August 4, 2023  Counterpunch


With the public support for a national single payer system remaining strong and the need greater than ever, why is the movement stalled? What are the key sources of our power? Who are our allies? What can we do and how do we focus our energies to build the power necessary to end profiteering and make health care free at the point of service?

More than a decade after the misnamed Affordable Care Act, (ACA) we still have tens of millions without any coverage while millions more are saddled with high deductible, narrow network “junk health insurance” plans. The pandemic exposed the USA’s bankrupt for-profit privatized “healthcare system.” The industry and bipartisan political response continues to prioritize profits over public health, resulting in more than a million deaths – including hundreds of thousands who died due to the lack of basic health care. Rather than expose this system of corporatized healthcare fiefdoms and push for national single payer, both Democrats and Republicans continue to support billions in tax subsidies to prop up the alleged “market based” plans that would collapse without them.

A Society in Crisis

This healthcare catastrophe is but one part of the systemic social, economic, and political crises now unfolding in the USA. Clarity is required. Root causes must be identified, and we must unite around real solutions.

Income inequality is rising, almost fifty-eight percent of Americans live paycheck to paycheck, medical debt is the largest form of consumer debt, plaguing nearly two-in-ten, of which 60% are covered with health insurance. Student and credit card debts are literally killing the working class. Poverty is now the fourth leading cause of death. As Biden, Democrats, and Republicans united to cut 15 million poor from Medicaid health benefits and millions more from Food Stamps (including new “work requirements” added for those aged 50-54 in the “debt ceiling” deal), liberals, labor, and NGOs remained silent.

Despite the fact that traditional Medicare was created because insurance companies could not make enough profit covering seniors, the decades-long privatization of traditional Medicare continues under Biden as with Trump and all previous Presidents and Congresses. The ACA has even immortalized a Fraud and Abuse Waiver that voids prosecution and literally encourages corporations and private equity to privatize Medicare under the guise of “innovation.” It has no Congressional oversight.

The USA has the highest maternal and infant mortality rate among any other high-income countries despite spending the most on health care. Lifespans are down, food pantries are overwhelmed. Corporate profits from the world’s top 722 companies were more than $1 billion in 2021 and 2022, 89% higher than their average over the previous four years. While profits are sky high, real wages remain stagnant and homelessness is growing, but there is always billions and billions of dollars for war. And all these crises have a much greater impact on the poor, minorities, women, seniors and children.

Weak Ineffective Insider Strategy is Not The Solution

As Ralph Nader recently stated, many have succumbed to “the satiety of exposing and denouncing, without moving to action.” Is describing the evils of privatization, war spending and corporate profiteering enough? There is a need for new and bold initiatives exposing not just the “bad actors” and their enablers, but the wholesale corporate takeover of America as the source of our dilemma.

Instead of organizing a real fight, we have the siren song of incrementalism pushed by the Democrat Party and aligned nonprofit groups who are now openly discouraging the fight for national single payer because the ”political climate” is just not right.

It undermines, demoralizes, and weakens the movement’s principles and makes it incapable of providing the necessary practical and bold program the country needs and wants. It reduces the fight for healthcare as a human right to the whims of opportunistic politicians and political horse trading. It shows a total lack of confidence in the necessary strategy of winning people over to support single payer when the “political climate” of public opinion is in fact receptive to our message. As if the corporate monsters and their political enablers are receptive to piecemeal legislation when every social and labor gain won through mass struggle in the USA is now under attack. We must have the courage and endurance to understand and fight back.

Inside the unions, the top leaders are following a similar Democrat Party line that falsely merges labor and the public interest with corporatism. Going backwards from over 600 union endorsements for John Conyers’ HR 676 more than a decade ago, labor leaders parrot the corporate line of privatization which includes selling tax-subsidized
for-profit Medicare Advantage plans and ignoring the ongoing privatization of traditional Medicare. Rather than raising the demand to take healthcare “off the table,” they continue the approach that pigeonholes each union into making health coverage an individual “bargaining item,” extracted at the expense of improved wages and working conditions. This strategy has already proven it can not lower costs or provide secure benefits to union members, retirees or the public.

Similarly, many Democrat and labor operatives attribute the privatization of traditional Medicare to Republicans and Donald Trump – when in fact the program has been under constant attack by corporate interests supported by both parties since its inception. Trump picked up and used the program created by the Affordable Care Act under Obama to accelerate the corporatization of Medicare which Biden continues. The Center for Medicare and Medicaid Innovation was originally given a ten year billion dollar budget to privatize under the guise of innovation.

Not surprisingly, the AFL-CIO refuses to issue any statement against Medicare privatization since they too are selling the “product.”

How Can We Make A Difference?

National Single Payer welcomes and encourages a vigorous debate to help shift the direction of our struggle to create a nonpartisan independent popular movement, connecting healthcare to the broader issues of inequality.

We need labor unions that will initiate rank-and-file and public education programs that explain and expose the for profit healthcare system and how national single payer can change people’s lives for the better.

In the late 1990’s the local Central Labor Council in Pennsylvania where I was President held a public Town Hall on the threat of Social Security privatization. Hundreds attended, including union members and the public. Many remarked that you could see and feel the untapped potential to change the political discourse if hundreds of similar town halls were organized by labor in conjunction with allies. A good example of the kind of independent politics that is both possible and incredibly necessary today.

Let’s use this understanding to reach out and explain, build relationships with everyday people and the organizations they are involved in to help push them into action. We need to garner popular support by encouraging grassroots organizing activities like town halls, rallies, teach-ins, voter referendums, petition drives, mass meetings with public officials that encourage citizen involvement and the building of coalitions of like minded people. Do we have the clarity to understand the necessity of a peoples solution as the only way out?


-Ed Grystar has more than 40 years experience in the labor and healthcare justice movements. He is co-founder and current chair of the Western Pennsylvania Coalition for Single Payer Healthcare. Served as the President of the Butler County (PA) United Labor Council for 15 years. Has decades of experience organizing and negotiating contracts for health care employees with the Service Employees International Union and the Pennsylvania Association of Staff Nurses & Allied Professionals.