Single payer activists want Medicare for All front and center in Congress.

But Senator Bernie Sanders and Congresswoman Pramila Jayapal have put the issue on the back burner.


Sanders has yet to reintroduce his single payer legislation in the Senate.

Instead, Sanders is pushing for a step by step approach – dropping the Medicare age to 60 and expanding it to cover dental, hearing and vision.

This step by step approach is justified by Sanders supporters like Michael Lighty who wrote recently that “Medicare for All isn’t yet winnable – expansion is.”

And while Congresswoman Jayapal introduced her Medicare for All legislation (HR 1384) in March, she made it clear that she was more interested in the Sanders step by step approach.

Inside the beltway progressives refuse to challenge Sanders and Jayapal.

But Kay Tillow of The All Unions for Single Payer Health Care in Louisville, Kentucky says that the step by step approach won’t work.

And she questions why Sanders and Jayapal didn’t just re-introduce HR 676, the original single payer proposal in the House.

Tillow wrote to Jayapal at the end of December 2020 with her concerns.

Jayapal has yet to answer Tillow.

“We are deeply concerned that HR 1384, the bill that succeeded Congressman John Conyers’ HR 676, dropped some of the key principles that were in Conyers’ model single payer bill,” Tillow wrote to Jayapal.

“There is no reason for any compromises to be made at this point. We need model legislation that sets the stage for the struggle that is to come. If a principle is not placed on the table at the beginning of the bargaining, it is conceded. Unionists know that the outcome does not improve in the negotiations. The effort for the integrity of the single payer model in actual legislative form needs to be made.”

Tillow says that the main defect in the Jayapal legislation is the failure to remove for-profit institutions from the healthcare system with a plan of conversion.

That provision to remove for-profit institutions was included in HR 676.

“It is now gone from HR 1384, therefore conceding that especially important principle of removing the profits that harm patients as they cost us more,” Tillow wrote “We propose that you put that principle, the HR 676 removal of the investor-owned facilities, into your bill. The current language in HR 1384 allows the for-profit hospitals to remain in the system, but the funds cannot be used for profit. It may sound good, but it will not work. Unless the hospitals are converted and kept for health care use, the investor owners will convert them to the highest profit-making concern, leaving us with holes instead of hospitals. Just look at what happened with Hahnemann in Philadelphia where the for-profit corporation closed a vital inner city hospital to make greater money on condos.”

Tillow says the second defect in the Jayapal bill is the two year transition period.

“The transition period with the buy-in to Medicare in HR 1384 is harmful,” Tillow wrote. “It promotes the false assumption that we must move gradually, that we cannot go directly to a national single payer system. The buy-in also endangers the bill by adding complex administrative steps that will greatly raise costs while not recovering the savings of single payer. The buy-in will disrupt community unity because different people are covered in different ways and pay in unfair ways. The buy-in transition period endangers the success of the plan and should be removed.”

Finally, HR 676 had two years of salary for displaced workers. Jayapal’s bill does not.

“It was concrete and therefore particularly useful in winning the support of insurance workers,” Tillow wrote to Jayapal.  “Here in Louisville, we reached out to Humana workers with this and won many hearts and minds even in that cold marble headquarters. The less specific language in HR 1384 does not give that concrete guarantee and makes it much harder to persuade such workers that their needs will be met. The two years of guaranteed compensation from HR 676 needs to go into the new improved Medicare for All bill.”

This article  first appeared in the Corporate Crime Reporter