Medicare for All in One State
by Ann Jones
You may have noticed that quite a few of the formerly united states of America have been choosing to go their own way. My own state, Massachusetts, now blooms with sanctuary cities sworn to protect residents from federal intrusion. Its attorney general, Maura Healey, was among the first to raise the legal challenge to President Trump’s Muslim bans. She also sued Education Secretary Betsy DeVos and the Department of Education for abandoning rules meant to protect students from exploitation by private for-profit schools. (Think Trump University, for instance.) Even my state’s Republican governor, Charlie Baker, announced well before the presidential election that he wouldn’t vote for Donald Trump.
It’s been like the Boston Tea Party all over again, with citizens and public officials refusing to abide by the edicts of their supposedly lawful rulers. And Massachusetts is not alone. Hawaii, Washington State, New York, Minnesota, and Oregon all joined the legal battle against Muslim bans, while many other states have denounced federal policies that threaten the nation’s international reputation, the environment, or what’s left of democracy itself. So far at least 10 states (as well as Puerto Rico) and more than 200 cities have committed themselves to work toward the environmental goals of the Paris Accord, just as the United States as a nation had promised to do before Trump trashed the deal.
We should recall that our founding fathers cobbled together our federal union — our United States — because they were convinced that the revolutionary colonies, each standing on its own, could not survive. For a time, the Civil War did then tear the union apart, and, a century and a half later, here we are, overstretched and teetering under the rule of an administration whose allegiances, if any, are far from clear. But there’s no denying a new spirit in many states worthy of the Gadsden Flag of revolutionary times which warned, beneath a drawing of a distinctly American rattlesnake: Don’t Tread on Me.
Some prospective political challengers to the current feckless crew in Washington go even further. Take, for example, Ben Jealous, former head of the NAACP, a Democrat now vying to become governor of Maryland in 2018. He’s not the only Democrat running for that position, but he’s the one endorsed by Bernie Sanders. Jealous advocates something a bit vague called “climate action” plus a $15 minimum wage, an end to mass incarceration, the protection of immigrants, and — get this — statewide single-payer Medicare for All.
Let’s talk about that health care possibility. Recent polls and reporting by the New York Times indicate that a lot of voters — including Trump voters — who opposed Obama’s Affordable Care Act have changed their minds. They now not only like Obamacare but want to keep it and improve upon it. As one man in Pennsylvania told the Times, “I can’t even remember why I opposed it.” What’s more, a Pew survey reports that fully 60% of Americans now say that health care for all is the responsibility of the government.
This awakening has been prompted by the unexpectedly enlightening spectacle of belligerent Republicans smuggling tax cuts for the rich into their very own totally man-made plan to deprive tens of millions of Americans of their bodily well-being. West Virginia Senator Shelley Moore Capito, a Republican, drove a stake through the heart of her party’s second “health” care plan with a single comment: “I didn’t come to Washington to hurt people.” (After Trump harangued a crowd of 40,000 at the Boy Scout Jamboree held in Capito’s home state, telling them that they “better get Senator Capito to vote for” a third Republican health care plan, she changed her mind, opting to hurt people rather than the President.)
The Stars Align
This combination of circumstances — the newly rebellious spirit of the states, the collapse of the corrupt Republican Congress, and the absence of executive leadership (as opposed to tweetstorms) — comes as part of a propitious realignment of astral constellations in America’s natal chart. It suggests an opportunity to change course and take action.
Bernie Sanders argued for just such a change during the Democratic presidential debates last year. Remember? He tried hard to push lessons to be learned from the Scandinavian social democracies: Denmark, Sweden, and Norway. Every international evaluation rates those countries among the most successful and happiest on the planet, but Sanders proved unable to sell their ideas to Americans. His own understanding of social democracy was on the foggy side and that taboo word “socialist” kept getting in his way. But right now might be just the moment to try again.
Take Ben Jealous and his statewide Medicare for All plan. We’re talking about a single-payer universal system that would cover every resident of his state, regardless of the condition of his or her health, and with no insurance companies jockeying for profits in the mix. Such a simple system is the one used by all the Scandinavian countries. If Maryland and other states adopted it, they would be delivering at the state level what most developed nations already provide for their citizens.
Isn’t it worth a try? American politicians who refuse to learn lessons from Scandinavia usually dismiss those countries as too “small” to be relevant to America’s exceptionally grand experience. And they do have a point: it’s surely easier to implement a big plan on a smaller scale.
If that’s true, however, then applying Medicare for All at the state level should be easier. And of all the states, only eight have a population greater than that of Scandinavia’s biggest country, Sweden (nine million), while 30 states have fewer residents, most far fewer, than either Denmark (5.5 million) or Norway (5.3 million). In short, the most popular argument against single-payer health care for the nation — the contention that we’re way too big for such a system — simply vanishes if you start at the state level.
But hold on. If a state becomes a single payer, where does it get the money?
Taxes, of course. Progressive income taxes. And let’s not forget taxes on corporations and financial transactions. In most states, the money’s there, even if it has a way of clinging to the pockets of the rich and disappearing from circulation. The job of any good government should be to collect its fair share of the wealth and redistribute it for the good of all. That’s what social democracies do. That’s why they’re called social democracies.
Raising taxes on the rich in the United States, however, would take some persuasion at first, partly because so many of them seem to have lost all sense of obligation to others, and also because most millionaires claim to have worked hard for the money, and dammit, it’s theirs.
Not that you would know it in this country, but a larger tax bill more than pays for itself in the social benefits it buys: an overall population in better condition (and probably significantly less desperate, angry, and violent); a healthier, more reliable work force; kids in better shape who don’t miss school as often; and a widespread feeling of well being, of knowing that you will indeed get the care you need and that no one will be left behind. When Senator Capito claimed that she didn’t want to hurt people, surely she spoke for most Americans.
Nonetheless, there’s another reason that American politicians disdain the Scandinavian example and it may, on first glance, seem far more compelling. Those countries are not only small but to a significant degree ethnically homogeneous. So naturally, Norwegians don’t mind helping each other, since they’re all essentially alike — or so the argument goes anyway. On the other hand, diverse and polarized Americans are never going to be persuaded to let the state pick their pockets for the good of other, very different and presumably less deserving people.
And let’s admit it: the opposition does seem to have a point. Scandinavian social democracies are indeed among the most stable in the world. What’s more, they are economic democracies; that is, they have the world’s smallest gap between their upper and lower income earners. Their citizens are just about as equal to one another as it’s possible to become on our present planet.
Considered more carefully, though, that’s hardly a reasonable basis for arguing against trying to redistribute the wealth in a diverse American state. Quite the reverse, in fact. Historically speaking, Scandinavians weren’t born equal. Well into the twentieth century, many of them languished in isolated pockets of rural poverty, while others dined in style in prospering cities. Some were healthy, some not; some well educated, others unschooled. Some had good jobs, others none.
To overcome such disparities and engage all their citizens in the project of democracy, Scandinavians worked hard to create forms of government and social policies that made people ever more socially and economically equal. In Norway, for example, workers led the struggle for fair employment laws, gaining compensation for accidents in 1894, unemployment in 1906, and illness in 1909. Socially conscious political leaders worked to harness the nation’s wealth and used it to meet the basic needs of all men and women for health care, education, and employment, as well as for the special needs of children, the elderly, the disabled, and others. In short, when you radically equalize wealth in a country, even in increasingly multicultural ones like those of Scandinavia, you unite disparate people. When most poeple have plenty of money, populations begin to feel downright “homogeneous” — especially if they’re healthy, well educated, and happily employed in the bargain.
Scandinavian economists will tell you that social democracy developed out of pure self-interest. These were, after all, poor countries that learned one simple lesson fast: their strength and well being lay in solidarity. They invested in the future by investing heavily in children. Just think for a moment about all those well established Scandinavian programs that American feminists keep talking about: paid parental leave; early childhood education; and excellent, free, equally well funded public schools (and universities) for all. Could such giveaways be in the nation’s self interest? You bet. Scandinavian societies were, and still are, intent on developing a work force of the future that eventually will care for the very elders preparing the way.
The Road Ahead?
Were he elected, could Ben Jealous actually put any of these ideas to work in Maryland? The state has already laid some significant groundwork for his ideas. But really, who knows?
Instituting a single program statewide like Medicare for All or equal investment in public schools could prove to be a breakthrough experiment for this backpedaling nation. It might also be a reminder that such acts of solidarity worked well once upon a time, even in America — under both President Franklin Roosevelt’s New Deal in the 1930s and President Lyndon Johnson’s Great Society in the 1960s.
Real social democracy, however, is far more than a few isolated programs. It’s a complete system of reciprocation that is incessantly subjected to adjustment and fine-tuning. Today, the comprehensive welfare state that characterizes Scandinavian social democracies has largely moved beyond political ideology. Always open for discussion, it’s nonetheless taken for granted and favored by every party, across a broad range of political opinion. It is simply the way things are.
Yet social democracy might not have developed at all had it not been for the leadership of the working class, a strong alliance of labor and farmers, and the undeniable claims of women. In that Democratic presidential debate last year, Bernie Sanders argued that “we should look to countries like Denmark, like Sweden and Norway, and learn from what they have accomplished for their working people.” But he’s got that slightly backwards. For a real lesson in inspirational history, we should learn from what the working people of Denmark, Sweden, and Norway accomplished — and are still accomplishing — for their countries. Social democracy doesn’t come from the top down; it’s people’s politics at its best.
Unfortunately, it seems way too late to count on America’s working class to lead this country to social democracy. Here in the U.S., the plutocrats crushed labor long ago and corporatized the farms; women were turned back in the 1970s, social welfare in the 1990s. Who even remembers exactly when the working class or the poor fell — or were pushed — off the edge of the political map? A woman worker in an Indiana factory where candidate Trump promised to save jobs, speaks now (as workers are let go and the plant moves to Mexico) of his having “blown smoke up our asses” with a “sneaky kind of shit-eating grin” on his face. The Democratic Party — once the party of the working class, lest you’ve forgotten — has just announced yet again its intention to “devise an agenda that will resonate” not with workers but with the “middle class.” Meanwhile, working-class Americans, some still wearing their Trump hats, turn their gazes upward and wait for something — anything — to trickle down.
So have no illusions. A single experimental program like statewide Medicare for All, coupled with the taxes to pay for it, won’t transform this country into a social democracy. Nor, on the other hand, is it likely to lead to the dissolution of the Union and a second civil war.
Still, a single program launched by a single state is better than none. And it just might work.
If it does, states can look to the Scandinavian toolbox for other projects. What’s more, a good idea in one state may prove contagious, as we’ve seen with the rise of sanctuary cities and pledges of allegiance to the Paris Accord. (States are learning from the consequences of bad ideas too, including the catastrophic financial collapse of Kansas after its Republican governor’s stubbornly stupid Reaganomics tax-cutting regime.)
Some states, like Massachusetts, are even taking inspiration from their own feistiness. In California, Governor Jerry Brown told the Los Angeles Times that if Trump shut down the U.S. satellites gathering climate change data, “California will launch its own damn satellite.”
Sounds good to me, but for now, as a healthy, happy Medicare recipient myself, I’ve got my eye on Maryland and statewide Medicare for All.