Kshama Sawant on single payer

Glimmers of healthcare politics at meeting of Western Washington docs

Tough talk from Kshama Sawant and others at annual gathering of Western Washington Physicians for a National Health Program.

By Ted Van Dyk (Seattle), July 23, 2014

Seattle City Council member Kshama Sawant also was critical of Obamacare, arguing that the administration colluded with drug and insurance companies in framing it. Sawant spoke longest and most avidly at the meeting. She called on committed single-payer supporters to follow the example of those who sought a $15 minimum wage in Seattle, and bring tireless pressure to bear on Democratic officeholders in particular. Sawant is a committed socialist who often referred to "working class interests" and "corrupt corporations, banks, and hedge fund operators."

Kshama Sawant (video at 4:45):

"Our discussion should be formulated not on the basis of whether or not the ACA delivered something good. Maybe it did, but that's not the point. The point is, what are we not getting from it, and why didn't we win single payer health care? That's what I would like to focus on."



By Don McCanne, MD

Socialist Kshama Sawant, a member of the Seattle City Council, came to national attention by leading her fellow council members in passing a $15/hour minimum wage for their city. Having shown that political activism can still be effective, she has important advice for us in our efforts to enact single payer reform.

Currently attention has been diverted from single payer, as most progressives are celebrating the supposedly great successes in implementation of the Affordable Care Act (ACA). Even the Republicans in Congress who have voted several times to repeal ACA, are now suing President Obama for not implementing it fast enough.

Those of us who continue to adamantly support single payer are facing criticism for not joining the ACA bandwagon. This is where Sawant’s message is so important. Whether “ACA delivered something good” is not the point. The point is, we have to inform the public on “what are we not getting from it.” And what we are not getting is most of the goals of reform! The accomplishments are extremely modest compared to the reform that we need.

What are we not getting from ACA that we would be getting from single payer?

  • Truly universal coverage
  • Dramatic reduction in administrative waste
  • Removal of financial barriers to care
  • Coverage of all essential health care services
  • Free choice of hospitals and health care professionals
  • Removal of the interventions and excesses of the private insurers
  • Taxpayer financing based on ability to pay
  • Infrastructure reform that would slow spending to sustainable levels

And what successes are the ACA supporters touting (though using different rhetoric)?

  • Coverage of only about half of the uninsured
  • Shift to underinsurance products
  • Guaranteed issue of these underinsurance products
  • Deductibles that keep patients away from care by erecting financial barriers
  • Insurance subsidies that are inadequate
  • Ultra-narrow networks that take away choice
  • Insurance marketplaces that increase administrative complexity and waste
  • Inadequate cost containment policies (except for perverse higher deductibles)

Sawant delivers a very strong leftist message on social justice issues, and includes in her comments the failures of the Democratic Party to act. But this point on what we are not getting from ACA and why we need single payer is not a leftist message. It is a call for all of us from across the political spectrum who support single payer to take control of the message. We can no longer allow ourselves to be a meek voice silenced by those who, for noble and ignoble reasons, celebrate the paltry successes of ACA.

Again, the something good that ACA did is not the point. The point is what we are not getting from ACA and would be getting under a single payer system. Let’s drown out the message of the ACA supporters who wimped out on real reform.