The Battles Ahead: Meet the Biggest Opponents of Single-Payer

This piece is part of Fighting for Our Lives: The Movement for Medicare for All, a Truthout original series.

It has become fashionable to write premature obituaries of the Senate bill to "repeal and replace" the Affordable Care Act, using hyperbolic and misleading language. The Senate bill, according to varying headlines, is "in peril," on "life support" and "dead on arrival." These stories should be of little comfort given that the exact same headlines were published prior to the House passing its version of the repeal. That bill was also reportedly "on the verge of collapse," "in tatters," "flailing" and even "dead."

Such sentiment could give Americans a false sense of complacency. There is still a real danger that this contemptible bill, which according to the Congressional Budget Office would lead to 22 million Americans becoming uninsured, will still become law. Considering this, stopping this legislation -- which repeals Medicaid as much as it does the ACA -- should remain the top short-term priority for advocates of health care justice.

But the fight to stop Trumpcare must also be part of a wider struggle for health care justice. The threat of this shameful legislation alone has demonstrated that it is morally indefensible to leave anyone without coverage. As a result, the argument for single-payer health care is starting to make sense to a lot of people, including a record number of Congress members and Sen. Elizabeth Warren, who publicly came out in favor of the policy in a Wall Street Journal article last week.

What Constituency Is Being Served in Washington?

Indeed, it is a testament to this growing support for single-payer that the New York Times devoted a front-page story to the issue in June. "The Single-payer Party? Democrats Shift Left on Health Care," the headline read. But while a front-page story on momentum for Medicare for All is a welcome sight for advocates, the article amplifies a falsehood that reflects why the policy remains so elusive.

"Representative Nancy Pelosi of California, replied with a flat 'no' when asked if Democrats should make single-payer a central theme in 2018," the Times reported. "The comfort level with the broader base of the American people is not there yet," Pelosi said.

The House minority leader, however, is wrong. Polls show the public supports "Medicare for all," and has for years. A recent Economist/YouGov poll, for instance, shows 60 percent support for the policy, including 75 percent of Democrats. Even a plurality of Republicans supports single payer: 46 percent support Medicare for All, compared with 38 percent opposed. (Seventeen percent are not sure.)

This begs the questions: If Medicare for All has popular support why do power brokers like Pelosi claim it isn't viable? What constituency is not "comfortable" with a more efficient system that would provide universal health care? It is an especially relevant question now when we see Republicans go full bore trying to pass a bill that has only 12 percent support from the public, according to a USA Today poll.

The fact is that a very small and powerful group of rich people would be a little less rich if single-payer became a reality. "Insurance and pharmaceutical firms are the most important opponents of single payer," said Dr. David Himmelstein, a founder of Physicians for a National Health Program, in an interview with Truthout. For-profit hospitals and manufacturers of medical devices oppose single-payer for the same reasons, he added.

These industries, and not the public, are the constituency who are not "comfortable," with Medicare for All. This group might represent a very small number of people, but it is disproportionately powerful. In fact, according to data from the Center for Responsive Politics, Pelosi gets more money from health services than from any other industry -- more than double the amount she receives from public-sector unions and investment firms combined:

A screen shot of data from the Center for Responsive Politics shows the industries who spent the most in lobbying in 2016. Health-related industries accounted for four of the top six sectors. (Credit: Center for Responsive Politics)

From a wider angle, the attack on single payer (and Medicaid for that matter) is, like so much of the neoliberal agenda, a form of class warfare that seeks to privatize and commodify almost everything. The goal is to add to the enormous fortunes of corporations and billionaires while, in the words of Eugene Debs, "millions of men and women who work all the days of their lives secure barely enough for a wretched existence." These forces are emboldened by the ever-pervasive role of money in politics and enabled by the corporate-owned media establishment, which reliably serves elite interests.

Other enemies of single-payer include the American Medical Association (AMA), AARP, the Koch Brothers and the Chamber of Commerce. Even some ostensibly liberal advocacy groups, particularly those with industry funding, have also served as an obstacle to single-payer.

Understanding the nature of the opposition is a necessary, if daunting, step for advocates of health care justice to take on the road to making this reform a reality.

Single-Payer: An Existential Threat to the For-Profit Industry

The most significant enemies are health insurance and drug companies. "A single-payer reform would end insurers' role in the health care system, essentially wiping out their entire business," Himmelstein said.

The health sector spent more than $500 million on lobbying in 2016 and several billion in the last decade, according to the Center for Responsive Politics' data. Lobbying from pharmaceutical firms accounts for almost half of the overall spending, totaling a little more than $245 million.