Medicare for All: A History

The story of socialism vs. the establishment

Before it was branded “Medicare for All,” the term for a truly universal, government-funded insurance plan was “single payer,” and the first serious attempt was in 1971, when Sen. Ted Kennedy introduced his health care plan. It would guarantee healthcare to all, funded by the government, paid for with an additional payroll tax.

He didn’t have a receptive audience in then President Richard Nixon, who said (in a taped, private conversation) “ I’m not too keen on any of these damn medical programs.”

John D. Ehrlichman replied that his idea was to expand a role for private HMOs. “ All the incentives are toward less medical care, because… the less care they give them, the more money they make.”

To this, Nixon replied “not bad.” Two years later, Nixon signed the HMO act into law, which shaped the system that most of us still use today. It works exactly as Ehrlichman and Nixon envisioned: insurance companies do everything they can to avoid paying, and hundreds of thousands of people go bankrupt every year because they can’t pay. (Related: Joe Biden is the reason why people who go bankrupt can never escape their debts now, but let’s not get off topic.)

When Nixon resigned, President Ford was similarly uninterested in helping people get more healthcare, even vetoing a bill to support training nurses.

But after the election of 1976, a Democrat was in the White House. Ted Kennedy finally had his chance. Unfortunately, that President was Jimmy Carter, a moderate, who called for preserving a role for private insurance companies (sound familiar?) Kennedy and Carter both refused to compromise, which ultimately led to Kennedy’s challenging Carter in the Democratic Presidential primary in 1980. Kennedy lost, and then Carter went on to lose the general election Ronald Reagan. Many years after Carter was out of power, he admitted that Medicare for All would have been a great idea. This will become a theme.

Reagan’s election meant any hope of “Medicare for All” style healthcare was dead. In the 1960s, when Congress was debating the original Medicare bill, Reagan had put out a record warning that Medicare (and Social Security) would the death of American liberty.:

We are going to spend our sunset years telling our children and our children’s children, what it once was like in America when men were free.

The country would have to wait until 1993 to try to reform healthcare again. President Bill Clinton’s plan wasn’t a single-payer program. Instead, it looked more like the watered-down version backed by Jimmy Carter. But this time, Ted Kennedy was willing to settle for half of a loaf. So too was Bernie Sanders, who helped travel around to country to sell Clinton’s plan, despite believing that Medicare for All was best.

But the health insurance industry still wasn’t happy with it. They spent a then-staggering 14–20 million dollars airing deceptive ads to turn the public against the plan. Soon, it looked like Clinton would have to compromise. The leader of the Republicans in the Senate, Bob Dole, was happy to do that. There was already an even more watered down health care proposal out there, this one crafted by the ultra-conservative Heritage Foundation.

That plan created a government mandate that everyone buy private insurance, or face a penalty. The idea was to give insurance companies as many healthy customers as possible to spread out the risk.

Conservative commentator Bill Kristol, though, was against any compromise. He said that allowing Clinton to “win” on healthcare would lead to his re-election, and he urged Bob Dole to vote against anything and everything. This, in turn, would allow Dole to run again him in the 1996 Presidential election, running against Clinton’s “failure” to get healthcare done.

Bob Dole followed Kristol’s advice, which killed healthcare reform for the country, but Clinton still beat Dole in 1996. The Democrats would wait more than 15 years to try again.

By 2009, a large majority of Americans supported a single payer, Medicare for All program, and had for decades. This only makes sense, since America is pretty much the only wealthy country in the world without such a system, and our own system so expensive and inefficient.

Yet the singe player approach wasn’t favored by then President Barack Obama, or Max Baucus, the influential Senator who ended up writing most of what became known as “Obamacare.”

During Senate hearings, Baucus heard proposals on a number of systems but refused to even consider single payer, and even had supporters arrested for protesting in front of his office. He ended up settling on a plan very similar to the conservative Heritage Foundation’s plan. (In a truly bizarre twist, the Heritage Foundation decided it was now against its own plan, and then lied about having come up with it.)

Once Baucus retired, he admitted that Medicare for All was indeed the right approach. So did Barack Obama.

Obamacare passed, the first real health care reform since the 1970s. It was great for insurance companies, but for the American people, not so much. Prices for plans doubled in just a few years, and even insured people can still be denied care. Of course, the insurance companies rewarded Democrats by… you guessed it, giving even more money to Republicans.

You can see how every generation of Democrat was a little more timid, a little bit more cowed by corporate interests. The courage of the young Ted Kennedy left the party, and in its place was only an appetite to crush the left.

In 2015, Senator Bernie Sanders announced his run for the Presidency. Bernie was no ideologue. Not only had he supported Clinton’s plan in 1993, he’d also supported Obamacare in 2009, after the plan was changed to include billions in free community healthcare centers. Still, it was obvious that he really believed in Medicare for All, and that just couldn’t be allowed to happen.

The elite institutions of the Democratic party and the media began a negative campaign against Bernie which was unprecedented in American history. The media fed Hillary Clinton debate questions in advance. The DNC was run by one of Clinton’s cronies, and operated as though Sanders was the enemy.

Matt Taibbi summed up the sentiment of the party thusly:

Nobody saw his campaign as an honest effort to restore power to voters, because nobody in the capital even knows what that is. In the rules of palace intrigue, Sanders only made sense as a kind of self-centered huckster who made a failed play for power. And the narrative will be that with him out of the picture, the crisis is over. No person, no problem.

Hillary Clinton, who declared in defiance of Sanders that single payer would “never, ever happen,” won the primary and then lost Trump. But there was one more thing left to do. Make sure that nobody close to Sanders ever had power either. Obama helped block Sanders ally Keith Ellison from becoming DNC chair, instead supporting the more moderate Tom Perez, who won.

But Sanders and his allies didn’t quit. Over the next 2 years, he traveled the country, spreading his message and changing hearts and minds, even in the Democratic party. Despite the establishment and the media being against him, by 2019, more than half of all Democrats in Congress supported Medicare for All.

Around this time, it was clear that nearly all of the Democrats running for President, except for former Vice President Joe Biden, supported it too. Senators Gillibrand, Harris, Warren supported it. So did former HUD chief Julian Castro, Reps. Tulsi Gabbard and Beto O’Rourke, and Mayor Pete Buttigieg.

And yet, when these candidates were asked to raise their hands in support of the plan, on the night of the first debate, all refused except Warren and Harris. (Harris later took it back the next day.) Over the next few months, most of those candidates running became openly hostile to Medicare for All.

Why? In part, because Bernie Sanders himself was running again. There was little to be gained in running on Bernie’s platform, if voters could support Bernie himself. But more importantly, the insurance industry started running scared. After multiple focus groups, they decided the best way to attack Medicare for All was to frame it as “taking away” people’s private insurance, which sounds bad until you realize you are taking it away because care becomes 100% free at the point of service.

Polls showed public support slipping when the “taking insurance away” phrase was used, so the media decided to use it constantly as the main way to reference the policy, including during the debate. (Incidentally, when pollsters tried clarifying that you could keep your doctor, support went back up, but that went largely ignored by the media.)

It was this fear — plus some lobbying money — that was the main cause of the right turn most of the primary field against the plan. (Warren, the last support of the plan besides Sanders, recently tweeted that she’d only try to support it in her third year as President, as strategy seen as essentially giving up on the program altogether.)

Former President Obama weighed in as well, warning against going “too far left” in policy aims. How far is too far? Medicare for All? The same Medicare for All that Obama called “a good idea?” just a year ago?

This can all start to fill like a silly game, but it's deadly serious. Implementing Biden’s modest version of health care reform of instead of Sanders’ would likely cost America 125,000 lives over the next decade.

Why, exactly, is the establishment of the Democratic party and the media so interested in pushing insurance industry talking points, instead of trying to help the American people? Fear, a poor understanding of politics, and corruption all play a role.

However, the responsibility rests with the citizens in a democracy. The establishment can be defeated, as Trump showed when he beat back the GOP establishment to win the nomination in 2016. Bernie nearly did in that year, too, despite all the cards being stacked against him.

If we really want to have a system that works for us, we need to only vote for politicians who work for us, like Bernie Sanders, AOC, and anyone else who consistently and unequivocally backs policies like Medicare for All, especially when it is under threat. And it might mean staying home of the only choices are a sellout Democrat and a Republican. It means actively pushing back against dishonest media, especially when it purports to be center-left in its ideological slant.

We have to do this work because it is obvious that the political class is not going to do it for us. And even if Sanders does become President, that will not be the end of the fight. We will still have to go through Congress, and the insurance industry, the media, the Republican Party, and much of the Democratic party will do everything they can to kill his plans.

But I refuse to believe that what’s possible in Canada, France, the U.K, Japan, and everywhere else in the developed world is impossible here. It will happen. How soon is up to us.