Even in the face of a fiercely conservative administration, universal health care took center stage in 2018 with the potential to dramatically improve the lives of more Americans than any other social program in our nation’s history. A publicly financed but privately delivered single-payer program, more popularly known as Medicare for All, remains the best option for ensuring that every American has access to quality health care.

Twenty-eight million Americans will remain uninsured, without access to primary care that could prevent costly and life-threatening diseases, as long as the United States does not have a single-payer health care system.

People fortunate enough to have insurance will continue to face prohibitively expensive co-pays, premiums, and deductibles that limit access to care. Medical expenses will also remain a leading cause of bankruptcy.

While their stories indicate a health system that remains in the service of profits over patients, there were moments during 2018 that offer hope in the fight for universal health care.

According to a Reuters–Ipsos poll, an overwhelming majority of Americans—70 percent—now favor a single-payer health system.

The shift in support for Medicare for All was evinced by a wave of progressive candidates, who helped make universal health care a central issue in the minds of voters. Even former President Barack Obama officially endorsed national health insurance.

This could be a sign that rank-and-file Democrats may finally shift their focus away from merely defending Obama’s signature health legislation, the Affordable Care Act (ACA), and instead work towards easing the burden of struggling Americans by implementing a sustainable solution to our collective health crisis.

“When Democrats said, ‘Fix the ACA,’” wrote Dr. Margaret Flowers of Health Over Profit, “the grassroots response was, ‘We want Medicare for All.’”

“We are being heard.”

Here are some of the highlights.

“WE MADE HISTORY!”: Teachers Tie Health Care Rights To Labor Rights And Strike Over Skyrocketing Insurance Premiums

In February, public school teachers in West Virginia initiated a nine-day wildcat strike that inspired a wave of similar walkouts across the country. One of the primary motivations driving educators into the streets was their increasingly expensive-yet-meager, health care coverage.

“It’s the insurance,” fifth-grade teacher Mary Clark told the Los Angeles Times. “That’s the big deal.”

In a historic victory, West Virginia teachers won a five percent raise and the establishment of a task force to address the exorbitant cost of their health care.

The purpose of both health care and public education is to serve the common good of the community, not the bottom lines of corporations. The majority of American workers believe health care is the most important issue facing the nation. The teacher strikes underscored the central role that universal health care could play in uniting individual struggles within a broader movement for human rights.

As Meagan Day underscored in Jacobin, “The task for the Left and labor is to take the West Virginia fight national, to unite the teachers in Appalachia with nurses in California and to connect the demand for single-payer health care to the tactics of working-class militancy.”

Seventy Members Of Congress Launch The Medicare for All Caucus

Caucus members hope to provide a base of support for other legislators to throw their weight behind Medicare for All. They also plan on sponsoring briefings to educate their colleagues and the public about the benefits of a single-payer health system.

Congressional support for single-payer has surged during the last several years. The Medicare for All bill in the House, H.R. 676, currently has 123 co-sponsors—up from 49 legislators in 2015. Meanwhile, 16 co-sponsors back Bernie Sanders’ Medicare for All Act in the Senate.

The caucus is a symbolic victory and a source of hope for single-payer advocates.

“This year is different,” Wendell Potter, the former head of corporate communications for Cigna and founder of Tarbell.org, told Shadowproof. “The [insurance] industry knows it’s got more work to do this time and the odds are not as easy for them as it has in the past.”

However, “they’ve been very effective in the past in pushing back against any kind of reform they didn’t like,” Potter said.

One should not take false comfort in believing the fight for Medicare for All will be won by a vanguard of elected officials or by the stroke of a legislator’s pen. Instead, health providers, advocates, and patients must continue building broad coalitions with a unified voice for change.

“The Medicare for All Caucus is by no means a substitute for grassroots organizing,” Physicians for a National Health Program (PNHP) President Carol Paris told Truthout. “In fact, it exists largely because of strong grassroots pressure.”

Progressive Democrats And Independent Candidates Put Medicare For All On The Ballot

Bernie Sanders lost the Democratic primary in 2016 but insurgent candidates, like democratic socialist Alexandria Ocasio-Cortez, continued his crusade for Medicare for All into the 2018 midterm elections.

In addition to running on a range of other progressive issues like abolishing ICE, providing free college tuition, and implementing a $15 minimum wage, some candidates sought to break down barriers in other ways.

Ilhan Omar was elected in Minnesota and became the first Somali-American representative in Congress while Andrew Gillum garnered national attention during the primary election as the first black nominee for governor in Florida.

Before he lost in the Democratic primary, Abdul El-Sayed was poised to become the first Muslim governor of Michigan. Sayed, a physician, ran on a state-based single-payer plan he called “Michicare.”

Democrats inched their party closer to becoming the “party of single-payer.” According to a survey released by National Nurses United, “In 52 percent of Congressional races, Democratic Party candidates across the U.S. support Medicare for All.”

Only time will tell, however, whether establishment Democrats will follow through with their campaign promises.

“Many who back Medicare-for-all are vague or open to incremental approaches, like a ‘public option’ that maintains the current insurance structure while allowing people to buy into Medicare,” reported Elisabeth Rosenthal and Shefali Luthra for Kaiser Health News.

Veterans Affairs Secretary David Shulkin Warns Against Trump administration’s Push to Privatize Veterans Health Administration

President Trump fired Shulkin in March partly because the physician refused to wrest control of the VA health system away from the federal government and into the hands of the private marketplace.

“I am convinced that privatization is a political issue aimed at rewarding select people and companies with profits, even if it undermines care for veterans,” Shulkin wrote in a New York Times op-ed. “The private sector…is ill-prepared to handle the number and complexity of patients that would come from closing or downsizing VA hospitals and clinics, particularly when it involves the mental health needs of people scarred by the horrors of war.”

Spearheading the privatization campaign is a non-profit with deep financial ties to the Koch brothers, called Concerned Veterans for America. Since 2011, the group has worked to bring the VA under a microscope, attributing wait times and other shortcomings as symptoms of socialized medicine.

It is true that the nation’s largest health system is the only one in which medical services are funded and delivered entirely by the government. But despite needed improvements, the VA remains popular among veterans precisely because their health is not constrained by market profiteers, like the pharmaceutical and insurance industries, as it is for the rest of us.

“They put their lives on the line for the red, white, and blue, not Blue Cross Blue Shield,” said American Legion Commander Denise Rohan.

Medical Students To Organized Medicine: “We Want Single-Payer Now!”

Throughout the 20th Century, the American Medical Association (AMA) mobilized attacks against major social programs intended to benefit all Americans, from Social Security to Medicare and Medicaid. Its membership has steadily declined since the 1950s, but the AMA remains one of the country’s most powerful lobbying organizations.

The AMA joined hands with lobbyists from the pharmaceutical and insurance industries over the summer to form the Partnership for America’s Health Care Future. According to documents obtained by The Intercept, the partnership is explicitly organized to “change the conversation around Medicare for All” and “minimize the potential for this option in health care from becoming part of a national political party’s platform in 2020.”

This opposition to Medicare for All puts the AMA at odds not only with their patients but also the majority of their peers.,

Fifty-six percent of practicing physicians favor the creation of a single-payer system. At the AMA annual conference in June, medical students demanded the organization end its decades-long opposition to a national health program.

Taking similar action, members of the Student Osteopathic Medical Association (SOMA) asked the American Osteopathic Association (AOA) to pledge its support for Medicare for All in July. The AOA resolution was referred to the organization’s Bureau on Federal Health Programs for further review. While they wait for the bureau to hand down its decision in July 2019, SOMA members plan to continue championing single-payer and generating support for Medicare for All.

Although neither resolution resulted in immediate action, the medical students’ efforts are a powerful harbinger of growing resistance to our profit-driven health care system.

“I think in most cases that the paradigms we accept early on are often the hardest to shake,” Wessley Square, political affairs director for SOMA and a medical student at the Philadelphia College of Osteopathic Medicine, wrote to Shadowproof in a statement.

“For this reason, I feel it is important for medical students to enter into practice already looking for a way to free our system of the controls private insurances use to dominate health care today.”

Growing Popularity For Single-Payer Spurs Rise Of So-Called “Reforms” That Threaten The Movement

Quentin Young, the late physician and champion of universal health care, would often say, “You can judge the effectiveness of your efforts by the vehemence of the opposition.”

Single-payer advocates have long trusted that Big Pharma, organized medical groups, and the health insurance industry would fight tooth-and-nail against their efforts to implement a national health program. But with Medicare for All enjoying broad popular support, opposition is mounting from all sides of the neoliberal establishment, including liberals bent on private insurance preservationism.

Such reformists raise the banner of universal “access” to health coverage but peddle proposals that would kill, water down, or sidetrack single-payer through inadequate stop-gap measures, further ensnaring Americans within a market-driven health care system.

Two great examples are the United States of Care and the Center for American Progress proposal, which is called Medicare Extra for All.

The United States of Care was trotted out by Andy Slavitt, a former Obama appointee to the Centers for Medicare and Medicaid Services, to reframe the debate about health reform. It sounds like a good idea at first until one realizes, instead of supporting universal health care that is free at the point of service, the United States of Care actually lobbies for reforms that merely guarantee Americans an “affordable regular source of care” and “protection” from financial ruin.   

Similarly, the Center for American Progress boldly champions the right to health, but its Medicare Extra for All proposal turns out to be nothing more than a shameless attempt by the Democratic Party think tank to capitalize on the goodwill surrounding Medicare for All, while undermining the very aspects of the program that make it so popular among Americans.

Medicare Extra for All perpetuates the exorbitant costs and inefficiencies of our current health system by preserving Medicare Advantage and employer-based insurance. It also resurrects the dreaded public option, which single-payer proponents and public health researchers David Himmelstein and Steffie Woolhandler warn will “not lead toward single-payer, but toward the segregation of patients, with profitable ones in private plans and unprofitable ones in the public plan.”

Imitation might be the sincerest form of flattery, but Americans want the real thing: a health care program that provides affordable, quality care to every person—ourselves, our families, and our neighbors—regardless of age, income, or employment.

This handy guide can help readers inoculate themselves against fake single-payer plans.