By John Geyman for Truthout.

The Democratic Party, as is the case with the Republican Party, has its own civil war going on as it looks to the upcoming election cycles in 2018 and 2020. Its division over how to proceed on health care shows how wide the divide is among Democrats.

Democratic centrists, so involved in defending the Affordable Care Act (ACA) against the Republicans, are riding high on their success so far in avoiding its repeal, but shouldn’t take too much of a victory lap since the GOP has no replacement plan, especially after more than seven years. Meanwhile, the centrists are pushing aside the efforts of progressive Democrats to place universal health care through single-payer Medicare for All on the party platform. This continuing wide gulf across the Democrats’ political spectrum will delay real health care reform, weaken their impact on health care, and could easily lead to losses by Democrats in the upcoming elections.

These examples of disunity among Democrats on health care are alarming, even after their loss of more than 1,000 seats nationwide last year and Trump winning the White House:

• In 2016, the Democratic Platform Drafting Committee voted down inclusion of Medicare for All on the Party’s platform by 7 to 6, with all the no votes coming from delegates chosen by Hillary Clinton.

• Strangely, after losing the election, her people still run the party establishment, as shown by the recent purging by Democratic National Committee (DNC) Chairman Tom Perez of high-ranking members who have been supporters of Keith Ellison, leader of the progressive wing of the party.

• The current bipartisan Alexander-Murray bill in the Senate, if passed, would trade off a two-year continuation of cost sharing reduction (CSR) payments for loosening of the ACA’s restrictions on insurers that would bring back skinny policies of little actuarial value, thereby splintering the market further to the advantage of insurers, not patients. These catastrophic policies, such as copper plans with actuarial value of just 50 percent, have low premiums but high annual deductibles ($7,150 in 2017).

• Talk among centrist Democrats of lowering the eligibility age for Medicare to 55 and bringing back the public option are surrender-in-advance approaches that, even if successful, would leave us far short of universal coverage, further fragment our wasteful financing system, and increase profits to an unaccountable insurance industry that leads the S & P 500 in profits.

• The weak approach by Democrats, trying to appease both ends of their party, goes against the will of almost 80 percent of Democratic voters and 60 percent of voters in both parties that support Medicare for All. It also ignores the fact that Rep. John Conyers House Bill 676 (Expanded and Improved Medicare for All) has 125 co-sponsors and Sen. Bernie Sanders Medicare for All Senate Bill already has 18 co-sponsors.

Jim Hightower describes the present situation this way:

Let’s be blunt: When it comes to the fiery leadership that America’s grassroots people want and need, the Democratic Party establishment is weaker than Canadian hot sauce. When you’ve got 60 percent of your party’s rank-and-file congressional members ready to go on such a basic issue and 60 percent of the public is also ready to go—it’s time to go!

Caution and cowardice over health care runs throughout the continuing Democratic Party establishment. House Minority Leader Nancy Pelosi, a strong defender of the ACA which she helped to pass, says that the American people are not yet ready for national health insurance (NHI) through Medicare for All (despite overwhelming public support). Rep. Debbie Wasserman-Schultz (R-FL), who led the charge against Bernie Sanders in the DNC during the 2016 election campaign, has also not joined support for NHI, even as they facing upcoming challenges from single-payer advocates.

Here are two opposing views that signal weakness among Democrats toward health care reform, as quoted by Corcoran, M. Single-payer fight fuels primary challengers against establishment Democrats. Truthout, August 23, 2017.

•  Senate Minority Leader Chuck Schumer recently said that: single-payer will happen . . .  in 10 or 20 years.

•  Democrats need to stop playing both sides. You can’t claim you support the moral principle of health care as a right and refuse to back any policy that would make it happen. It is time to pick a side. (Ben Day, director of Healthcare-Now.)

Do we think that these kinds of views are unrelated to campaign donations from corporations in a deregulated medical-industrial complex that benefits from the status quo? Look at the leading Democratic recipients of donations from the health sector in 2017, including leadership PACs and campaign committees, as provided by the Center for Responsive Politics in Washington, D.C.

Sen. Charles Schumer (D-NY)                              $2,715,088

Sen. Ron Wyden (D-OR)                                     $2,574,215

Sen. Michael F. Bennett (D-CO)                           $1,898,702

Sen. Bob Casey (D-PA)                                       $1,744,516

Sen. Patty Murray (D-WA)                                   $1,698,733

Sen. Robert Menendez (D-NJ)                              $1,667,151

Sen. Debbie Stabenow (D-MI)                              $1,614,073

Sen. Sherrod Brown (D-OH)                                 $1,556,500

Most of the progressive Democrat challengers are refusing corporate money, in contrast to the establishment wing of the party. Jessica Early, health care justice organizer for Rights and Democracy, has this to say about the impasse within the Democratic Party that creates an unnecessary and unwise risk of continuing losses in future elections:

If you call yourself a progressive, and claim to be for the working class, the poor, for women . . . at a minimum you should support a public, equitable, universal health care system. If you can’t support that, who exactly are you for? . . . The Democratic Party has been tone deaf. That is the real takeaway from the 2016 elections. The centrist/corporate message is not working. (Ibid. Corcoran, M, 2017)

Although the Republicans have no replacement plan, they are correct in identifying the inability of the ACA to contain health care costs and prices, its unaffordability for may patients, and its huge bureaucracy and administrative waste. Centrist Democrats, absorbed as they are in defending their ACA, have still not accepted its flaws after more than seven years of experience. These are just some of the ACA’s shortfalls, none of which will be fixed by incremental changes, and all of which will be made worse by ongoing sabotage efforts by the Republican-controlled Congress:

• Restricted access to care, dependent on ability to pay, and with some 28 million uninsured and tens of millions under-insured.

• Choice of physicians and hospitals severely limited by narrow networks as negotiated by insurers to save money, not enhance quality of care.

• Unaffordability of health insurance and care; a typical family of four now pays about $27,000 a year for health care, double that of ten years ago.

• Widespread disparities in health care based on socioeconomic status, race/ethnicity, age, gender, location, and disability status.

• Massive, inefficient bureaucracy; the overhead of the private health insurance industry is now almost $800 per capita.

• Severe Medicaid cuts are in the offing, while 19 states refused to expand Medicaid under the ACA.

Like the GOP, centrist Democrats have no replacement plan for the GOP sabotage of the ACA. They will not win in the forthcoming elections by only criticizing the GOP. Voters will want to know what the Democrats stand for, not just what they are against. Their goal should now be obvious—join with the progressive wing of their party in vigorous support of the only way to bring universal coverage to all Americans—Improved and Expanded Medicare for All.  This would be winning strategy in 2018 and 2020 as health care and the economy are the biggest concerns of the electorate.

This is a golden opportunity for Democrats to take on the greed and waste of a profiteering medical-industrial complex and to assure that all Americans have full access to all necessary health care in the most efficient and affordable way. Democrats need to grasp this opportunity instead of frittering it away through needless internal divisiveness. They have a plan—Medicare for All— but do they have the political will?

John Geyman, M.D. is the author of Common Sense about Health Care Reform in America (2017)Crisis in U.S. Health Care: Corporate Power vs. The Common Good, and The Human Face of ObamaCare: Promises vs. Reality and What Comes Next. Visit:

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