed like this. But some of the opposition is inside the Democratic party. It’s not the Karl Roves that’s the problem. In California, you try to pass-
KELLY COOGAN-GEHR: This will be our biggest form of inoculation.
PAUL JAY: Yeah, you almost passed it, and it was actually within the Democratic party that it didn’t pass. What’s the state of that fight?
KELLY COOGAN-GEHR: The way we look at it over the next year is there’s gonna be three primary areas of inoculation. Everybody really knows the first two, the for-profit hospital industry and the pharmaceutical industry. But the third most people don’t know, which is what you just named, the extreme center of the Democratic party. What they’re gonna propose is a public option, something like a Medicare Extra, Medicare Advantage, Medicare buy-in. What a public option does is yeah, it creates an option for people to get publicly funded healthcare, but who’s gonna get that healthcare? People who are gonna opt to get that healthcare are gonna be the sickest individuals. So what it’s gonna do is it’s gonna make it look like single payer would be extraordinarily expensive because while this public option is covering the sickest individuals, those who would essentially be cherry picked are gonna self select into insurance. And insurance, by some miracle then, is gonna be able to cover everybody so much more cheaply, and the neoconservatives and the libertarians are gonna take this and run with it, and make it evidence for why a single payer system won’t work in our country. And so we are trying to get-
PAUL JAY: Just to be clear for people who haven’t been following the issues so much, this is kind of what was proposed back during the Obama-
KELLY COOGAN-GEHR: Yeah, that’s right.
PAUL JAY: And the hearings where Bacchus was there, and they gave up on it. But the idea is public option would compete against private insurance companies, so a big open market.
KELLY COOGAN-GEHR: That’s right. The private insurance industry still remains in the driver’s seat. Our fundamental position is that the private insurance industry must be taken out of the driver’s seat. Human need needs to be in the driver’s seat. The public option leaves the private insurance industry essentially intact. And again, puts all the sickest individuals taking in that option, making it look like more expensive than it is. It’s going to set us up for failure.
PAUL JAY: To return to the theme, there’s a whole section of the leadership of what some people call corporate Democrats-
KELLY COOGAN-GEHR: Yes, that are proposing this.
PAUL JAY: That hate the Medicare for All and want to defend the insurance companies.
KELLY COOGAN-GEHR: That’s right.
PAUL JAY: How is that fight inside the party going to unfold?
KELLY COOGAN-GEHR: Right now, and this is the kind of thing that’s happening in our table in DC. Over the summer in July, NNU worked with Pramila Jayapal to establish a Medicare for All caucus in the House. This is not gonna be a fully adequate answer to the question that you asked, but basically the entire role of that caucus is to educate members of the House. This would be those who are on or willing or interested in getting on HR676, the expanded and improved Medicare for All Act, about what single payer actually is.
PAUL JAY: Couldn’t you get one of the committees to hold hearings, with subpoena power, and make a big drama out of it?
KELLY COOGAN-GEHR: What we’re trying to do is, and we’re trying to use the field campaign to do that. Right now, what we’ve got set up, and this is happening, it’s in the works right now. It’s leading up to a climactic week in February, from February 9th to the 13th. We are targeting key Democrats in the Ways and Means Committee, and Energy and Commerce Committee. These are the two regulatory committees for the House. In order for the bill to get a hearing, it has to get through these committees. So, we are going to hold something called a barnstorm, which is an organizing meeting that has a built in action component, and also has a built in ladder of engagement, so that people come to that meeting, they do an action right on the day of the meeting itself, but they’re also given a long term plan of engagement that’s extraordinarily concrete and that is designed to hold them accountable to literally put in thousands of phone calls in each of these districts for these representatives to get on the bill, to support the bill.
PAUL JAY: Because it seems to me there’s gonna be a fight in the party.
KELLY COOGAN-GEHR: Of course.
PAUL JAY: Over-
KELLY COOGAN-GEHR: There already is.
PAUL JAY: Oh, I know. Over these hearings, either focused on trashing Trump, or the hearings … I mean, fine. Trash Trump, but are there gonna be hearings that really create a vision for new policy?
KELLY COOGAN-GEHR: There better be. I mean, 70% of the American people have been demanding this. We have a bunch of freshman electeds who ran on Medicare for All. I think that actually their ability to make this a core issue in the next legislative session is gonna determine whether or not a lot of these people get reelected.
PAUL JAY: All right. Thanks for joining us.
KELLY COOGAN-GEHR: Thank you.
PAUL JAY: And thank you for joining us on The Real News Network.