How Socialists Can Fight for Single Payer
Socialists have played a key role in the fight for single payer in California. Their campaign has lessons for organizers everywhere.
In Bernie Sanders’s wake, the socialist left has experienced a historic resurgence. The Democratic Socialists of America (DSA), which now counts over 25,000 members, is the largest socialist group in the United States since Students for a Democratic Society in the late 1960s.
The challenge now is to hone its political vision and build a durable and democratic organizations that can affect real change. A focus on winning single-payer health care can help us do that.
The growing demand for single payer rankles establishment Democrats, who insist that the Affordable Care Act — with its labyrinthine subsidies program meant to provide coverage without undermining the private insurance industry — is the best deal on offer, and to demand anything more is pie-in-the-sky and politically counterproductive. But with Obamacare given reprieve for the moment (albeit unsafe from future attacks), and our still-broken health care system on everyone’s mind, socialists have an opportunity to organize ordinary people toward a better common goal: genuine universal coverage, managed and dispersed by democratic, transparent, and efficient institutions that are accountable to us, not corporate shareholders.
California has the unique potential to become the first state to pass single payer. A grassroots movement for the cause, spearheaded by the California Nurses Association, goes back decades. This movement twice passed single-payer bills through both houses of the state legislature in the 2000s, but both were vetoed by then-Governor Arnold Schwarzenegger.
Out of this legacy of popular action, 70 percent of California voters now support single payer in polls. To appeal to that active grassroots and public support, California Democrats have made single payer an official plank of their party platform. Democrats hold the Governor’s seat and an exact two-thirds supermajority in both houses of the legislature, so the time has come to deliver on promises.
We are two organizers with the East Bay chapter of DSA, which has made a strategic decision to focus on a single campaign: organizing around single-payer health care legislation, SB562, in California. The lessons from our campaign aren’t universal (no one’s are), but in explaining the strategic thinking behind our mass canvassing program and sharing the lessons we’ve learned from implementing it, we want to show how a focus on Medicare for All can increase socialist organizations’ organizing capacity and build working-class power for long-term struggle.
Zeroing in on Single Payer
In recent months, socialists — many of them newcomers to the movement — have flocked to DSA, seeking opportunities to continue pushing for left political-economic reforms after the Sanders campaign. Both the national DSA organization and local chapters have begun a program of political education to introduce these members to socialist history, theory, and strategy — some for the first time in their lives. The East Bay chapter has been no exception: over five hundred people joined after Trump’s election.
At East Bay DSA’s chapter elections in January — our first following the membership explosion — many candidates running for a leadership role pledged to focus our organizing on the California single-payer effort. The members who won election were nearly unanimous in their interest in pursuing this campaign.
Based on that mandate, the leadership voted to officially join the campaign for Healthy California in February and started canvassing almost immediately.
Two generations of our elected leadership have now committed to single payer as the core focus for our organizing work. Importantly, this hasn’t prevented ongoing chapter actions on other issues: our direct action committee helped blockade an ICE office and held the line to protect an elderly renter from eviction; we were at the airport protests, the Women’s Strike, and May Day; we have a housing caucus, a prison abolition caucus, and a socialist feminist caucus.
But we’ve found that focusing the bulk of our organizing effort on single payer comes with major benefits: we concentrate and replicate our capacity for training members, we stress-test our organizing against the clear benchmarks of a single campaign, and we build internal unity and transparency by working together on a common cause.
The singular focus helps convey to our coalition partners and members alike that we’re in this for the long haul, and we’re in it to win. As a result of our recent growth in both size and legitimacy, coalition partners have asked to table with us at events for increased visibility, and local candidates have sought our endorsement.
East Bay DSA’s commitment to campaigning for SB562 is a tactic in service of a larger strategy to build good internal structures in our burgeoning group and effective organizing skills among a new generation of grassroots leftist activists. We also seek to strengthen ties between socialists and the labor movement — in this case the women-led and substantially non-white nurses’ union — and win reforms that will strengthen the power of the working class.
The Ground Game
Our focus on winning single payer has driven the evolution of our organizing process.
Our canvassing strategy began with a focus on large canvasses that gathered members from across our entire chapter as well as non-members interested in joining in.
Before these canvasses, a select team of canvass captains received training from the union and community organizers in the chapter. On the day of the large canvasses, these captains trained and facilitated practice sessions for teams of about a dozen people each. To date, five hundred people have received training from team captains, then pounded the pavement together to knock on doors.
In a frightening national political moment, door-to-door organizing has been heartening for many members, showing us we’re not as alone as we think. One of our members, who originally described herself as shy, remarked that her canvassing experiences with our chapter had convinced her there are only two kinds of people in the Bay Area: socialists, and people who aren’t home.
Across all of our canvassing, we’ve focused on empowering neighbors to see their experiences with medical fees and debt in terms of class conflict, explained the mechanics and upsides of single payer, and gathered thousands of pledges to support DSA and our coalition partners in the fight for public universal coverage. In the process, our organizers have also developed as leaders. In a testament to the skill- and commitment-building potential of this tactic, about half of the chapter’s newly elected Local Council started out as single-payer canvassers.
The large, chapter-wide canvasses provided a good way to kick start training across our membership but weren’t well suited to build steady teams of organizers consistently working the same neighborhoods. To address this issue, our organizing tactic has shifted since May to focus on district canvasses, where our members develop dedicated teams for their own neighborhoods. The point is for socialist organizers to talk to their own neighbors and build lasting political relationships.
We live in an atomized, alienating society where most of us don’t know our neighbors’ names, and don’t see any reason to learn them. These district canvasses break our own members out of their isolation, while simultaneously building stronger community ties between our organization and existing neighborhood networks.
In early July, one of our canvassers, after a particularly successful round of door-knocking, was invited to speak at a block party. The person then found themselves literally organizing their neighborhood. Another district canvasser was invited to give a talk for a second block party just last week.
A third stage in the evolution of our organizing is just beginning. Our canvassing program has done well at training our members for the initial conversations with neighbors, but we’ve found we need more structure and shared skills for follow-up to keep our neighbors consistently involved. As our chapter grows, the most involved members have largely had their workload expand just as fast; this has made it clear that helping members develop into leaders needs to become a central part of our organizing system.
To clarify who should take on our member development efforts, we passed new bylaws in April which created distinct positions (both elected and appointed) for internal organizers and external organizers. The internal organizers, who were elected in June, are now focused on developing a member steward system based on the model used in many unions and the New York City and Philadelphia DSA chapters. This will build a trained network of stewards among our membership, with each responsible for supporting and catalyzing a set of less-active members and interested neighbors to become regular participants.
Strong local relationships like these are invaluable to socialist organizers and can be tapped in future campaigns for fights around housing justice or workers’ rights. Democratic elites have all but abandoned field organizing, especially in down-ballot races, in favor of exorbitant, consultant-led media strategies. In many places, by training even a few dozen regular canvassers through the single-payer cause, socialists can quickly develop one of the strongest ground games in town.
By building ongoing relationships with our neighbors, this emphasis on field organizing will put us in a position to be helpful, in-demand allies for local unions and other Left campaigns, and lay the foundation for real impacts on electoral politics. And while we should only organize for what we are committed to winning, we should also organize so that, whether we win or lose one round in a fight, we are building the skills and relationships for power in the long term.
The focused campaign gives us an opportunity to troubleshoot our organizational structure and its challenges, which makes our chapter increasingly resilient, responsive, and effective, and will serve us well beyond the fight for single payer. Already, our work has rippled outward; we’ve shared our training guides, canvassing scripts, and leave-behind literature to be put to use in chapters across California and as far afield as Ohio.
Advancing the Program
The advantages for our organization are only part of the equation. Any unifying campaign will be beneficial to an organization finding its footing, but single payer is a strategic central focus. In fighting for it, we can build solidarity across lines of difference and continue to build power for the working class.
Everybody needs health care. Nearly everybody in the working class has been hurt by private insurance greed, or has seen a friend or family member denied care so that a rich few can profit. When we organize in the East Bay, we share our own personal stories and ask our neighbors about what they could personally gain from single payer.
We work to show how our direct self-interest intersects with that of all working people: we can only win single payer for ourselves if we win it for each other. Political education that fosters this sense of shared self-interest — rather than charity for a distant other — is the foundation of a sense of solidarity built to last.
The fight for single payer is an urgent anti-racist struggle. Currently in the United States, the uninsured rate is 60 percent higher for black people than for white people. The Movement for Black Lives platform demands a universal, guaranteed health care system, with particular focus on equitable access for currently excluded communities of color. In committing to the fight for single payer, socialists can take up that call to action.
Meanwhile, across the US, Latinos have an uninsured rate 300 percent higher than white people. Undocumented immigrants — and many documented ones — are not covered by Medicare, nearly all Medicaid programs, and many subsidized private plans. This cruel exclusion is despite the fact that immigrants pay into the public system through taxes, and worse, is in spite of the fact that they are members of our communities who need care like everybody else.
By providing coverage to all state residents regardless of documentation status, California and New York’s single-payer bills not only directly help millions, but could point a socialist path out of the current dead end around immigration politics in the US and Europe. Over the past decade, most parties of the center and many on the left have shifted towards far-right positions on refugees and migrants as a supposedly necessary concession to white-working-class xenophobia. This is morally and strategically wrong.
When socialists win truly universal social programs that cover migrants, we can demonstrate that social care is not a zero-sum game. Instead, building social systems for everyone who lives here makes for stronger public institutions and a healthier society for all. If we are to push further towards building a powerful multiracial working-class movement, then a proud politics of inclusion for immigrants is not only right — it’s essential.
Single payer is also a critical feminist fight. Public health coverage for all would be transformational to a society in which most unpaid and underpaid care work falls to women. When people can’t get the care they need, someone is usually compelled to pick up the slack — and, especially in the realm of home care for family members, those people are disproportionately women. (“The best long-term care insurance in our country,” concluded a recent study about home care for older adults, “is a conscientious daughter.”)
Women are more likely to receive health insurance as dependents, which means that losing a spouse through death or divorce puts them at greater risk for being uninsured. Single mothers are nearly twice as likely to be uninsured as mothers in two-parent households. Meanwhile, women who are insured also suffer disproportionately from confusing and predatory private insurance industry practices. Care costs more for women, is harder to obtain, and employers can refuse to cover contraception on religious grounds, meaning a woman’s reproductive health is in many cases dependent on the conditions of her employment. California’s Medicaid program covers abortion, contraception, and prenatal care. To universalize that comprehensive and inclusive care is an urgent and crucial feminist reform.
The California Nurses Association, which is leading the charge on the state single-payer effort, has eighty thousand members across both unionized and non-unionized workplaces in the state. These workers are overwhelmingly women, and about half are people of color. Women fill nearly all of the top leadership roles at CNA.
Who better to lead the fight to bring care into the public sphere than women care workers, who disproportionately shoulder the burden of undervalued care? Organizing in close alliance with care workers is an essential way we can put our principles into practice and expand socialist-feminist understanding within our ranks.
Working with organized nurses is also strategic for building solidarity between socialists, the labor movement, and the broad working class. CNA has led the drafting of legislation and steered the inside game while coordinating and supporting grassroots allies across the state. Nurses at the helm makes this not just a “consumer movement,” made up of health-care users, but a workers’ movement. The nurse-led campaign sets up a clear dynamic of workers, both inside and outside the industry, against our common adversaries at the very top: health insurance executives, shareholders, and the 1 percent.
Over the last half-century, the relationship between socialists and the labor movement has grown tenuous, as both groups have been diminished and devitalized by state repression and capitalist advancement. As socialists, we know that acting in concert with organized labor is fundamental, and that it’s necessary to rebuild our role, both as socialist organizers and workers ourselves, in the labor movement. By uniting with nurses against CEOs, we’re committing to working-class solidarity in practice, not just in theory.
Socialists must continue to build our own independent organizations steered by the democratic power of our members, but the nurses are a strategic ally to learn from and fight alongside in this moment.
Finally, single payer would win power for the working class like no other reform popularly on the table in the US today. When socialists consider fighting for a reform, we should ask if it builds working-class power towards future struggles. Some left organizers and scholars call this “building the crisis”: by winning reforms that strengthen the material conditions and class consciousness of working people, we advance the fight for more radical victories.
Many union workers, who have seen spiraling private health insurance costs undermine their position for wage and benefit increases, have rallied behind single payer as a bulwark for future battles with management. For non-union workers, too, single payer would strengthen both their actual health and their bargaining position for raises and other benefits. A push for single payer, in this political moment, is uniquely able to draw clear lines of class conflict: it’s capitalists versus all of us who work.
Single payer is already a concession on the part of socialists. We want fully socialized medicine, which would function on the same principles but extend to hospitals and doctors themselves, and which already exists in many nations. We envision single payer as a first step in a long struggle to implement full universal social programs. We see it as a non-reformist reform: that is, a structural modification of power relations that elevates the ability of working-class people to fight against capital while radically shifting the window of political possibility.
We’re interested in using SB562 as a political education opportunity for our membership and neighbors, and publicly advancing the idea that universal social programs are better than means-tested ones. According to the neoliberal logic of means-testing, some people need public assistance to attain things like health insurance, but only those in the direst of straits. Socialists, on the other hand, believe in the decommodification of essential goods and services for all, for both moral and politically strategic reasons.
Universal programs are essential to eliminating wealth inequality. They decrease disparities in the here and now, creating a stronger working class that is less fearful and insecure, and therefore less easily exploited by capital. They also build powerful new constituencies dedicated to defending public goods against privatization.
In this way, universal programs can function as “engines of solidarity.” To make health insurance universally guaranteed and public is to both assert that coverage is a right, and to build a stronger body politic that can mobilize to protect that right.
In our discussions at peoples’ doors, we hear our neighbors’ indignation that the wealthy are able to receive medical care when necessary without fear of ruinous financial consequences, while everybody else is faced with hard choices about whether to go into massive amounts of debt to seek necessary treatment. In those conversations, we hear the raw material for a mass oppositional class politics.
That’s why we ask for commitments from those people to join the campaign, instead of just signing a petition or donating once. For example, behind one door was a twenty-six year old with a bandage wrapped around his hand. He had just lost his job, where he was paid poorly to work with dogs, one of which had bitten him badly. He was a few months too old to be listed as a dependent, and suddenly found himself uninsured.
He talked to our neighborhood canvassers for twenty minutes. At the next neighborhood canvass there he was, DSA clipboard in his healing hand, knocking on doors with the rest of us.
California’s Single-Payer Melee
Pressured by a growing movement and a single-payer bill that has passed the State Senate, elite Democrats have been forced to show their true loyalties. In late June, Assembly Speaker Anthony Rendon froze the bill in committee, halting any formal legislative progress in his chamber until next year.
We knew this opposition was coming. Contrary to recent allegations of unpreparedness and deception, from the start of the campaign, CNA leaders have been clear on statewide conference calls with coalition activists that we are building strength for a multiple-year effort — which could require a ballot campaign as a costly last resort. That’s only necessary if the legislature can’t be pushed to deliver single payer past the state’s tax and spending constraints.
The coalition’s current effort to turn up pressure on Rendon and other resistant Democrats is essential to build that necessary legislative will. At doorsteps, DSA organizers have been talking with our neighbors about what it will take to win this protracted and difficult fight.
After fifty years of conservatives and centrists passing severe restrictions on taxes and spending, California’s political playing field is badly rigged. That’s why our victory requires building a powerful movement off that field. Democratic elites — steered by donors from real estate, insurance, dirty energy, and tech, and backed up by the management of huge non-profits and major unions — treat the handcuffs on state power as “sacred doctrine that should never be questioned.” Even if they wanted to overturn suffocating restrictions on the state, Democratic leaders can’t imagine building the popular power needed to do it.
If Democrats bury the legislation now, they will be opposing the idea that politics ought to involve imagination, mass effort, and the will to fight uphill battles so that people’s lives might be freer and better. In this context, socialists have a critical role to play in the movement for single payer: unlike the Democrats, we can build broad working-class power while expanding the public imagination of what politics could be.
East Bay DSA regards SB562 as an opportunity to build, mobilize, and grow our organizations and movement. While the bill is frozen in committee, we’re going to continue educating, coordinating, and taking full advantage of the swelling interest in both single payer and socialism. In those respects we’re already winning, and no legislative defeat can undo our victories.
But this isn’t a trap, or a trick question meant to expose neoliberal hypocrisy. Single payer is a real policy demand, and we want it to pass. If it does, there will be several subsequent obstacles to actually implementing a functional single-payer health care system in our state. If we proceed to a ballot measure, the health insurance lobby will wage a media war to scare Californians out of it. (Of course, the best way to combat a propaganda campaign that well-funded is to organize and educate people on the ground, grassroots-style — which we’re currently doing.)
In the meantime, socialists around the country must start thinking critically about building and wielding organizational power. Not every socialist group has the opportunity to rally behind state single-payer legislation like we have. But given our national moment of historic upheaval for health care and the broadening popularity of Medicare for All, we think socialists throughout the nation can build alliances and open political imagination by being a loud voice — and given the refusal of the Democratic Party to champion it, perhaps the loudest voice — for single payer in their specific political climate.
A nationwide single-payer campaign that embraces a diversity of location-specific tactics can help socialists replicate a skill-building, infrastructure-honing strategy across cities and states. This shouldn’t preclude simultaneous local and regional campaigns on other issues, but we believe a primary nationwide focus on single payer, more than any other issue, will build power for socialists and the working class.
East Bay DSA’s campaign for single-payer legislation shows how we can get started.