Reflections from 1992: DSA and Single-Payer

DSA has been campaigning for Medicare for All(M4A) for — well, a long time.  Universal health care has been a priority of the organization going on three decades now. In the early 1990s, DSA was part of a nationwide coalition promoting “single-payer” health care — M4A with less-catchy branding. Ultimately, Bill Clinton won the White House, and his administration promoted health care reform that was far short of single-payer and which ultimately failed. History echoes itself with the imminent arrival of another Democratic president whose health care agenda appears limited to supporting the Affordable Care Act, which also fell far short of M4A principles. Can Joe Biden be pressured to do more? This article that I wrote for the February 1992 Socialist, when I was a member of DSA’s national Health Care Committee, set out the state of play at a time that the single-payer movement was building momentum — and, as in 2020, a recession was making millions of Americans anxious about their own access to health care.

-- Bill Mosley

DSA Pushes Single-Payer Health Care Reform

By Bill Mosley

Health care is an issue that increasingly preoccupies both voters and politicians. The gathering recession — or should I say depression? — has illustrated the inadequacy of employer-based health insurance plans which vanish along with the job. The growing rolls of the unemployed mean an increase in the number of uninsured, now totaling 37 million nationwide.

Much was made of how Harris Wofford’s upset victory over Dick Thornburgh in the Pennsylvania Senate race constituted a mandate for health care reform. But what kind of reform? The leadership of the two major parties have put forward proposals ranging from the Bush administration’s universal health care identification as “a credit card with no credit” — to the Democratic “play or pay” scheme, which would require companies either to insure their workers or pay into a fund that would cover those without on-the-job insurance. While the latter would theoretically provide coverage to everyone, it would retain the employer-based system at its core, with its co-payments, inequalities in coverage, deductibles and ineffective cost controls.

Democratic Socialists of America, in contrast, is allied with organizations such as Citizen Action, Physicians for a National Health Program and numerous unions in calling for a “single-payer” system similar to Canada’s. In such a system, state governments would insure their entire populations without out-of-pocket costs, deductibles or co-insurance, with effective cost controls and universal coverage. A few Democrats have bucked the party line, most notably Rep. Marty Russo of Illinois and Sen. Bob Kerry of Nebraska, both of whom have introduced single-payer bills — as has independent socialist Rep. Bernie Sanders of Vermont.

The depth of concern of the health care crisis was illustrated by a series of town meetings held around the country on Jan. 14 by Democratic members of Congress. In the District, over 200 citizens packed DC Council chambers to hear Del. Eleanor Holmes Norton and a panel of notables underline the depth of the crisis. In the “speakout” portion of the evening, speaker after speaker expressed dissatisfaction with the status quo and called for change. Many speakers were representatives of unions, advocacy organizations and other groups (including DSA), and a substantial number spoke in support of the single-payer approach.

Meanwhile, Virginia Gov. Douglas Wilder, off the presidential campaign trail and for a change turning his attention to his state, promoted his plan to tax hospitals, nursing homes and doctors to offset the cost of health care for the poor. While bashing health care providers may be politically expedient, it ignores the fact that the real enemies of reform are the private insurance companies, who drive up administrative costs while scheming to deny benefits to anyone who has the temerity to get sick. Hospital and doctor fees are driven up by the complicated billing systems imposed by insurers and, in the case of hospitals, by the burden of providing uncompensated care. Providers are more victim than perpetrator, and only by replacing the insurance industry with publicly administered plans will these problems be tackled.

The heavy rhetoric and flimsy substance of the health care debate is understandable in light of the power of the insurance companies, whom most politicians fear to take head-on. That is why DSA and its allies are needed to stiffen spines in Congress and channel popular rage into articulate demands for meaningful change.

The DC/MD/NoVA DSA local, building on the success of last fall’s DSA-organized nationwide tour of Canadian physicians, labor leaders and officers of the socialist New Democratic Party, is answering this challenge on a number of fronts:

  • It is initiating a campaign to urge the DC Council to pass a resolution in favor of establishing a national single-payer health care system. This would be the first step toward educating and mobilizing the community toward the eventual goal, in the absence of a national program, of the adoption of a single-payer system for the District.
  • The local, as part of the local Reproductive Health Access Project, has published a critique of health care legislation pending before the DC Council.
  • The local will follow the progress of a bill introduced in the Maryland General Assembly by Del. Paul Pinsky of Prince George’s County to establish a single-payer health care system for the state and will work in conjunction with the Baltimore DSA chapter to mobilize support for it.

Editor’s note: Mosley ended the 1992 article with an invitation to join the local’s health care committee and attend the next meeting. We’ll instead note that our MDC DSA Medicare for All workgroup meets weekly on Sundays at 5 pm (here’s the next one) and hosts biweekly discussion groups. Watch the Update calendar for more.

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