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Is there an incremental path to Medicare for All?

March 3, 2021

Topics: Quote of the Day

We talked to Dr. Abdul El-Sayed about M4A and building a movement in the wake of Biden’s victory.

By Natalie Shure
The Nation, March 1, 2021

Even if the near-term dream of getting a Medicare for All (M4A) champion into the White House ended with the defeat of Senator Bernie Sanders’s 2020 primary campaign, the fight to win single-payer health care financing in the United States is far from over. The House and Senate M4A bills have over 100 Democratic cosponsors, and Congress’s insurgent left flank is growing.

Nonetheless, the path forward for any robust reform is challenging. Moderate congressional Democrats opposed to M4A still outnumber those in favor of it, and President Joe Biden is on their side.

But that’s no reason to despair, argue Drs. Abdul El-Sayed and Micah Johnson in their new book Medicare for All: A Citizen’s Guide.

Natalie Shure: You’ve stressed the importance of advancing the case for Medicare for All in the context of health care policy debates that are all but imminent with a slim Democratic majority under the Biden administration. How should Medicare for All advocates orient themselves toward incremental reforms, and differentiate between those that get us closer or farther from our goals?

Abdul El-Sayed: I have a pretty simple rubric: I ask myself, (a) Does it expand health care access generally? (b) Does it do so via public means? And (c) does it reduce the power and influence of health care corporations? If the answer to all three of those things is yes, then I support it. And if the answer to any of those things is no, I’ve got to take a far closer look, but usually I don’t. So, for example, take COBRA subsidies for people who have lost their employer-sponsored insurance. In theory, it’s going to extend health care access, but it does so by feeding money into the corporate health system, and doesn’t extend the footprint of public health care. So I don’t support COBRA subsidies: I think they fuel the brokenness of a system that does not do the job it’s supposed to do, which won’t address its own failures. Compare that to something like a public option—which, don’t get me wrong, has its real issues; but if you have a truly public public option that expands the footprint of public health care, expands health care generally, and reduces the power and influence of health care corporations, then I think it’s a plan we could get behind. But here’s the thing: We cannot accept that as the answer. We can accept that as a step toward the answer. I want folks to understand the difference. You can’t try to pitch it as the be all and end all of health care reform—only as a step toward a truly universal single payer system. But I’d rather take a step forward than a step back, and I’d rather take a step forward than staying where I am.



By Don McCanne, M.D.

Incremental steps toward single payer Medicare for All reform have always been controversial. Medicare was to have been a first step toward universal health care, but, after over half a century, we still do not have universal coverage. Many hoped that the incremental changes in the Affordable Care Act would lead to universal coverage, but it has locked into place many of our profound deficiencies in health care financing and clearly needs to be replaced, rather than simply being tweaked further.

The immediate prospects for single payer reform are virtually non-existent. We have elected a president who is steadfastly opposed and is extracting from his potential cabinet members a promise not to advocate for single payer.

What do we do for the next four years? Above all, we should continue to educate and advocate for Medicare for All. Support is growing and will continue to grow as more people come to understand the imperative of the model. In the meantime, there will be opportunities for incremental advances. Incremental improvements could be beneficial, but they risk delaying the end goal of a universal single payer system because of the inertia that follows reform efforts.

It is important that any incremental measures would move us closer to the ultimate model. As Abdul El-Sayed says, interim measures should expand health care access, through a public process, while reducing the power and influence of health care corporations. Although he can support a properly designed public option, he makes clear that we cannot accept that as the answer, but only as a step toward the answer.

The question is, would it be possible to enact a public option that would be a step toward single payer? It would have to be designed much like current insurance products since the intent is that it would compete with private insurance. As an incremental step, it would have almost nothing in common with the desired end result. You couldn’t very well pay for it through equitable taxes and give it free to the recipients while others continue to purchase their insurance using premiums or forgone wage increases. We do not need another insurance product; we need single payer, improved Medicare for All.

So let’s not divert our energy toward incrementalism. We need to keep on with education, coalition activities, and grassroots efforts. Right now we need to target that toward Present Biden. If the nation demands Medicare for All, he’ll have to yield.

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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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