It's Time to Stop Being Polite About Medicare For All

The House Rules Committee held the first-ever hearing on Medicare for All today. It’s a landmark moment to be celebrated; it was hard to imagine anything like this even a few years ago.

The last-minute addition of Ady Barkan, the Medicare for All activist who is dying of ALS, was undoubtedly a boon for single-payer advocates. His testimony was powerful, heartbreaking, and impossible to refute:

But as several health reporters pointed out, the hearing overall was perhaps surprisingly tame, given the stakes of the policy:

That doesn’t mean it wasn’t full of Republican bullshit, of course. Grace-Marie Turner, one of the witnesses invited by the Republicans, runs a conservative nonprofit that has received at least $235,000 from PhRMA, according to tax disclosures viewed at the Center for Public Integrity.

It wasn’t until almost four hours into the hearing that the tone of the debate heated up. Rep. Debbie Lesko, whose questions to the panel were predictably stupid and offensive—at one point she insisted that U.S. citizens won’t want to pay for the care of “illegals that aren’t citizens”—questioned why the committee was even holding hearings for a bill that the GOP Senate would pass. She argued that because her mother likes her Medicare Advantage plan, a Medicare for All plan that would end Medicare Advantage would be bad. B

Barkan noted that Medicare for All would deliver all the same benefits for no cost. Lesko’s response was, as Jonathan Cohn pointed out, clearly confused and did not address the substance of Barkan’s point at all.

Barkan’s response to this was devastating. He reminded Lesko that he had asked her about Paul Ryan’s plans to cut Social Security last year, and that she had “no idea” what he was talking about, and said she had “chosen to not get [her] facts straight today.” Answering Lesko’s question of why the committee was holding the hearing at all, his response was simple: “Why are we having this hearing? To keep people alive.”

It was a marked shift from the tone of the rest of the hearing. Not that Barkan was being impolite or even uncivil; given the stakes, every response should have been like that. Each and every Republican lie in that hearing deserved to be drowned out by jeers.

Much of the questioning focused on the cost of single-payer, both from Republican and Democrats, who it seems felt they needed to point out over and over again that single-payer could save money. This is true. Undoubtedly, it will be necessary to have endless, tiresome debates about cost and How We Will Pay For It, fought mostly on Republicans’ turf and with Republican or, at best, centrist premises—that you could never cut the defense budget, that raising taxes on anyone is politically impossible, that private insurance has any value.

Advocates do need to make the case that tax increases will be offset by the vast out-of-pocket savings for people who currently can’t afford to even use their insurance, and by the value of saving lives. But I pray that we eventually move beyond getting stuck on this wonky ground, and answering questions that have been answered over and over, and focus on the moral urgency of the issue, like Ady Barkan did.

It is time to start being meaner to politicians, Republicans and Democrats alike, who don’t support single-payer. Remind them what they do support when they say they want to preserve a system that includes $6,000 deductibles and people dying from rationing their insulin. Remind them what it means to say they want to preserve the private market when that means preserving a cost barrier to care. This is not some wonky debate over taxes and premiums; it is a moral emergency.