The Democratic Socialists of America, or DSA, is a nationwide, membership-based political organization that aims to build working class power by employing a variety of different tactics, from electoral organizing to workplace organizing and direct service. DSA is an organization comprised of dozens of local chapters, whose projects, aims, and strategies vary widely from chapter to chapter. Every two years, representatives from DSA chapters gather to participate in a national convention and vote on three priority issues. Last year, the membership voted to center three priorities: electoral strategy, labor organizing, and campaigning for Medicare for All, or M4A. The New Orleans chapter of DSA chose to participate in this campaign by forming a Health Care Committee in 2017, whose primary goal has been to fight for M4A. Currently, the committee has approximately 15 to 20 consistently active members.
FROM 1965 TO OBAMACARE: HOW WE GOT HERE
Until the creation of Medicaid and Medicare in 1965, private insurance was the only option for health coverage in this country. Medicare is a federal health insurance program that covers everyone over the age of 65, while Medicaid is a state-based program that covers people who fall below a certain income level. Medicaid and Medicare were the first public health insurance programs in the United States.
In 2010, the Affordable Care Act (or ACA, colloquially known as Obamacare) was signed into law by President Obama. Millions of previously uninsured Americans became insured, and the legislation delineated new standards that dictated what benefits a health insurance plan must cover. Also, as part of the ACA, the eligibility requirements for Medicaid were changed to include people who earned up to 133% of the federal poverty level, rather than just those living below that level. It was the most significant health care legislation since the 1960s. But still, the Kaiser Family Foundation, a non-partisan health policy research institute, estimates that over 27 million people remained uninsured as of 2016. KFF also found that, among those who are insured, total cost-sharing is increasing every year at a faster pace than wages. The ACA’s gains are existentially vulnerable, in part because the legislation did not directly challenge the principle that our health care system has been built upon: extracting profit from illness and injury. Instead, the federal government awarded subsidies to insurance companies so that they could enroll low-income Americans in health insurance without having to worry about their profit margins. We continued to accept that a financial incentive was necessary to meet this fundamental human need.
These failures and limitations of the ACA clearly illustrate why DSA, as a socialist organization, is taking on the fight for M4A. We can name the enemy. High uninsured rates, billing bureaucracy, high pharmaceutical costs, and unevenly distributed health care resources are not individual problems that can be tackled individually. They are interconnected symptoms of a larger problem: a health care system that is designed for a few to get rich when others fall ill.
CANVASSING TO BUILD POWER
Once a month, members of the New Orleans DSA Health Care Committee gather together on a weekend afternoon to canvass in our neighborhoods for M4A. The legislation we’re working for would create a universal, nationwide, comprehensive health insurance program (also known as a single-payer system) by expanding the current Medicare program to cover everyone living in the United States. If it were enacted, M4A would be the first truly universal health insurance program in the history of this country.
To canvass, we split into pairs and go over our script, divvy up turf maps, and practice asking each other open-ended questions. Then we hit the streets and start knocking on doors: Have you ever had anything weird happen with your health insurance? Have you ever had to stay in a job you didn’t like because you didn’t want to lose health insurance? What was that like? Stories of injustice surface quickly: a mother who couldn’t get in to see a doctor for her carpal tunnel syndrome because there were no orthopedic surgeons accepting Medicaid, a man who had to wait three months to get an MRI, an unexpected medical bill that winds up in the hands of a collections agency.
Some of these are the stories of people we meet when we canvass, and some of them are stories shared by our own organizers. One DSA organizer reported that she couldn’t get the contraceptive coverage that she needed because the only provider her plan would cover was Catholic, and refused to serve her on religious grounds. She was forced to pay for contraception out of pocket. Her medical debt built up quickly. Although she was able to switch plans, her doctor’s visits then weren’t covered, and she ended up owing Ochsner $5,000 which wasn’t covered by her insurance. These stories are so common as to be mundane; they comprise the fabric of our expectation for care in our society.
“Being in the DSA means hating your job so much that you work a second one for free”
Our committee is campaigning for M4A out of solidarity, not charity. Sharing stories like these at the door helps us build relationships in our communities, and building relationships helps us build power.
DSA’s structure—a loose federation of affiliated locals—means that our chapter has the freedom to build an M4A campaign that fits the local context in which we’re organizing. Louisiana is not California or New York or New Mexico, all of which have state-based single payer bills for which their DSA chapters can directly campaign. There is currently no candidate in our district that we can support who will champion M4A in Congress, although we do push Representative Cedric Richmond to co-sponsor HR-676, “Expanded & Improved Medicare For All Act,” the M4A bill in the U.S. House of Representatives. What we can do is work to shift the discourse and raise our expectations of our health care system, one conversation at a time. What we can do is remind our neighbors and ourselves that although our experiences of injustice at the hands of the healthcare system can feel isolating, we are not alone.
HEALTH FAIRS TO STRENGTHEN OUR COMMUNITY
Once every two months, our committee hosts free health fairs in a neighborhood park or an empty lot on a busy street. Enthusiasts that we are (to paraphrase a tweet from @_b_e_n_c_: being in the DSA means hating your job so much that you work a second one for free), we’re generally all decked out in our red DSA t-shirts, “No co-pays, no premiums, no deductibles” written in loud white font on the back. Some of us fan out into the surrounding area to talk to passersby and to let neighbors know about the event, while others hang back to set up the pop-up tents, tables, rice and beans, and ice chests filled with drinks. We offer very basic health screenings, information about community health resources, Medicaid enrollments, and assistance with debt disputes. People mostly come by for the food or the health screenings, but then they pull up a chair to chat. We spend an afternoon under the shade of an oak tree, talking to our neighbors about the campaign.
The health fairs offer direct service from our committee to our community. But while we are working to mitigate the impact of existing problems, we are also having conversations with people about why these issues shouldn’t be a problem to begin with.
We work with an organization called the Debt Collective to provide assistance disputing debts that have gone into collections. The Debt Collective is a group that organizes debtors and debt strikes. They formed during Occupy Wall Street and earned notoriety by staging a debt jubilee, in which they bought up personal debts for pennies on the dollar and then forgave them. They have built online debt dispute tools that allow anyone to easily dispute their debts, which can often lead to debt forgiveness. A 2007 study published in the American Journal of Medicine estimated that 62% of bankruptcies were caused by medical debt. A Kaiser Health Tracking Poll found that three in ten American households had problems paying medical bills in the last year.
If we are able to win an M4A system, no one would have to go into debt in order to pay for needed medical care. During the health fairs, we collect signatures in support of M4A and work to grow the membership of our organization. But many of the people we meet—and many of our own members—need more immediate relief from the injustices of our for-profit health care system. Fighting for M4A in cities like New Orleans means acknowledging these needs and working to deliver some relief, either through direct service work like the health fairs or by advocating for smaller, short-term gains, such as paid sick leave (which has been a big part of Austin DSA’s M4A campaign).
HEALTH JUSTICE AND THE BODY
In many different respects, Louisiana is a state with poor health outcomes. The Center for Disease Control’s 2013 HIV Surveillance reported that Baton Rouge and New Orleans have the second and third-highest rates of new HIV infections of any cities in the country, respectively. The CDC also reported that more than 35% of adults in Louisiana are pre-diabetic, meaning that their blood sugar is higher than normal, and they are at risk for developing Type II Diabetes. America’s Health Rankings, an organization that performs state-by-state studies of key health measures, found that Louisianans have higher rates of cancer deaths, cardiovascular deaths, and obesity than the national average. The same report notes that these health disparities are disproportionately shouldered by Black and Brown Louisianans.
These disparities are driven by a variety of historical, environmental, and political factors, including systemic, institutional health racism. Unequal access to health insurance is only one of these factors, and switching to an M4A system will not be a panacea that solves all our health crises. But the positive health effects of expanding public health insurance to cover more people have already been seen in Louisiana.
In 2016, Governor John Bel Edwards signed the state Medicaid expansion into law. According to the 2017 Louisiana Health Insurance Survey, in the two years since then, almost half a million Louisianans have gained health insurance, including over 53,000 people in New Orleans. Statewide, the Medicaid expansion halved our uninsured rate. In 2015, nearly 23% of the state was uninsured, but by summer of 2018, only 11.4% of the state lacked health insurance. What happens to physical health when half a million people get health insurance?
The Louisiana Department of Health has been tracking this closely. According to the Healthy Louisiana Expansion Dashboard, more than 75,000 people accessed mental health services as a result of the Medicaid expansion. Over 9,500 patients were newly diagnosed and treated for diabetes, and over 231,000 received new patient or preventative care. Nearly 27,000 people received colon cancer screenings, with one-third of those people receiving follow-up care as a result of that screening. In other words, not only did people receive cancer screenings that they likely wouldn’t have gotten otherwise, but many of those people were diagnosed with cancer as a result of that screening. Had they been uninsured, they might have waited until they were experiencing symptoms to visit their doctor, at which point treatment is less likely to be effective. It’s not hyperbolic to say that the Louisiana Medicaid expansion saved thousands of lives.
These improvements in coverage are an important first step forward, and they demonstrate the immediate, positive health effects of expanded public insurance programs. But the M4A system we are fighting for would cover every person living in the United States, regardless of age, income, citizenship, health history, ethnicity, sex, gender expression, or disability. It would be free at the point of service to all residents of the United States. All care would be covered, and all cost sharing (i.e. premiums, deductibles, copays, and coinsurance) would be eliminated.
Ultimately, nothing less will do. Any incremental reform, or any reform that doesn’t abolish private insurers, would simply extend our current tiered system of coverage to more people, with some people covered by expensive, private plans and others relegated to public plans that don’t offer the same benefits or provide access to the same providers.
Right now, our chapter’s fight for M4A involves campaigning for an idea more than campaigning for a specific policy proposal. (Although there are M4A bills in the House of Representatives and the Senate, they aren’t likely to be voted on anytime soon.) But DSA has identified five principles which comprise the M4A plan we are fighting for.
A Single Health Program: Everyone will be covered by one health insurance program, administered by the federal government, and have equal access to all medical services and treatments.
Comprehensive Coverage: All services requiring a medical professional will be fully covered. You go to the doctor of your choice. Dental, vision, mental health, long term care, medical devices, and pharmaceuticals are all included.
Free at the point of service: All health care costs will be financed through tax contributions based on ability to pay: no copays, no fees, no deductibles and no premiums. Ever.
Universal Coverage: Coverage for all United States residents—non-citizens included.
Jobs: A jobs initiative and severance for those affected by the transition to government-run health care.
The clarity of these principles is the most important part of our role in the fight for M4A. M4A is an increasingly popular idea, with the support of nearly 70% of Americans, according to a recent Reuters-Ipsos poll. But the power of the idea of M4A extends beyond the specific policy proposal to its ability to bridge two worlds: the world that is right in front of us and the world that we know is possible. In this campaign, our most important work is to paint a clear picture—for ourselves and for our neighbors—of the path towards that world. Through regular canvasses and health fairs, we are creating a space to have these conversations with our neighbors and to find our way forward, together.