Open Letter by Leaders and Members of the DSA LA Health Justice Committee

September, 2023

We are members of the Health Justice Committee of the second largest chapter of the largest socialist group in the United States, namely the Los Angeles chapter of the Democratic Socialists of America (DSA-LA). We also work in a close coalition with members of Health Care for Us (HC4US), and with independent socialists who are members of various community groups and social movements. We are committed to the public policy goal of a single-payer health care program, but we have found that our collective work cannot advance at present within DSA-LA. We are therefore resigning from membership in DSA-LA; and we are publishing this open letter to address the local and national membership of DSA, and the much larger number of progressives and socialists among the people of this country.

As is well known, the presidential campaigns of Bernie Sanders in 2016 and 2020 not only underlined the issue of Medicare for All and of single-payer health care in red ink, but also boosted the membership of DSA from roughly 6,000 members to just over 90,000 members. As a campaigner who filled stadiums with supporters, and who openly called for political revolution, Sanders deserves solid credit for renewing a national conversation about both democracy and socialism. Socialists crossed all lines of age, sex, race, and class, and were moving from protest to power.

Raising the ground floor of social democracy in health care cannot be optional for democratic socialists, no matter whether we work within the existing party system or outside it, and no matter whether we are members of DSA or not. Single-payer health care is a radical reform, in the sense that it does go to the roots of our present health care system, which has built in disparities that track along the lines of sex, race, and class. Indeed, every pandemic, including AIDS and Covid, reveals the “pre-existing conditions” of a class divided economy and culture, though in starker relief and detail when we study epidemiological charts and statistics.

A single-payer health care system is not a magical potion nor a social cure-all. It is, however, both a great moral and medical advance beyond a “free market” system that encourages perverse incentives among health insurance cartels. To extract higher profits from a population of patients, the insurance companies insure themselves first and foremost. They are like casinos that play the probabilities of their own gambling tables and machines, and stay in business at the general expense of most gamblers, though some will of course walk away with money. Likewise, insurance have greatly improved their older actuarial tables, and have much greater health data to cherry pick the healthier patients, and to lemon drop the sicker patients. Single payer requires a common “risk pool” of all patients: Everybody In, Nobody Out.

Although Medicare For All was the definitive issue raised by Sanders in his 2016 and 2020 campaigns and among the most powerful magnets drawing new and younger members to DSA, the organization has retreated from a commitment to pursuing single-payer health programs in order to accommodate the interests of Democratic politicians both at the national and the state level. While President Biden has been honest in his opposition to single-payer, vowing to veto such a bill were it to arrive on his desk, California governor Newsom twice ran on a single payer pledge, proclaiming in 2018, “I’m tired of politicians saying they support single-payer but that it’s too soon, too expensive or someone else’s problem.” The California Nurses Association sponsored a bus that toured the state with a picture of Newsom’s face and these words: “Nurses Trust Newsom. He shares our values and fights for our patients.”

But their trust was misplaced. Newsom did not share their values nor fight for patients. In early 2022, Newsom introduced his budget while the state Assembly began to move a single payer bill called CalCare. When he was asked about it, Newsom got testy and replied, “I have not had the opportunity to review that plan, and no one has presented it to me.” Though Newsom said that single-payer was still “the ideal system,” he added: “The difference here is when you are in a position of responsibility, you’ve gotta apply, you’ve gotta manifest, the ideal. This is hard work. It’s one thing to say, it’s another to do. And with respect, there are many pathways to achieve that goal.”

It is safe to say that Newsom and his allies have assiduously strategized to ensure that a Single Payer bill does not arrive on his desk.

We do not need leaders of DSA to play riffs on Newsom’s deadbeat excuses, or to explain why it is such hard work for Newsom to do what he says. As for “many pathways” to achieve the goal of single-payer, a long-time member of DSA named Michael Lighty has served California’s career politicians so well in changing the subject from an actual single-payer program to a legislative campaign of false advertising. Lighty worked from 1994 to 2018 for the California Nurses Association / National Nurses United, “where he coordinated campaigns for an HMO patients’ bill of rights,” according to his profile online as a Fellow of the Sanders Institute. Lighty served as Healthcare Constituency Director for the 2020 Sanders campaign. He also is a Medicare for All consultant with National Union of Healthcare Workers, and is President of Healthy California Now (HCN), billed on the same Sanders Institute site as “the state single-payer coalition.”

Except that HCN is not a single payer coalition. HCN’s signature effort this year has been the introduction of SB770, which is now headed for likely passage in the legislature, and which we believe is intended to distract, delay and divert the campaign for CalCare, which is a true single-payer bill.

After passing the Senate and the Assembly Health and Appropriations Committees, with the final hurdle of Assembly passage coming up, SB770 has now been amended in ways that make its true goals even more undeniable. The bill now mandates that the Secretary of the CA Health & Human Services Agency “engage with” unspecified “stakeholders” on issues relating to health policy and Federal waivers – replicating the work of the recently completed Healthy California For All Commission. More importantly, the Secretary is instructed to report on a timeline that seems guaranteed to undermine the timing of a vote on the CalCare bill that will be introduced in January. In its original form the report from this process – then a Working Group, now undefined “engagement” – was due June 1, 2024, making it easy for legislators to avoid voting on the CalCare bill sponsored by Assemblyman Ash Kolra [AB 1690] by the May 31, 2024 deadline. But the amended version now before the legislator makes this strategy even more obvious by moving the date for the interim report to January 1, 2025, and the final report to June 1, 2025. In other words, the goal of delaying and diverting real legislative action will be achieved and single-payer will be kicked down the road for at least two more years.

HCN’s SB770 also introduces the ambiguous term “unified financing” in preference to the simple and crucial term single-payer, while claiming that the two efforts – SB770 and CalCare are complementary.

In our view, and the view of CNA and most single payer activists, SB770 is intended to give cover for Democratic legislators who can point to their vote for SB770 as fulfilling their pledge to support single-payer health care while actually helping sink CalCare and spare Governor Newsom the political cost of betraying his repeated pledges to support single-payer.

Keep in mind that California has a Democratic super-majority and the public has given unambiguous support for single payer reforms. The career politicians of the California Democratic party did pass single-payer bills and not just once, but twice. But they did so knowing that a Republican governor, Arnold Schwarzenegger, would veto them.

It was in this context – widespread public support and a Democratic supermajority – that we, as members of the DSA LA Health Justice Committee, urged DSA LA and other CA DSA chapters to join the California Nurses Association [CNA] in fighting for CalCare, the single-payer bill spearheaded by CNA and their allies in the legislature. But, when we presented a proposal to the 2022 DSA LA convention last fall to make CalCare a priority our resolution was attacked and defeated. Our proposal was not debated in any fair and open discussion but it was attacked by members of the chapter Steering Committee, reading HCN talking points off their phones, and making clear to any uninformed members that the proposal was opposed by the Chapter leadership. One of them stated “we need to elect cadre to Sacramento” before a single payer bill could be considered. Another stated that they “would be in negotiations with the staffs of Newsom and Biden.”

Why did the Steering Committee of DSA LA feel that it was necessary to sabotage the chapter’s efforts to achieve one of the central goals that brought thousands of new members to DSA? The Steering Committee of DSA-LA was mentored, though not enlightened, by Michael Lighty. Lighty and his allies insist that their “unified financing” efforts provide “tangible steps” and a “concrete timeline” toward eventual single-payer programs. On the contrary, they are projecting Five Year Plans till kingdom come, and they are pitching a neoliberal policy with a “socialist” Good Housekeeping Seal of Approval.

An episode of political surrealism soon followed when Ryan Andrews (a member of DSA-LA’s Steering Committee) submitted a Resolution to the DSA LA Steering Committee to join HCN. Although there had been no open debate and forum on health care policy within DSA-LA, and the Health Justice Committee was not consulted despite their obvious relevance, the Resolution was duly passed by the Los Angeles Steering Committee and a similar Resolution was subsequently adopted by the newly activated CA-DSA body. Believe it or not, the DSA LA Steering Committee assisted Michael Lighty in converting the CA DSA chapters into subsidiary stocks of the holding company of HCN. As the last clause spelled out without ambiguity: “Let it be further resolved that CA-DSA will offer material support for legislation endorsed by HCN after adopting and in accordance with a broader organization-wide framework for legislative endorsements.”

One of the key arguments levelled by HCN against CalCare and in favor of SB770 has been the claim that organized labor supports their strategy and that the prime sponsor of CalCare, the California Nurses Association [CAN] is being divisive. It is worth noting that CNA has over 100,000 members, and many more by affiliation with the National Nurses Association. Whereas the National Union of Health Workers, despite its name, has around 10,000 members, mostly in California and Hawaii. There are unions on both sides of the issue, and the reasons are complex. It is also true that most workers in California are not unionized, there are millions of uninsured Californians, and the system of employer-provided health insurance, even for union workers, also serves to handcuff workers to their jobs in order not to lose crucial benefits.

Now this ought to be a genuine subject for debate among socialists—namely, why some labor unions maintain the status quo of employment-based health care benefits. After all, workers did fight for such benefits, but many things can be true at one time. Indeed, the contradictions of capitalism are real contradictions. The leaders of SEIU and NUHW favor previous health benefits. However, the casino, hotel, and restaurant workers of Nevada had voted against their own union leaders and in favor of both Sanders and Medicare for All, a real electoral wildcat strike. The labor unions of nurses are the labor backbone of the single-payer health care movement in this country, despite the charges of “divisiveness” so often levelled against them by Lighty and HCN.

The DSA LA Health Justice Committee members, committed to true single payer activism frankly went over, under, and around the obstructions of HCN and the Steering Committee. We wore hospital gowns and chanted for CalCare when Gov. Newsom gave a deadbeat speech at the California Democratic Convention in May; and we joined the nurses in testimony against SB770 – and again for CalCare—during a legislative hearing in Sacramento in late June. We have continued to advocate for CalCare and against the efforts of HCN and its allies to divert and delay this crucial legislation.

Judging by the national DSA convention in Chicago in early August, Lighty’s influence extends even to the national leadership. Otherwise, why did this conference treat the inclusion of single payer in the national program barely as a conversation piece, rather than a summons to action? Why was the Sanders-Jayapal single-payer health care bill now in congress not prominently featured as a central priority for DSA?

The leadership of DSA is more committed to the partisan campaigns of politicians such as Gov. Newsom of California and President Biden than it is to a class-conscious movement for comprehensive health care. Or indeed to any other crucial public policy in housing, education, energy, and the environment. A bipartisan consensus to raise the military budget by billions of dollars each year also reduces public funding for schools, childcare, clean air and water, and other social goods and services. DSA does not have a strong and unified policy against war and empire, though of course there are genuine anti-militarists among their members.

We, the former leaders and members of the DSA LA Health Justice Committee are not retreating from the battle for true single-payer health reform in California. On the contrary, we are separating ourselves from an organization that has lost its way by abandoning one of the key issues that fueled its explosive growth in the wake of the Sanders campaigns. DSA is no longer a trustworthy companion in the struggle we are committed to pursuing and, while we can hope that they will see through the smoke screen laid down by HCN and rejoin the campaign for single-payer, we are patients out of patience and we will fight as independent Socialists for Single Payer.

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