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Why Single Payer Medicare for All is an Imperative for Labor

June 11, 2019

Topics: Quote of the Day

By James G. Kahn
New Labor Forum, 2019, Vol. 28(2)

Public support for single-payer insurance is astoundingly high, with 68 percent in a recent poll placing high importance on achieving it. The most vociferous supporters are progressives and minorities, but single payer garners support from across the political spectrum. Single payer insurance is not just a policy tweak, nor another layer of complexity on our health-care non-system. It’s revolutionary and transformative and has the potential to both benefit from and build powerful coalitions.

The same cannot be said for all approaches offered by Democrats. They have also proposed several bills for Medicare expansions—mechanisms for individuals to “buy in” to Medicare coverage. At first, they sound attractive, an incremental insurance expansion in the direction of Medicare for All. But close consideration reveals fundamental flaws. There is a long list of reasons that all of us—and especially the labor movement—should oppose these Medicare-for-All impostors in favor of the real deal.

Where should labor position itself? Supportive of any “Medicare” expansion? Or resolutely committed to Medicare for all? After 25 years researching, writing, educating, and advocating in this arena, I propose that single payer is the only solution consistent with universal, affordable health care and with the solidarity values long supported by the labor movement.

Why? There are 13 reasons that Medicare for All is superior to Medicare buy-ins:

  1. Medicare for All insures everyone.
  2. Medicare for All insures everyone well.
  3. Medicare for All keeps everyone in the same game.
  4. Medicare for All removes health care as a bargaining burden.
  5. Medicare for All delinks health care and employment.
  6. Medicare for All enhances administrative efficiency.
  7. Medicare for All controls health-care costs in other ways.
  8. Medicare for All enhances quality.
  9. Medicare for All reduces clinical waste and fraud.
  10. Medicare for All empowers patients.
  11. Medicare for All empowers doctors (and other providers).
  12. Medicare for All fosters a comfortable and lasting patient-doctor relationship.
  13. Medicare for All ends battles to protect myriad pieces of the current health system.

For complicated reasons, largely centered on employer-based health-care plans, some unions have opposed single payer. This misses larger considerations: single payer is about supporting working people (and the unemployed, and the rich) with the resources needed for a comfortable, secure life. The labor movement did as much as any great social reform to foster health and security. Single payer is the next great step in this tradition.

Let coworkers know what the real Medicare for All is: Everyone is covered, with the same comprehensive benefits package, from cradle to grave. This is critical to reduce the opposition of some unions, which represent a large portion of workers with employer-provided health care, but a small portion of working people overall. Everyone needs to understand that true Medicare for All is the only way to assure excellent access to health care, regardless of income and employment, and to empower providers and patients to focus on quality care and on each other, not on insurance glitches and administrative paperwork.

James G. Kahn, MD, MPH, has been a professor of health economics at the University of California San Francisco for 30 years and has been active in Physicians for a National Health Program, including president of the California chapter, since 1994.

(This article appears in the spring 2019 issue of New Labor Forum, published by the CUNY School of Labor and Urban Studies. The journal appears three times a year and includes articles on issues relevant to organized labor and working-class communities.)


For the full article:


By Don McCanne, M.D.

Labor would benefit greatly from enactment and implementation of Single Payer Medicare for All, yet some in the labor movement remain reluctant to give up health plans they have won through labor negotiations. This article explains why labor should welcome the change to a program that is truly universal – including all labor, that is fully prepaid, that is permanent and will always be there, and that expresses the solidarity that has long been supported by the labor movement.

The link (above) to the full four-page article should be distributed widely to be used to explain to labor why Single Payer Medicare for All deserves their strong support, not to mention using it to bring the entire nation into solidarity behind this truly egalitarian proposal.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

About the Commentator, Don McCanne

Don McCanne is a retired family practitioner who dedicated the 2nd phase of his career to speaking and writing extensively on single payer and related issues. He served as Physicians for a National Health Program president in 2002 and 2003, then as Senior Health Policy Fellow. For two decades, Don wrote "Quote of the Day", a daily health policy update which inspired HJM.

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