What Can the US Nurses’ Campaign for Medicare for All Teach Organisers in the UK?

by Jo Beardsmore

9 February 2019


This Saturday volunteers in the UK will call people in the US, encouraging them to put pressure on their elected representatives to demand Medicare for All, which would guarantee healthcare for all Americans. This experiment in international solidarity – supported by Momentum – is timed to coincide with a huge week of action in the US organised by National Nurses United (NNU), aimed at building support for a new Medicare For All bill in the House.

As people on both sides of the pond connect their fights for healthcare justice, it’s worth taking a closer look at the nurses’ campaign for Medicare for All to see what lessons can be learnt to inform the fight to defend – and expand – free universal healthcare in the UK.

1. With focused organising efforts, the status quo can shift quickly.

In 2016, Hillary Clinton declared Medicare for All would ‘never, ever’ happen. Just a few years later the idea has become near hegemonic. Pledging support for Medicare for All is now a litmus test for Democrats entering the 2020 presidential race. The idea has significant and growing support in Congress and enjoys historically high levels of support from American people across the political spectrum.

This turnaround has happened despite opposition from powerful corporate lobbyists, the Republicans, and the leadership of the Democratic party (who spent vast amounts of political capital first establishing and then defending the system known as ‘Obamacare’). The rise and rise of Medicare for All has a number of causes. The ongoing healthcare crisis has created the material conditions for a social movement focused on real and radical healthcare reform. The Bernie Sanders presidential campaign of 2016 elevated Medicare for All as an idea and helped to turn it into a potential rallying point. But it is organising efforts, particularly those of NNU, that are capitalising on this moment, and turning this potential into real political power.

2. Medicare for All reframes the debate around people’s healthcare needs.

The nurses have been able to mobilise people by offering a solution that won’t just tinker around the edges of the healthcare crisis, but will seek to solve it. The campaign is pursuing a big, bold vision of what healthcare justice must mean. It goes far beyond defending what already exists, and has moved the debate out of the right-wing frame of ‘how are we going to pay for it?’. Volunteers having door-to-door conversations with people about their experience of the healthcare system, sharing personal stories, has recentered the debate around people’s healthcare needs. This ‘deep’ approach to canvasing is similar to that used by Momentum in 2017, and in recent progressive referendum victories in Ireland.

3. ‘Big Organising’ provides the tools and framework to reach scale.

NNU’s bold vision is grounded in an ambitious but achievable plan to win. The nurses must mobilise enough people to overwhelm entrenched politicians and outfight corporate interests. But the union’s aim is not just to mobilise people – it’s to direct them to take effective actions in a coordinated way, following the leadership of the nurses’ union and key elected officials. While the plan is centralised, the work is decentralised and distributed. The union provides training for actions – door-to-door canvassing, crowd canvassing, phone and text banking – which people can then carry out in their own communities. This approach draws on the ‘Big Organising’ model pioneered on the 2016 Bernie Sanders campaign. Tactics, trainings and systems are tested, iterated, and improved enabling organising efforts to scale up.

4. The struggle is worker led.

Nurses are authentic and authoritative leaders of the campaign. They are on the frontline of America’s healthcare crisis, and are trusted voices in their communities. They are the best people to lead this fight. The nurses’ campaign is part of a wider movement for what Americans call a single payer healthcare system – made up of healthcare workers, patients, trade unionists, socialists, and a network of grassroots and advocacy groups. The Medicare for All campaign draws resources and strength from the ecosystem of that movement, but it also crucially gives the movement a focus, channelling energy into effective political action. Rather than waiting to build consensus within the movement about how the campaign should be organised, the nurses’ union pioneered a new approach, proved it worked, and brought people with them.

5. Going viral doesn’t mean giving up control.

Organising efforts have taken a marginalised and maligned idea and made it popular and winnable. Given the odds stacked against it, this is in itself a remarkable achievement. Medicare for All is now a dominant idea in US politics. But the fight is not over; it’s entering a new phase. People need to hold politicians to account and ensure rhetoric translates into actual legislative action, and to guard against attempts to co-opt and de-radicalise the issue. This will be a struggle likely to last well beyond the 2020 election. NNU is seeking to do this by working with Rep. Pramila Jayapal to introduce the new Medicare for All Act of 2019. By focusing organising efforts around a clear definition of what Medicare for All must mean, it will fight to guard against co-option and ensure nurses have a strong voice in the ensuing battle.

The Medicare for All campaign has been built person-to-person, neighbour-to-neighbour, worker-to-worker. That is how it will continue to grow, and eventually win. Now it’s spreading to include person-to-person conversations across the pond. The British phone bank volunteers are pre-empting the recent call from Jeremy Corbyn and Alexandria Ocasio-Cortez to ‘build a movement across borders.’ We will build that movement through these acts of true solidarity: the sharing of campaign tactics that work, and the lending of material support.

This solidarity is mutually beneficial, as the struggle for universal healthcare in the US and UK are entwined. Just as the NHS is threatened by a creeping ‘Americanisation’, a socialised healthcare system in the US would clip the wings of the American ‘healthcare’ corporations that are circling the Brexit negotiations like vultures. By advancing Medicare for All in the US, the UK may protect its own NHS. By learning lessons from the campaign we can go beyond ‘saving’ the NHS and fight to expand what free universal healthcare in the UK could mean.


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