Issue 3

Organizing for Single Payer and Health Justice

NYC-DSA healthcare organizer reflects on her experiences.

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At the time of publication, Kingsbrook Jewish Medical Center has completed the plan to cut more than 200 inpatient hospital beds. 

Before I joined DSA, I worked for 3 years as a counselor to people having issues with Medicare and Medicaid long-term care. Sometimes I was able to assist with the problems they were having, often by putting together an appeal of service denial or choosing the most cost-efficient plan. But the victories were shallow. They fed into the illusion that if people made the right choices, followed the right rules, or had the right skills, they wouldn’t get ground up by the gears of the healthcare system. Even when everything was done “right,” when someone was a U.S. citizen with sufficient work history and good retirement benefits, they could still be told by their Medicaid managed care plans that they weren’t entitled to their prescribed 24 hours of home health care– they could only be provided 12 hours of home care for their daytime needs and a monthly supply of adult diapers for the nights. Their health and dignity weren’t worth anything to the insurance plans in charge of administering their benefits. The care needed to live dignified lives was a consumer good they couldn’t afford. 

Because we were a nonprofit with a specific mandate, we couldn’t help anyone who didn’t have Medicare. We weren’t getting grant funding and donations to fight for general healthcare access; we were just there to protect the rights of Medicare beneficiaries to their Medicare benefits. We couldn’t help with other things that affected clients’ health either–if a caller’s health issues were caused by their lack of access to healthy food or the conditions in their apartment, we could only give them different phone numbers to call. 

Something that felt like a major barrier to  change was that often the people I spoke with were certain that someone else was taking the good healthcare that they were supposed to get. There was always an immigrant, someone in a different part of the country, who hadn’t worked very long, served in the military, paid as many taxes, who had access to the healthcare my client needed, that, implicitly or explicitly, depending on the person spoke with, didn’t deserve it. As long as people believe healthcare is a scarce consumer good, that their access to services is threatened by others’ access to that same service, it seems impossible to build a large enough base to meaningfully demand anything better.

In my final weeks on the job, I started sharing my frustrations with a friend: how my clients were getting screwed over in such predictable ways, how some of my coworkers could see these problems and still believe in a market-based healthcare system, and how the nonprofit model was so ill-equipped to deal with these systemic issues. My friend listened semi-patiently to my complaining, then said, “you know, that’s something you can organize about.” 


Late last summer, I started attending NYC-DSA’s Healthcare Working Group meetings. The working group was started in 2018, with many of its members previously involved with DSA’s National Medicare for All campaign and NYC-DSA Socialist Feminist Working Group’s healthcare campaign. When I joined, the working group was working on research for a city-level healthcare platform, liaising with soon-to-be elected DSA-endorsed state legislators, and, their largest campaign, a pressure campaign to pass the New York Health Act (NYHA). The NYHA is a state single-payer bill that, like Medicare for All, would provide free, comprehensive health coverage to everyone who lives and works in New York State, while virtually eliminating private health insurance. It would cover all medically necessary services, including dental, vision, long term care, and comprehensive mental healthcare, while eliminating out-of-pocket costs. It will be paid for by progressive income and payroll taxes, meaning that more than 90% of New Yorkers would pay less under the New York Health Act than they currently do for healthcare. And like Medicare for All, it will significantly lower the overall costs of healthcare, by dramatically cutting back administrative costs and having enormous purchasing power with which to negotiate prices. 

Shortly after joining thee Healthcare Working Group, we did a series of street canvasses and virtual town halls in support of the New York Health Act. We’ve since formalized a field team structure; our members attend field events in areas close to them and plan meetings, field events, and actions with people who live in the same or nearby neighborhoods.I’m part of our Central Brooklyn field team, so when I’m tabling I mostly talk with other people in Central Brooklyn–who often have the same elected officials as me or my comrades, and who live near the same hospitals and medical facilities. When I ask about what kind of issues people have related to their healthcare, people answer in unique ways that reflect a diversity of backgrounds, income, age, and health status; but themes tend to arise: lack of insurance, poor elder care options, how urgent care centers have sprung up all over the area that cost a lot and don’t offer much help. 

When I talk to someone about the New York Health Act, as part of a phone bank, a street canvass, or an educational event or town hall, I’m talking to them about their own interests. If someone tells me they’re paying too much for drugs, going without needed care, or struggling to navigate a provider network, I can explain the ways that the NYHA will eliminate or alleviate their concerns. Drugs will be free, doctor’s visits will be free, there will be no provider networks–the lives of almost everyone I speak to will get substantially easier. But these conversations are also opportunities to speak to the way that their interests are tied in with the interests of their friends, neighbors, and people they currently don’t give a shit about. The New York Health Act, and single-payer more generally, isn’t a better or cheaper health insurance plan; it’s a step toward the decommodification of healthcare and ending the devaluing of human life and dignity that has to happen when we insist on  reducing something so essential to a market commodity. For a healthy person who currently has “good” employer insurance, getting involved in the fight for the New York Health Act means both fighting for the immediate and urgent needs for their undocumented neighbors to access primary care, and fighting to make their own access to services easier, ensuring that their own potential illness, injury, or job loss won’t be so devastating. In this sense, talking to my neighbors about the New York Health Act is also talking to them about socialism. It’s a refutation of the false narrative of scarcity and a reminder of common interests and common enemies. 

Our field team has shared a tabling location a few times with the NYC-DSA Defund NYPD campaign. Initially, I worried that it would be tricky to talk about both of these issues, because our campaigns deal with different legislators and budgets, and we have different asks for the people we speak to. Instead, it was hearteningly easy. People might approach our table for different reasons, but once one group spoke to someone, the conversation with the other group was easy. When we talk about the violence of a bloated police budget to surveil and terrorize working people, it’s natural to talk about what that money ought to be spent on: healthcare, housing, education, and social services that promote genuine safety and wellbeing. When we talk about a single-payer system that should be incentivized to provide for the long-term health of a whole population, we can talk about providing adequate mental healthcare to people rather than criminalizing mental illness, and we can address the impossibility of providing for the health of people who we are simultaneously locking in cages.


Our field teams have started to get involved in some of the urgent fights for health justice that are happening in our neighborhoods. In Brooklyn, Kingsbrook Jewish Medical Center, a safety net hospital that provides services regardless of a patient’s insurance status or ability to pay, is slated to close all of its inpatient medical units, totaling more than 200 inpatient hospital beds on July 1.  This is being billed, by the state and the hospital system that owns Kingsbrook, as a “transformation” from an old-fashioned hospital to a sleek, modern, “center of excellence” for outpatient care. In reality, it means cutting an already underserved neighborhood’s access to inpatient care, specifically from a hospital that provided crucial care both during crises like COVID and Hurricane Sandy (it is one of only a few Brooklyn hospitals that does not sit in a flood zone). 

This closure was set in motion before COVID, and in the past year the hospital system has set, then postponed, three different closure dates. Each week, the ICUs at Kingsbrook, and the hospital it’s being consolidated with, are well over 90% capacity, but the hospital system and local progressive politicians insist that the deal is done and the closure needs to move forward. Over the winter, our working group joined a coalition of healthcare workers and community members who had already begun fighting the closure. The healthcare worker’s unions, NYSNA and SEIU 1199, are also both officially supportive of the closure–medical staff were all offered jobs or retirement packages as part of the restructuring. However, several members of our coalition are nurses, doctors,  and other medical staff in 1199. The coalition began by collecting signatures from individuals and community organizations and organizing a press conference in opposition to the closure. Since getting involved, the Healthcare Working Group has supported these efforts any way we can: phonebanking to drive calls to state legislators, running the coalition’s social media strategy, setting up a rally outside the hospital, tabling and flyering to inform and engage community members.

The plan to close Kingsbrook is a direct result of the care for Black, Brown, and poor New Yorkers being devalued. Kingsbrook serves a community of people who mostly use public insurance or are uninsured, and as a safety net hospital, it cannot turn people away for lack of insurance. Medicaid rates are drastically lower than the rates paid by private insurers for the same services, and the indigent care pool (a fund that’s intended to reimburse hospitals who serve a disproportionate number of uninsured and publicly-insured patients) reimburses New York’s rich private hospital systems at a much higher rate than public and safety net hospitals. It’s simply not profitable to provide care to low-income communities. The hospitals that do are routinely understaffed and low on life-sustaining supplies and equipment, and they are regularly closed or combined with other hospitals (as is happening now to Kingsbrook) as soon as the opportunity arises, with no regard for the needs of the communities they serve. Multiple closure dates have loomed over us as we struggled to bring attention to the issue. But the hospital remained open through the winter and spring–as COVID-19 numbers surged several times and the emergency and intensive care units were flooded with people in need of care– likely due, at least in part, to the actions of members of the coalition. Recently, a message I sent to a few of my comrades after a planned closure date was once again postponed read: “It’s a relief that even though we don’t have the power to stop bullshit like this from happening right now, we can at least be really annoying to them and try to slow things down while we’re working on building that power.”


The connection of issues like hospital closures to the fight for single-payer is crystal clear: as long as healthcare is a commodity, rather than a public good, it will only be provided when and where it’s profitable. And it’s our job as socialists to talk with people and draw these connections. But our engagement with fights like the Save Kingsbrook Campaign, and with other health justice campaigns that aren’t explicitly about single-payer, can’t just be to show up and talk about our great ideas. We need to be acting in solidarity with ongoing fights against the most urgent expressions of health injustice–showing through our actions that we understand the deep stake we have in each other’s survival and ability to thrive. This is not only a better way to build trust and strong relationships with people and groups who are already invested in fighting health injustice, it’s also the only way to fight for a healthcare system that’s actually just. 

If we stand by while hospitals close in majority-Black neighborhoods, even a perfect single-payer bill won’t be able to address the disparities in geographic access to medical services. If we accept the transphobic definitions of “medically necessary” that are currently used in the provision of gender-affirming healthcare, it won’t be enough to remove insurers from the decision-making process. Already, disability rights advocates and birth justice activists have lobbied for improvements to the NYHA that do more to address the needs of people with disabilities and birthing people than the bill would have in its original iteration. We can only envision a more just healthcare system, and certainly can only win it, if we understand and account for the specific needs of people who are being harmed by the healthcare system as it exists. And the best way to understand and account for those needs is to be working on securing them; living our understanding that healthcare is a right, not a commodity, while we work on winning the world we deserve. This necessarily means being part of a broader fight for socialism. Insurance companies and hospital profiteers pose serious threats to our health and our rights to live dignified lives, but no less serious are the dangers posed by the police and prison industrial complex, by workplace exploitation, by climate change, by the United States’ imperialist war machine. I found my way to a socialist organization because I believe we deserve access to health and dignity, but being part of it has only expanded my understanding of what those things are, and the scope of the struggle required to win them.

These are some of the reasons that in the fight for health justice we need a vision and strategy that’s wider than a legislative pressure campaign for a single-payer bill. Single-payer is a crucial but incomplete tool for achieving health justice. And, at the point when the NYHA or any other piece of single-payer legislation becomes viable, the healthcare industry will do everything in their power to crush it. They’re such a behemoth that we need a base that’s larger and more dedicated to this fight than a small group of single-payer-focused activists and legislators can possibly be. The potential base for this kind of movement is huge, largely because insurance companies, hospitals, and drug manufacturers are screwing so many people over. There are already so many people outside the single-payer movement who are fighting against the injustices of the healthcare industry–engaging in urgent and immediate battles for survival and access to basic needs. 

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