Why single-payer healthcare can win in California: An interview with Michael Lighty

By Shane Ruiz

Michael Lighty is a national leader in the fight for Medicare for All, served as the Healthcare Constituency Director for Bernie 2020, was a lead policy analyst for SB-562 to create a single-payer system in California, and for over twenty years worked for healthcare workers’ unions CNA/NNU on campaigns for patients’ rights, clean money elections, and a tax on Wall Street. He was also the National Director of DSA from 1989-93 and now serves on the Steering Committee for DSA’s Medicare for All campaign.

Majority’s Shane Ruiz interviewed Lighty, and the interview has been lightly edited and condensed.

Shane Ruiz: Let’s start with the basics: what is single-payer healthcare, and why is it beneficial to the typical, working Californian? 

Michael Lighty: When we say “single payer” we mean a Medicare for All-style program that replaces co-pays, deductibles, and all individual costs with a publicly financed system that provides every Californian healthcare as a human right. We’re not just talking about “access” to healthcare, which means “access if you can afford it.” We mean everybody. 

The “single payer” is us, we’re all in it together. Right now we pay all our money to middle-men insurers, who make money by denying care. In a single-payer system, the medical decisions get made by patients, families and medical professionals. It puts doctors and nurses in charge of our care, and frees healthcare workers to actually provide care instead of dealing with insurance company bureaucracy. 

The benefits of a single-payer system to working people are unquestionable. Single payer means more freedom: freedom to change jobs, freedom to get healthcare even if you lose your job, freedom from your boss. It also frees up money from employers that can go to higher wages, pensions, increased staffing, more vacation. Really it’s all upside for working people. 

When Republicans and establishment Democrats talk about single payer, they inevitably bring up “the costs.” What are the costs of single payer and why is that a misleading frame?

Because single payer doesn’t cost money, it saves money. Every study has shown that. Most recently, the Republican Congressional Budget Office found $650 billion in savings from a single-payer bill. It saves on retiree health benefits, saves on direct costs of healthcare, it saves school districts money to spend on staffing and safe schools. It saves municipalities money to improve public services. So the cost of single payer actually has to be weighed against the cost of not doing single payer, which means living with the skyrocketing costs and poor results we have now. Our for-profit system is very costly in terms of dollars and lives. 

The murders of George Floyd and Breonna Taylor earlier this year reignited mass uprisings across the country against racial injustice. Dr. Martin Luther King Jr. famously said that “of all the forms of inequality, injustice in health care is the most shocking and inhumane.” How would single payer fight racial disparities in healthcare? 

Medicare for All won’t eliminate racism, but by creating a universal healthcare system, rooted in quality care for all, it can act as a bulwark against the structural racism that permeates our society.  What we’re talking about building is a system that puts everyone on an equal footing, something that has never been provided to minorities in this country. It would be the culmination of decades of anti-racist struggle, going back to at least the desgregation of hospitals through the Medicare progam. 

The stakes are high for communities of color. Minorities are more likely to be uninsured, underinsured, and subject to financial and geographic barriers to care. They are less likely to have insurance that gives them access to a quality network of healthcare providers, and when they do they are more likely to have high co-pays and deductibles. Minorities are also more likely to live in concentrated poverty, a major contributor to poor health.

A single-payer system would guarantee people get the healthcare they need, regardless of race or neighborhood. By funding public health, preventive care, culturally competent care, and mental health care for all, it would bring more healthcare resources to the communities that need it most. For too long, the social determinants of health have been addressed through policing and not caregiving. 

In 2017 Senators Ricardo Lara (D-Long Beach), Toni Atkins (D-San Diego), and the California Nurses Association (a union representing 100,000+ nurses) introduced and passed a single-payer healthcare bill through the State Senate. In a controversial move, Speaker Anthony Rendon (D-Los Angeles) refused to call a vote in the state assembly, redoubling activist skepticism that Democrats only support single payer rhetorically, but won’t fight when it actually counts. Now there is a renewed effort to pass single payer in the state led again by the California Nurses Association. 

Why is this time any different? 

There are a few reasons to think this time is different: a new governor, a new White House, the explosive growth of DSA, and a global pandemic.

To give a peek behind the curtain, the reason the bill got shelved by the State Assembly in 2017 was because Jerry Brown didn’t want it on his desk. This time not only do we have a governor that campaigned on single payer but who made it a central argument for supporting him over Los Angeles Mayor Antonio Villaragosa. In office, he’s also submitted a waiver to the Trump administration to use federal funds to pay for a statewide single payer system. I fully expect him to do the same with a new Health and Human Services secretary, California Attorney General Xavier Becerra, who is on record supporting Medicare for All.

This new set of electoral circumstances is colliding with a change in our political movements. The Bernie campaign popularized Medicare for All, making it the defining issue in the healthcare debate. Where you stand on Medicare for All defines where you stand on healthcare. It’s gone from the margins to the center, its support has exploded. 

But is popularity really enough? 

Well no, not on its own, but that brings me to another huge change — the continued growth and seriousness of DSA. Of course lots of things are popular that don’t get done because the rich and powerful don’t want it. But with the growth of DSA, we’re seeing thousands of active, smart organizers take on these powerful interests. Organized people beats organized money, and DSA organizes people very effectively. It’s effective because it combines a persuasive and fundamental critique of society with concrete actions that directly address the needs of workers. That’s a strategy that makes sense to people. It gives people concrete tactics to carry out. It also has a very democratic and collective style that gives people a stake in the decision-making. That’s how you grow a movement. 

Lastly, and probably most importantly, we have to talk about the crisis of the current moment. The pandemic has revealed the profound structural deficiencies in our current healthcare model around equity, staffing, supplies, planning, and public health. It has revealed that we don’t have a healthcare system at all, we have an industry model. It can’t deliver in a crisis. 

Before we get back to the pandemic, let’s talk about the political forces in California. Given our relatively high union density, Democratic politicians are generally pretty responsive to the labor movement’s demands, but as of yet, labor has not come out in a unified effort to support single payer. 

What is the role of the labor movement in winning single payer, and how can we get more unions behind a demand that would universally benefit working people? 

In some ways I don’t accept the premise. We have a lot of labor support but it hasn’t been galvanized to the level we want. We need to address specific union members’ concerns: what’s it cost? What does it mean to me? We have to do it in concrete terms, not just platitudes. We have to tell union members this will be better than your union benefits, and not just approach them with slogans. We have to be clear, like Bernie was, that savings from healthcare will go back into union contracts, wages, pensions, not to the bosses. 

But really, it’s a no-brainer from a labor perspective. This saves employers and workers money. It will provide new money that unions can negotiate for in their contracts. It takes healthcare off the bargaining table and eliminates the employers’ leverage to use healthcare against us. Like raising the minimum wage, it actually increases leverage against employers, because it raises up the whole labor market. Workers will no longer be reliant on their employers to see a doctor. That’s a huge shift of power to workers. 

Still, it’s true there’s a lot of work to do in educating members and union leaders. We’re not going to win this demand without full engagement from the labor movement, but we can get it if we do the hard work of educating. 

COVID-19 has obviously brought the issue of healthcare to the forefront of everyone’s minds, but the mass death and illness is often portrayed as an “act of God” rather than a public health challenge. Would a single payer system help us deliver better care in future public health crises? 

Absolutely. Public health has diminished in the past hundred years. A system based on an industry model, that emphasizes profit-making, must essentially defund public health, which it has. That shift of resources from public to private has devastated our ability to respond to pandemics. 

The industry model views healthcare like any other business — like making hamburgers or cars. They have imposed a just-in-time supply chain, and just-in-time staffing, which naturally has resulted in supply and staffing shortages in the midst of a crisis that dramatically increased demand for healthcare. We don’t build PPE as a country, we count on private industry to do it for profit. Well, we see how that turned out. On the other hand, when we institute public financing for public health, we get emergency response based on the needs of the community. 

At the level of our whole society, the pandemic has created division. In other countries, with national health systems, they have a sense of solidarity and security in having those social systems. We lack those systems so you see division, distrust, and insecurity. A single payer system is the first step, not just in providing everyone healthcare, but in rebuilding our society on the basis of human need over profit.