[[{“value”:”
By Maxine Bouvier
BOSTON, MA – In a nation that does not guarantee its citizens healthcare as a right, people are regularly left with the impossible choice of getting the care they need or acquiring vast medical debt. While 90% of Americans have health insurance, many remain underinsured and unable to pay for the care they need. This gap in care leads to worse health outcomes in the long term as people are disempowered to seek preventative care.
Socialist organizers across the nation have taken different approaches to building campaigns to address the systemic injustices in our healthcare system, but those approaches all form a common understanding of universal healthcare as a cornerstone of socialist politics in the United States. In Boston’s DSA chapter, a dedicated healthcare working group collaborates with nonprofit Mass-Care to pass a bill establishing a single-payer Medicare for All healthcare system in Massachusetts that would ensure that patients have access to all healthcare for free at the point of care.
Medicare for All has seen increasing popularity among the American public – particularly since the 2016 presidential campaign of democratic socialist Bernie Sanders, who raised the issue as a key policy demand. Beginning in 2016, Boston DSA’s healthcare working group focused on contributing to efforts to pass the measure on a national level alongside other parts of the national DSA organization, working to pressure Representatives and conduct local canvasses to build popular pressure, hoping to see it championed in Congress – but the issue was swept aside. After Biden’s election in 2020, the group shifted their focus to Medicare for All as a bill at the state level.
Movement in Mass
As part of the effort to establish a popular grassroots movement for M4A, Boston DSA and Mass-Care have run non-binding ballot measures in districts across Massachusetts that have consistently passed. Cambridge and Somerville City Councils, for example, both passed resolutions supporting the state-level bill in 2019. Unsurprisingly, people are broadly in favor of everyone having easy access to the healthcare they need. Unfortunately, these measures have not seen the same support on Beacon Hill that they see among the public.
Over the years, Mass-Care has repeatedly submitted bills for Medicare for All to the Massachusetts Legislature that have yet to make it out of committee and come to the floor. That approach reached a new crescendo on April 1, 2025, when organizers gathered at the State House to raise support for Medicare for All. Organizers and supporters shared their experiences as patients and healthcare workers with legislators. Most legislators remained stony on the issue. Attendees told Working Mass that legislators told them repeatedly that their bills “needed work” but without specifics on what required changing.
The April 1 stonewalling is only the latest in obstacles faced by the campaign. Despite decades of effort since Mass-Care was founded in 1995, little has shifted on this issue. Leaders in the State House have a vested interest in maintaining the status quo – many of their wealthiest donors are finance and insurance companies who profit directly from the inequities of our existing system. Aligned alongside these direct donors, the healthcare and life sciences industries are central to the Massachusetts economy with lobbying power difficult to combat with sheer popular support.
The power of industry is not the only force at work, however. The legislative system lacks transparency. Votes on the floor are very rarely recorded, and most state representatives and senators vote to align with leadership and advance their careers rather than take action to make change. The fact that the Massachusetts Legislature is radically untransparent became a key flashpoint in another arena of local socialist struggle even beyond the healthcare working group. Boston DSA’s electoral campaign to seat former Harvard Graduate Students Union (HGSU) and DSA member Evan MacKay on Beacon Hill became a campaign focused on transparency. In the words of Eric L and Siobhan M in the Democratic Left:
[Voters] were shocked to hear about the legislature’s system of private committee votes and their representative’s role in keeping those votes under wraps. Once community members were engaged in conversation about our opaque and undemocratic structures, it was straightforward to pivot to the consequences: tax giveaways for the rich, failure to pass climate legislation, and skyrocketing rent prices unabated by rent control.
The stonewalling of legislators to prevent the passage of Medicare for All in Massachusetts may be another consequence.
Alternative Organizing
As the movement for Medicare for All continues, working people still struggle with the burdens of medical debt. Other DSA chapters have chosen to fight against the injustices of the healthcare system in a more direct manner – buying up medical debts in bulk with nonprofit organization Undue Medical Debt, which functions as a sort of reverse-debt collection agency. The organization buys up debt from collector markets, and using the money they fundraise, pays off mass amounts of debt in bulk.
In Missouri, where nearly half of all residents owe medical debt, Mid-Missouri’s DSA chapter partnered with other DSA chapters in and around their state to raise $1,600. That allowed Undue Medical Debt to pay off $160,000 in medical debt for Missourians. Similar collaborative fundraising efforts have raised thousands in Tennessee. For every $1 raised, Undue can erase $100 dollars of medical debt, freeing people from incredible stress, poor credit, and enabling them to make investments in their future like buying a car or a home.
Buying up medical debt has a much more immediate impact for working people across the country than the fight to pass Medicare For All. It provides vulnerable families with direct relief. However, its impact is ultimately limited to a relatively small number of people when taken in the context of the estimated 100 million Americans struggling with medical debt. The strategy may be a valuable mutual aid effort to help people under our current system, but not a solution that addresses the root causes that perpetuate medical debt itself.
What can be done to push the movement for Medicare for All further?
Building the movement for Medicare for All to adequately pressure leaders who reject the proposition outright will require continued coalition building. Coalition-building with labor is a crucial road. Historically, unions have not always supported universal healthcare. Since the Red Scare and the long decline of labor, unions often defend sectional bargaining for better insurance benefits and shy away from movement-wide wins for the working class. One famous example is UNITE-HERE Local 226 – the Culinary Union, which despite its militancy, fought the Bernie Sanders campaign viciously over Medicare for All in the interest of preserving their private healthcare plan as won by the union by its own members. The ways in which leadership of unions can squash rank-and-file support for Medicare for All also underscores the need for building reform caucuses within our unions to build the bridge with labor needed to win Medicare for All. There remains one important truth: Medicare for All would free up unions to fight for other parts of the contract that aren’t healthcare, including better working conditions and the solidarities we need to win mass movements.
These bridges have begun to be built. The Massachusetts alliance for Medicare for All has allied itself with the Massachusetts Nurses Association and other unions across the state. However, this is not enough. There is a need to foster an even deeper relationship with labor. With continued pressure campaigns and a broad worker-centered movement, there is hope to see this essential right guaranteed across Massachusetts.
Maxine Bouvier is a member of Boston DSA and contributor to Working Mass.
“}]]