How We Win National Improved Medicare for All

Recommendations from Single Payer Strategy Retreat
Oakland, CA December 8-9, 2018
Sponsored by Health OverProfit for Everyone

This report describes the results of an in-depth strategy analysis on how the single payer movement can win National Improved Medicare for All (NIMA). It was developed at a two-day strategy retreat held in Oakland, CA on December 8-9, 2018 at Friendly Manor, St. Mary’s Center. The retreat was organized by Health Over Profit for Everyone (HOPE), in collaboration with Women’s Economic Agenda Project (WEAP), and included people with different backgrounds in healthcare policy, poverty and welfare rights, as well as people who have provided health services as nurses and doctors to diverse populations.

The strategy conference began with a review of the stages of successful social movements and the roles that individuals and organizations play in the various stages. Mapping of the movement and an analysis of strengths and weakness, opportunities and threats was conducted. From that, immediate, short, medium, and long term goals were established and action steps were determined.


Immediate goal

Protect the integrity of HR 676. The most immediate threat is the redrafting of HR 676, which has been the gold standard of the single payer movement for the past 15 years and is based on the Physicians Working Group proposal, by the new lead sponsor Congresswoman Pramila Jayapal (D – WA). Groups are being asked to mobilize for national days of action in February, to coincide with the introduction of the bill, but the content of the changes are unknown. A decision was made to request that the text of the draft bill be released to the movement.


  1. Letter to Congresswoman Jayapal by December 17, 2018.
  2. Call-in tool to Congresswoman Jayapal’s office after the letter.
  3. Issue a call for action to demand release of the text if there is no satisfactory response.
  4. Organize actions if there is still no satisfactory response.

Short-term goals

Improve the text of S 1804. The senate bill introduced by Senator Sanders has serious deficiencies, some of which arguably make it a multi-payer, not single payer, bill. While Senator Sanders will likely reintroduce the bill in 2019, he has expressed an unwillingness so far to make significant changes. It will take a larger constituency to influence Senator Sanders.


  1. Draft a letter to Sen. Sanders and all of the current co-sponsors urging improvements to the bill.
  2. Use that bill for outreach to other groups to request their sign on and support.
  3. Deliver that letter by January 22, 2019.
  4. After the letter is delivered, organize call-in days to all Senate co-sponsors as needed.

This short-term goal serves a long term goal of pressuring candidates for president to adopt language from the single payer movement when advocating for National Improved Medicare for All. Many of the current senate cosponsors have also expressed an interest in running for president. They need to hear from people in the movement so they talk about including longterm care, taking the profits out of the system, using effective cost control measures, removing financial barriers to care, rapid implementation and more.

Keeping the National Improved Medicare for All message in the public dialog. Opponents of NIMA will try to suppress news about NIMA (unless its negative), will try to spread falsehoods about it and will try to generate fear of it. The movement needs a mechanism for keeping NIMA in the public dialog and for rapidly countering misinformation.


Media mobilizers – a group of people who will generate and share regular content through social media, will respond to news and misinformation about NIMA and will draft and promote letters to the editor about NIMA. A repository of graphics and sample social media posts will be shared on the HOPE website for people to use.

Educating legislative staff about National Improved Medicare for All. Most congressional health staffers hear frequently from medical industry lobbyists who are benefiting from the current system. Staffers do not have knowledge of NIMA or know how to respond to common questions about it.


Single Payer Educators – constituents will volunteer to be a liaison for their Member of Congress’ health staffer and will send regular emails (generated by the HOPE campaign) to that staffer with key information about NIMA. They will also encourage staffers to reach out to them when they have questions or need information.

Connecting HOPE organizers with each other and with new members. There are people involved in advocacy for NIMA throughout the country and some who are starting HOPE chapters. They are somewhat isolated from each other. HOPE will facilitate communication and collaboration, provide resources and connect new members with local advocates.


  1. HOPE will provide a list of local groups and contact information.
  2. HOPE will look into collecting geographic information about new members.
  3. HOPE will create a listserv for local advocates.
  4. Consider making state HOPE Facebook pages.

Medium term goals

Educating the public about NIMA. As more people join the movement for NIMA, they will need information and resources to be able to speak and answer questions about it.


  1. Develop an FAQ about NIMA that uses easy-to-understand language.
  2. Create a basic power point presentation and a script to go with it.
  3. Identify podcasts and videos that discuss NIMA and promote those.
  4. Create templates for simple cards and post cards that people can download, print and pass out.
  5. Start a speaker’s bureau.

Expose the profits/privatization in the current system. The bottom line of NIMA is a healthcare system that is public and not-for-profit. One obstacle to building support for this approach is the public’s belief that privatization is more efficient and/or higher quality than a public, not-for-profit system. We need information that exposes how profiteering and privatization raise costs and lower quality of care.


  1. Develop simple one-pagers on various ways that profits/privatization undermine the current system such as privatization of Medicaid, Medicare, monopolization and vertical integration and arrangements such as Accountable Care Organizations (ACOs).
  2. Create videos from patients and providers describing how profits/privatization hurt access to and quality of care.

HOPE as a place for activists to go. While there are tools and resources for activists on the HOPE website, it is not clear to new people how to access that information and the website needs more tools and resources that will make it a place activists and others use.


  1. Develop a welcome page for new activists to let them know what resources can be trusted, how to contact local groups and where to find information.
  2. Update the Action Map.
  3. Create a Medicare for All Facts as a fact and citation page for legislators, the media and advocates.
  4. Leadership development for HOPE speakers and organizers.

Involve people who are impacted by the current healthcare system. The most powerful advocates for NIMA are those who are impacted by the system. HOPE will reach out to impacted people and provide materials that can be used by people with different needs and concerns.


  1. Create a shared document where we describe specific changes to HR 676 that guarantee it meets human rights principles and the needs of everyone.
  2. Involve various constituencies in defining what should be in the legislation. There is a long term working group. Also need to consult people who use Medicaid, the Indian Health Service and the Veterans Administration.
  3. Publish informative pieces about from various constituencies.
  4. Develop one-pagers for various constituencies and how they will benefit from NIMA.

Gather co-sponsors for the new legislation. New bills will be introduced in the new Congress in 2019 and the signing on of co-sponsors will begin all over again. 113 of the previous co-sponsors were re-elected, 13 new members ran on a NIMA platform and 18 new members express support for some of the principles of NIMA.


  1. Create a packet of information that constituents can use in meetings with legislators and staffers.
  2. Facilitate meetings with constituents and members/staffers using teleconferencing technology.
  3. Track who has signed on and who hasn’t.

Recruit Republican support for NIMA. NIMA is a policy that should have bipartisan support. It is based on Medicare, which is popular across the political spectrum, and it is both fiscally conservative and liberal in its coverage and benefits. To prevent NIMA from being a political football, it requires bipartisan support.


  1. Identify specific Republican lawmakers to target as supporters/co-sponsors of supported bills.
  2. Work with constituents to organize in those districts and impact those lawmakers.

Impact the 2020 elections. Opponents of NIMA are planning to keep NIMA out of the dialog during the 2020 elections. We must work to make it a major campaign issue on which all candidates must take a position.


  1. Write letters to presidential candidates about how the movement defines NIMA.
  2. Use techniques such as birddogging to raise awareness of NIMA and pressure candidates to support it.

Impact the strategy of the movement. This strategy was developed by a diverse group of people based on knowledge of stages of social movements and tasks during those stages. For more information about movement stages, see


  1. Share this strategy document and tools and resources widely.
  2. Build alliances with people and groups in the movement and collaborate on actions.
  3. Identify areas of unity and focus on those, rather than dividing the movement.

Long term goals

Build national consensus that we can win NIMA. While national consensus is building for understanding that there is a healthcare crisis, that the current system can’t fix it and that NIMA is the solution, there is still not consensus that the people can win this victory. Some believe that we must compromise for something less. Of course, that is what our opponents will say.


  1. Educating people about how social movements succeed and how close we are.
  2. Celebrating progress and victories.

Build a national network of organizations. The single payer movement will need to be able to communicate with each other and respond rapidly as needed to win. This idea has not been fully fleshed out.


  1. Develop a plan so that organizations across the country can be kept up to date, share information and coordinate actions.

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