As a healthcare activist and someone with a chronic medical condition, the fight for Single-Payer is one I feel compelled to wage until it is successful. This is, perhaps, the least controversial social welfare program being discussed at both the state and federal levels.
The Affordable Care Act continues to see insurers leaving the market as a result of Republican/Trump sabotage over Medicaid expansions and national legislation, such as the AHCA, threatening to overhaul the system into a veritable tax cut for the wealthy. Premiums continue to rise, and the market itself is on the brink of collapse.
I have three prescription medications I must take every day. I have to be able to see doctors at a moment’s notice. This fight isn’t a choice for me, nor is it one for the 3+ million uninsured Californians, nor the millions more of under-insured whose plans cover very little, or cost so much as to make the ‘benefits’ unaffordable and seeking care unreasonable.
California, we’re told, is a ‘blue state’ — it will continue to be a bastion of liberal democracy in the face of Trumpism. The state legislature boasts a super-majority of Democrats and a Democratic governor in Jerry Brown, who used single-payer healthcare as a campaign rallying point during his 1992 Presidential run. This state will surely lead the way on healthcare, much like it has in the past with other social issues, such as gay marriage, abortion rights, and marijuana legalization. Right?
Independent journalist David Dayen has made covering the California legislature’s handling of healthcare a priority. He followed the movement of SB-562, a state single-payer bill, through the state legislature. Dayen’s thorough journalism noted a few exceptional flaws in the process in two separate pieces published in The Intercept, along with scores of podcast/radio appearances.
Dayen presents himself as on the side of single-payer, and the problems with SB-562 he points to, along with another recent article on the promise of a single-payer system in Maryland, give no reason to doubt his sincerity.
SB-562 was made overly-complicated apparently by design and seemed never to have been considered with the attention it needed from the beginning. Senators Ricardo Lara and Toni Atkins wrote SB-562, entitled the “Healthy California Bill” by the California Nurses Association (CNA), the bill’s sponsor. SB-562 sought to provide a comprehensive single-payer healthcare system to the state of California, funded by progressive taxation. The bill was debated at length, appropriated, and passed by the state senate before moving on to the assembly — the two steps required in order to send the bill to the governor’s desk for signature. After its senate passage, a week went by and nothing new happened. And another. Then, on a Friday, at 5PM, as the second administrative week after its senate passage came to a close, Assembly Speaker Anthony Rendon announced he would be shelving the “woefully incomplete” bill indefinitely.
Dayen’s sharpest critique is of the California senate’s intentions: in his view the senate passed a shell bill and left it to Rendon to fall on his sword in the service of the insurance and pharmaceutical industries. Democratic state senators with higher political ambitions, Dayen plausibly claims, passed SB-562 in its unworkable condition as political cover — to wrap themselves in the cloak of Medicare for all support while simultaneously ensuring it would not come come to pass.
Dayen’s criticisms are worth mentioning — he correctly noted a few aspects of the bill that require addressing before it can pass through the current legislative process. He accurately pointed out that there was more the Senate could do, even while the bill remained shelved in the Assembly. He noted the Prop 98 provision, which would require a statewide ballot initiative to ever fund SB-562. These details weren’t well known or understood publicly, even by citizens aware of the single-payer bill. This wasn’t Dayen’s focus, though — that was the appetizer. He decided to place the majority of the blame for the shelving of this bill on healthcare activists and organizers, who he said “deceived’ the public about SB-562.
Blue State Californians, represented by a super-majority of Democrats, are now all as vulnerable to the national healthcare fight as the rest of the country, forced to follow regular updates about national Republican legislation seeking to strip somewhere between 22–35 million people of their health coverage. Speaker Rendon has done nothing to work on the bill, and activists — the CNA and others — recognized his inaction as unacceptable.
Dayen often clarifies that he’s referring only to the CNA when he talks of the “organizers” who sabotaged his bill, but the attempted guilt-by-association seems clear. A follow-up article then detailed what he sees as a “fracturing” of the single-payer coalition in California, with the CNA at fault for their aggressive tactics and scapegoating of Anthony Rendon as the “sole” obstacle to passing a workable version of SB-562.
Dayen is interested in taking a step back, discussing the nuances of the bill, and outlining the mechanisms and procedures needed to get a final version of SB-562 passed. He’d like to stop focusing on Rendon, and instead shine a light on the ineptitude of the entire California legislature. But when he grinds it all down to a fine powder, Dayen sees one perpetrator — the “organizers” — which again, for Dayen, means the California Nurses Association.
As an organizer who works alongside, but never directly for CNA, I believe it is essential to note that our fight is not quixotic. We have always been aware of the challenges mentioned by Dayen, but we’ve felt — and continue to feel — a strong need to push this bill forward because we don’t have any other choice. Our back is up against the wall, and lives, including my own, are at stake.
Activism is bigger than the state legislature, bigger than the sponsor of what can still be an effective bill with far reaching positive societal impacts. The fight doesn’t end when a bill is shelved, legislators stop deciding to do their jobs (if they ever start), or when a journalist presents potentially de-mobilizing facts about the process.
Organizers who want single-payer are seeking to create a people’s movement with collective action. Single-payer is the best path forward for healthcare in America, which is something Dayen has acknowledged. The focus for organizers must be on the dramatic effect a workable single-payer health distribution system can and will be. CNA knows this, as do all organizers and activists fighting this battle.
This perhaps comes down to a disagreement over tactics. The CNA has focused on this issue, emphasizing the most prominent obstructionist members of California’s state legislature, while Dayen blames the CNA for downplaying the obstacles on the potentially years-long path to single-payer on a state level.
Single-payer is on the horizon. But with ACA market exchanges collapsing and insurers pulling out of state markets, the question we must ask is whether this will be a publicly-funded social welfare program or a statewide marketplace controlled by a corporate insurance monopoly. The latter will price out the people who require care most and leave them to die, while the former is the only hope for millions of Americans like myself.