A member essay on a recent anti-zionist resolution considered by the members of the Metro DC Democratic Socialists.

Written by Matt P, Video and Photos by Margot P

‘Twas the strike before Christmas when all through the land,
Starbucks Workers United had made their demands,
Over pay, understaffing, respect and their rights,
Greedy bosses should regret they e’er picked this fight.

For months we had been hearing chatter from our comrades with Starbucks Workers United (SBWU) about their growing momentum. Each week brought more unionized stores, organizing goals surpassed and replaced with more ambitious ones. From the first stores they successfully organized in Buffalo only a few years ago, they have now exceeded 500. It feels as though a tide had turned, a dam had been broken.

Those of us who have worked in retail coffee and know how difficult it can be to organize in this space recognize how historic this feat has been. If you ask Starbucks workers about it, though, some would tell you it is not as hard as it seems. As one SBWU member Caitlin put it: “The idea of unionizing feels really frightening, it feels like a really big word, a really loaded word. […] But it doesn’t mean that much to unionize. If you are complaining with your coworkers about how much you hate your job, you’re like 60 or 70 percent of the way to having a union. So just go the extra mile. You are so close, you’ve gotten through most of the bad parts.” Decades of conditioning by the bosses to fear the boogeyman – the scary U-word – began to crumble as workers realized their experiences with poverty wages, understaffing, and workplace harassment were far too common to be merely personal problems. Get enough workers together regularly sharing their stories and grievances, and a union is almost certain to follow.

At the same time as Starbucks locations were being unionized left and right, there were contract negotiations taking place even though SBWU could not speak about it publicly. Despite the limited information, it was clear that Starbucks management was in a very different fight this time around. Bargaining, like any battle, depends critically on one’s perceived strength as much as actual, and it certainly appeared SBWU was lacking in neither.

The rank-and-file’s demands varied by store location, but there were some common refrains. Given Seattle’s high minimum wage, pay has been less of a concern here compared to other cities where wages are still far behind the cost of living, but the company’s offer on annual raises was nothing short of insulting. Conversely, Starbucks workers in very conservative parts of the country might rank employment protections and healthcare benefits as their top concern, especially for trans employees. Still other stores have demanded improved health and safety in lieu of the COVID-19 endemic.

Nonetheless, SBWU has been fighting to ensure every worker and workplace is heard at the bargaining table. As Caitlin put it: “Trans healthcare benefits are not something we are going to be fighting for so much for ourselves [here in Washington State] but for our siblings in those [conservative] areas […] We have a pretty wide range of things people are prioritizing for themselves and their states, but one of the most beautiful things about bargaining is that we are really good at balancing those priorities and finding the balance that’s going to benefit the most people while leaving no one behind.” It may sound like a broken record, but the old labor adage “an injury to one is an injury to all” still resonates in 2024 as it did in 1924.

Then came the news last week. Starbucks Workers United members had overwhelmingly voted to authorize a strike. Despite this clear mandate given by the rank-and-file to their bargaining team and the credible threat it now posed – i.e., industrial action – Starbucks management refused to budge. And so the evening of December 19, it was made official: Starbucks workers would be going on strike over the holiday weekend in several cities including right here in the company’s hometown of Seattle. Years of educating, agitating, and organizing workers would now give way to mobilizing members to the pickets.

The decision to take action by striking is no small affair as it is costly and is not without risks. Individual grit and determination are certainly important qualities to have, but above all else a strike requires the trust, confidence, and security only a community can provide, most especially one’s coworkers. As another Starbucks employee Mari explained: “My store has always been a fairly tight knit community, but it’s been a lot better after we unionized. We understand we are here for each other, and so people are much more free with reaching out with needs for support, or if managers are annoying or doing something illegal. There’s a lot of camaraderie and a sense of community.” At a time when many workers increasingly feel alienated and disempowered by their economic insecurity, the surest way to regain our sense of dignity and strength is by leaning on our coworkers and conversely letting them lean on us. The bosses want us divided and demoralized. But the workers united? We will not be defeated.

Once the pickets began, local community members including Seattle DSA sprang to action to lend their support not just in words but in actions. Coming off of months of strike support with the Boeing machinists and Seattle Art Museum’s Visual Service Officers, Seattle DSA’s Labor Working Group was already mobilizing members the night the strike was officially announced. Meanwhile, the People’s Breakfast pivoted to provide warm meals to picketers, building off its years of mutual aid work in the U District. Those of us close to the action have been making regular deliveries of needed materials: from hot coffee and homemade pastries to hand warmers and propane tanks for the space heaters. (Seattle Decembers are not exactly a pleasant time to be holding round-the-clock pickets.) The night owls amongst us have been helping to provide relief for the graveyard picket shifts, often the time of day in which deliveries are made and therefore a great opportunity to persuade delivery drivers to maybe reconsider crossing an active picket line. Let’s just say more than a few voluntarily chose to skip ahead on their early morning route.

At the time this is being written on Christmas Eve, the strike has spread from its original target stores to more than 300 in 45 states across the country. This comes amidst a national series of strikes by Amazon warehouse workers and delivery drivers in addition to years of increasing labor agitation nationally. While the recent elections came as a major blow to many, we must also look to these courageous workers and their spirited campaigning for inspiration and hope. The ruling class will never make concessions voluntarily without workers demonstrating their power including the undertaking of direct action. As picketers chanted recently: “Workers united, give ‘em holy hell! It’s not just our right but our duty to rebel!” The louder this refrain grows, the more workers will be encouraged to take their own initiative, and the more we have cause for hope.

This holiday season, give the gift of solidarity by going to a picket line near you and supporting a strike materially. I promise you it will help to alleviate any hopelessness that ails you.

Charlotte Food Not Bombs (FNB), an organization we have collaborated and share cross membership with, recently released a statement platforming allegations of sexual violence. These allegations regard an individual involved in several activist spaces in our city.

Charlotte Metro DSA stands in solidarity with FNB in their pursuit of restorative justice for the survivor(s) as they come forth. Our organization has zero tolerance for sexual assault and harassment and will refuse to work with anyone credibly accused of such—or the organizations which uncritically harbor them. We recommend that everyone check out @clt_food_not_bombs on Instagram for details on the developing situation and how to support the survivor(s).

As a reminder, per DSA's Resolution 33, we have a grievance policy in place to seek justice for survivors and hold perpetrators accountable in our organization. If you would like to file a grievance or learn more about our process, please check out https://charlottedsa.org/grievance-policy.

As socialists, we recognize sexual violence as an outgrowth of patriarchy, itself one of the principal ways our capitalist society divides the working class and furthers our collective exploitation. The fight for socialism is inseparable from the fight for women's liberation. We have to look out for our comrades and allies by fostering welcoming and inclusive organizing spaces. This will require us to seriously reflect on how we can set an example of feminist community and organization as we fight for the overthrow of class society and its systemic perpetration of patriarchy.

In solidarity,

Charlotte Metro DSA Steering Committee

Written by Collin R.

On the 11th of February 2025, the voters of Seattle will decide the fate of Proposition 1A: the people’s plan to dedicate funding to the Seattle Social Housing Developer (SSHD). Seattle DSA worked in coalition with House Our Neighbors on Initiative 135 to create the Seattle Social Housing Developer and Initiative 137 (I-137) to get Proposition 1A on the ballot, which is it is essential that we as socialists mobilize to ensure the success of this important step towards creating a more equitable city.

Proposition 1A will create a 5% excess payroll compensation tax on businesses paying an employee more than $1 million, which will raise ~$50 million per-year—enough to provide 2000 social housing units to a city over the next 10 years. TLDR: the wealthiest corporations of Seattle will contribute 5 cents of every dollar they pay an employee above $1 million to house thousands of their neighbors.

Politically, it is essential that we nullify the dirty tactics of the corporate backed members of the city council. After delaying the adoption of I-137 to appease their corporate backers to ensure it wouldn’t appear on the high-turnout November ballot, councilmembers Maritza Rivera, Cathy Moore, Sara Nelson, Joy Hollingsworth, Rob Saka, and Robert Kettle are attempting to hijack the people’s initiative with Proposition 1B: the Chamber of Commerce’s plan to strangle the SSHD in one hand and the city’s JumpStart funding in the other.

Proposition 1B would generate but one fifth of Proposition 1A’s funding and sunset after 5 years, meaning the SSHD will neither be able to provide nearly enough housing to even slightly close the housing deficit nor capitalize on experience with long-term plans. Most insidiously, Proposition 1B robs Peter to pay Paul: it plans to fund the SSHD by taking $10 million from JumpStart funding, an already existing payroll tax which funds private affordable housing, nutrition assistance, grants to small businesses, and support for immigrant families. Apparently, Maritza Rivera, Cathy Moore, and Robert Kettle think there isn’t a housing crisis, people face no difficulties affording food, small businesses have no financial issues, and immigrants can be ignored.

Ensuring Proposition 1A passes is a critical step forward for the socialist movement in Seattle and the United States. Proposition 1A validates the political labor our comrades have contributed to organizing a robust social housing program in Seattle, and represents a mandate for socialist housing policy over the current ineffective privatized approach. Seattle voters are tired of the tent cities adjacent to neighborhoods lined with walled mansions that materially and symbolically embody capitalist barbarism. Not only us socialists, but all ethically conscious human beings demand the equitable decency that social housing provides. Adequately funding the SSHD is especially critical given the current financial climate, as private affordable housing developers are suffering from a capital crunch due to ballooning costs. A dedicated revenue stream will insulate the provision of affordable housing from market fluctuations, and while 2000 units over the next 10 years is far from enough to alleviate the city’s housing crisis, it’s an essential step in proving that a better world is possible.

Without establishing an independent funding mechanism to provision the Seattle Social Housing Developer, the housing crisis will exacerbate and inequalities will widen. This is exactly why tens of thousands of voters signed I-137: to establish a new and independent funding mechanism for the SSHD. Proposition 1A will fulfill this goal, while Proposition 1B will only further strain the already overburdened funding bottlenecks in affordable housing. As socialists, we must mobilize to ensure our city takes a step on the right side of history.

Join us the morning of January 4th to kick off 2025 talking to voters about raising progressive revenue to fund permanently affordable social housing! Dozens of volunteers all across the city will be knocking doors letting voters know that they have a chance to lead the nation on a proven housing solution. With Proposition 1A, Seattle will take a leap forward towards addressing the housing crisis – but we need your help to make that possible!

Starting Jan. 4th through election day on Feb. 11th we will be knocking thousands of doors turning out our neighbors who support and benefit the most from social housing. Once folks arrive around 10:30am, we will have a short training on door knocking, Proposition 1A, and social housing so you are set up for success at the doors. At around 11:00am we will officially kick off and start hitting the doors!

If you have any questions or concerns, please reach out to the field director Ben Ferlo at field@houseourneighbors.org. We hope to see you then – let’s build social housing!

RSVP for the kickoff events happening nearest to you to receive any updates or changes to this event!

Beacon Hill: https://www.mobilize.us/houseourneighbors/event/747105/

Capitol Hill: https://www.mobilize.us/houseourneighbors/event/747089/

Columbia City: https://www.mobilize.us/houseourneighbors/event/747088/

Fremont: https://www.mobilize.us/houseourneighbors/event/747087/

North U-District: https://www.mobilize.us/houseourneighbors/event/747093/

Wallingford: https://www.mobilize.us/houseourneighbors/event/747092/

Thorn West: Issue No. 222

City Politics

• LAist talks with incoming (DSA-LA-endorsed councilmember Ysabel Jurado about her vision for CD 14. Conversely, Streetsblog LA covers the last day of outgoing CD14 councilmember Kevin de León. 

• The office of City Attorney Hydee Feldstein Soto has elected to press charges against several dozen activists who were arrested while blocking traffic on the 110 Freeway, to demand an end to the ongoing genocide in Gaza.

• A report from the CAO updates the city’s worsening budget problem.

Health Care

• The Los Angeles County Department of Public Health launched the Medical Debt Relief Program. The program enables the county to purchase $500 million of qualifying county residents’ medical debt, at a fraction of its cost. The debt is then automatically forgiven.
• Governor Newsom has declared a state of emergency to combat the spread of bird flu, following several confirmed cases across the state.

Labor

• LAUSD school principals have voted to join the Teamsters union. The result of the election is seen as a rebuke of Superintendent Alberto Carvalho who has pushed to cut administrative jobs and increase principal workloads.

Housing Rights

• LA Public Press projects the various ways that an incoming Trump administration could disrupt housing and homelessness policy in Los Angeles.

• The city’s Board of Transportation Commissioners has voted not to transfer a city parking lot in Venice, which is planned for use by a low income housing project. City Council can vote to override the decision. A lawsuit against the city alleges that officials, including City Attorney Feldstein Soto and Councilmember Traci Park, have colluded to sabotage the project.

Transportation

• The incoming Trump administration has threatened to cut federal funding to the long-planned high speed rail project connecting Los Angeles and San Francisco.

Incarceration

• CalMatters places Proposition 36, which will result in more people being incarcerated in the California prison system, in the context of the state’s obscenely high number of inmate deaths.

• Last week, the LA County Probation Department announced that it will not comply with a state order to close the understaffed and unsafe Los Padrinos Juvenile Hall. This week the Board of Supervisors later voted 4–1 to declare a state of emergency in a last-ditch effort to keep the dysfunctional facility open.

Environmental Justice

• The Supreme Court has declined to hear a challenge to California’s vehicle emission standards – which are more strict than the federal standard – leaving them in place for now.

• Demands to close the Aliso Canyon natural gas storage facility have thundered since it was the site of the largest methane leak in U.S. history, nine years ago. Despite public outrage, today the California Public Utilities Commission voted to delay the closure indefinitely, until such time as the demand for natural gas has dropped.

The post LA County Pilots Medical Debt Relief Program + New Councilmembers Seated appeared first on The Thorn West.

In an era when democratic institutions face mounting threats, the Democratic Socialists of America (DSA) offers something invaluable: a space where people can come together not just to resist deteriorating conditions, but to actively build a better world. This combination of practical organizing and genuine community provides essential support for personal well-being and effective political action.

Walking into your first DSA meeting can feel like finding an oasis in a desert of political despair. Here are people who not only share your concerns about the direction of society but are actively working to change it. Whether it’s your local DSA chapter’s mutual aid program, tenant organizing efforts, or labor solidarity initiatives, you’ll find concrete ways to channel your anxiety into action.

The mental health benefits of joining DSA extend far beyond political engagement. Research consistently shows that feelings of powerlessness contribute significantly to depression and anxiety – feelings that are particularly acute when witnessing the rise of antidemocratic movements. DSA membership offers a powerful antidote through collective agency. Rather than doom-scrolling through news alone, you’re working shoulder-to-shoulder with comrades on tangible projects that make a real difference in your community.

“In times like these, it’s pretty easy to feel alone. Joining DSA, attending meetings, coming to social events, all of these have helped me see that I’m not actually alone. There are people out there who value solidarity, equality, and democracy, and DSA is where they connect with each other.”
– Anonymous, member since 2024

The structure of DSA chapters combines social connection with political purpose. A typical month might include formal organizing meetings, but also movie nights, shared meals, or informal gatherings where members can relax and build genuine friendships. These social bonds strengthen the organization’s political work while providing vital emotional support. There’s something profoundly comforting about knowing that your concerns are shared by others who are willing to work alongside you for change.

The physical aspect of DSA gatherings shouldn’t be underestimated. In an age of increasing digital isolation, coming together in actual spaces to both socialize and organize creates connections that online interaction simply can’t match. Whether you’re planning a campaign, joining a reading group, or sharing a potluck dinner, the simple act of being physically present with others who share your values helps combat the alienation that makes authoritarian movements possible.

DSA’s democratic structure provides members with genuine agency in shaping both the organization and its initiatives. Unlike traditional political organizations where decisions come from the top down, DSA chapters empower members to propose and lead projects they’re passionate about. This participatory approach not only leads to more effective organizing but also helps members develop practical skills in leadership, project management, and collective decision-making.

The intergenerational nature of DSA provides unique opportunities for learning and growth. Newer members can learn from those with decades of organizing experience while bringing fresh perspectives and energy to the organization. This creates a living tradition of solidarity and collective action, where knowledge and skills are constantly shared and refined.

Working within DSA also provides an important counter to the feeling of historical inevitability that authoritarian movements try to create. When you’re actively building alternatives – whether through mutual aid networks, tenant unions, or labor organizing – you demonstrate in practice that other ways of organizing society are possible. Each successful project, no matter how small, becomes evidence that collective, democratic action works. The regular rhythm of meetings and actions helps maintain hope and purpose, while the concrete achievements of collective work provide tangible evidence that change is possible.

“I joined DSA because I was tired of feeling powerless to stop the world from getting worse. The moment when you commit to joining an organization – to doing politics together with other people rather than simply thinking the right thing – is such a powerful one. Working with comrades has given me hope and prepared me to be a better member of the society we hope to build.”
– Luke, member since 2018

DSA chapters also serve as crucial hubs of information and rapid response in times of crisis. When communities face threats – whether from hostile legislation, corporate exploitation, or direct attacks on vulnerable populations – DSA members learn to work together to properly analyze the moment, and develop tactics and strategies that drive successes, rather than simply respond in a way that is itself status quo.

For many members, DSA becomes not just a political organization but a central part of their social world. The friendships formed through shared struggle and celebration create bonds that extend beyond political work. These relationships provide emotional sustenance during difficult times while strengthening the organization’s capacity for long-term organizing.

Joining DSA offers a powerful combination of political engagement and personal connection that’s particularly vital in challenging times. By bringing people together in physical spaces to both socialize and work toward concrete political goals, DSA provides the community, agency, and purpose that people need to maintain their mental health while building effective resistance to anti-democratic movements. The path to a better world isn’t found in isolation but in coming together with others to actively create the future we want to see.

For decades now the federal government has, to a certain extent, mediated relations between the classes through the National Labor Relations Board (NLRB), the National Mediation Board (NMB), the Department of Labor (DOL), the Occupational Safety and Health Administration (OSHA), etc. The Labor Bureaucracy has been fine with that because it kind of keeps them […]

Thorn West: Issue No. 221

State Politics

• A new state legislative session has begun. Both houses have adopted new rules that reduce the amount of bills a member may introduce: from from 50 to 35 in the Assembly and from 40 to 35 in the Senate.

• Though Republicans gained a few seats in the state legislature, Democrats have maintained their supermajority in both houses.

• Several close House races across California have finally been called, with the results favoring Democratic Party candidates. The final split in the House of Representatives will be 220-215 in favor of Republicans.

• The special legislative session called for by Governor Newsom to “Trump-proof” California met for the first time this week. So far, it has introduced legislation to set aside $25 million for potential legislation against the Trump administration (a move which does not require that the legislature be called).

City Politics

• This Saturday, several of DSA-LA’s successfully endorsed candidates for local office will sit with DSA-LA members running for organizational leadership in 2025 for a panel discussion on “what our roadmap to a Los Angeles for the working class looks like in the year ahead.” Click here to find out more or to RSVP (note that this event is only open to DSA-LA members in good standing).

Labor

• Starbucks Workers United is entering a critical phase in contract negotiations, and is organizing solidarity flyering events nationwide. In Los Angeles, DSA-LA is organizing a flyering event on Sunday, December 15, at 2 pm, at the Starbucks at 3785 Wilshire Boulevard. (For more info, email:  labor@dsa-la.org)

Immigration

• StreetsblogLA goes into depth on LA’s new “sanctuary city” ordinance, placing it in the context of the attempts to implement such a law, which have run into the LAPD’s unwillingness to be democratically controlled. The final version of the ordinance was put into effect by a unanimous City Council vote this week.

• Though both the city and state have announced intentions to fight the Trump administration’s stated intention to conduct dystopian levels of deportations, there may be no way to stop the planned construction of a new detention facility that the Immigration and Customs Enforcement wants to build in the state.

NOlympics

• Outgoing City Council President Paul Krekorian has been appointed to lead LA’s newly created “Office of Major Events,” which will oversee, among other things, the Olympic Games in 2028. More from Torched.

• The LA Metro Board has sent a letter to incoming President Trump, asking him to set aside $3.2 billion to fund transportation projects, specifically in support of the Olympics.

Local Media

• A former editorial writer for the Los Angeles Times explains the motive for his recent resignation: the ongoing heavy-handed interference of the paper’s billionaire owner, Dr. Patrick Soon-Shiong, on behalf of the hard right Trump coalition.

Environmental Justice

• LA Public Press spoke with several local experts on the potential impact of a Trump administration on the city and state’s climate policy.

The post Final Election Results in CA + City, State Prepare for 2nd Trump Term appeared first on The Thorn West.

Opening Scene

On the quiet morning of Saturday, November 16th, 2024, I met a retired neurosurgeon from the Carolinas ready for a healthcare revolution. 

He wasn’t alone; over 300 doctors, medical students, and allied health professionals arrived at Venue Six10 in Chicago to take part in Physicians for a National Health Program (PNHP)’s annual conference. They arrived from across the country, hailing from sprawling health networks and neighborhood clinics, Ivy League academic centers and county hospitals. They were doctors at the end of storied careers and medical students who had not yet spent a full year on the wards – a dynamic group of committed professionals who deeply understood why American healthcare wasn’t working but did not entirely agree on the best next step.

Although most of the American left is familiar with Senator Bernie Sanders’ signature platform, Medicare4All, the attendees at PNHP prefer the more generic concept of “single-payer” to describe a shared idea for a national health insurance covering everyone. This is not to say attendees are not ardent supporters of current insurance plans like Medicare and Medicaid, which respectively enroll 67.7 million and 79.6 million Americans. Indeed, protecting and fortifying these two institutions represents the organization’s legislative roadmap for success. Outgoing PNHP president Dr. Paul Verhoef, a critical care physician currently working in Hawaii, summarized the organization’s vision: a “Triple Aim” that seeks to convert inertia and apathy for change into widespread confidence in a unified, government-managed program. 

A single-payer system cannot be achieved without proving to voters that doctors have the political power to end healthcare profiteering and strengthen “traditional Medicare,” which includes the current benefits afforded to retirees, disabled individuals, and dialysis patients. Alongside these legislative goals, PNHP features a critical research branch to change the medical narrative on for-profit healthcare, as well as a fledgling coalition model of organizing which brings together unions, medical students, retirees, and healthcare justice activists to carry their message into the general populace. 

Opposing Medicare Advantage

In the U.S., the two major political parties are equally guilty of loosening healthcare’s regulatory apparatus and allowing legalized graft to gum up the current system. Both Presidents Trump and Biden encouraged a mass transfer of patients from government-managed Medicare to Medicare Advantage, a network of privately administered insurance providers that bills the government for any retirees it accepts into its risk pool. Medicare “Disadvantage”, as conference lecturers dubbed it, represents a prime example of corporate greed impeding the group’s vision.

First, private insurance companies run aggressive advertiseing campaigns at senior citizens who are promised vision, hearing, and dental plans (which traditional Medicare does not offer) as well as free home nursing assessments if they switch from Medicare to Medicare Advantage. The government agrees to pay insurers a “per-capita” cost for every person covered. On paper, different companies are bidding to provide this insurance to large groups of patients at the lowest possible rates; in practice, insurers seek niche, carve-out populations in specific neighborhoods or with union retirement plans to avoid competition.

Once these patients have been aggregated, the company’s actuaries start calculating the risk of catastrophic health problems they might experience. For retirees, these risks represent the burdens of economic and social disparities experienced throughout life, and future costs of care can be modeled and anticipated using clinical risk factors. 

For example, a college-educated grandmother who just ran a marathon is going to cost significantly less than an elderly nursing home resident struggling with multiple chronic medical conditions and a new cancer diagnosis. To balance out these varying levels of “healthiness,” the government offers higher per-capita payment plans for high-risk patients. The insurance companies have realized they can game risk pools by recategorizing the marathoning grandmother to look sicker on paper. 

Cue the visiting home nurse, who documents that the grandmother actually lives on the second floor of a townhouse with enough stairs to qualify as a fall risk. Then, according to some lab work drawn during the visit, it turns out she meets the criteria for pre-diabetes and has chronically low potassium, which has never been an issue but which now appears in her medical documentation. Suddenly, she bumps over into the higher-tiered risk pool and earns the company a higher per-capita rate. From her perspective, she gets optical and dental insurance that she doesn’t have to purchase on a fixed income, but behind the scenes, she will be limited to the same narrow selection of in-network doctors’s offices and subject to many of the same insurance claim denials and prior authorizations that the average person with private insurance through their job experiences.

Finally, insurance companies can score additional rebates if they meet benchmark health criteria set by the government. These criteria, while conceptually valid, often become a system of automatic flags that prompt doctors to order repeat tests. In combination, all these perverse incentives, as well as the baseline advertising costs, shareholder dividends, and CEO payouts, add up to a significantly inflated cost of care compared to traditional Medicare. 

There were numerous slides describing and predicting the rates of overpayment and abuse this kind of system permits, but during the first two hours of the conference I was so overwhelmed by the stream of high density statistics that I didn’t jot down any of the half-dozen charts meant to clinch your conviction that Medicare Advantage is a threat to all healthcare socialists. Instead, I’ll quote one slide by Dr. Adam Gaffney, a powerhouse researcher working out of Cambridge Health Justice Lab: “Medicare Advantage does not only waste money, its business model is based on care denial, and it is undermining the idea of equitable single-tier for the elderly.” 

PNHP Victories

Given all the clear evidence of overpayments, PNHP National has staked out intense opposition to these corporate handouts. Since Medicare Advantage is a federal program, it represents a yearly budget fight between insurance companies and executive-branch employees at the Centers for Medicare and Medicaid Services (CMS). In 2024, PNHP won a rare budget victory by opposing the above-inflation rate increases that Medicare Advantage lobbyists demanded of the Biden administration. In a coordinated campaign across multiple chapters, activists drew the eyes of enough federal legislators to make CMS wary of continuing business as usual. 

The audience applauded in catharsis when the presenter showed images of insurance company stocks dropping $95 billion after the federal government’s announcement it would limit the rate increase of Medicare Advantage payments. Presenters also told of labor organizers and PNHP allies fighting against the New York City Council, which dropped 250,000 city employees onto an inferior Medicare Advantage plan. These retirees have now won a string of lawsuits to regain their original healthcare benefits and demonstrate another spark of hope against the decades-long onslaught of privatization. 

These individual stories pale in comparison to the immense task of electoral victory required to expand the welfare state. This could be most clearly seen in President Biden’s failure to pass Build Back Better, which would have included provisions that strengthened traditional Medicare in the form of adding vision, dental, and hearing insurance to every beneficiary. PNHP was a staunch supporter of Build Back Better in order to meet its Triple Aim, but obviously represented just a fraction of the progressive pressure that failed to win Senator Manchin’s vote of support. From one perspective, the structure of the U.S. Senate represents public enemy number one to members of the group seeking to achieve a single-payer system; from another, it is the only formidable barrier that has protected the Affordable Care Act (ACA) and Medicaid expansion from hostile Republicans. This could not have been clearer than when a medical student leaned over during Dr. Verhoef’s presentation to tell me “This guy has no concept of theory of change.” Among PNHP leadership, faith in electoral incrementalism remains the path for welfare expansion. 

Students for a National Health Program

The relationship between Students for a National Health Program (SNaHP) and PNHP is not unlike that of YDSA to DSA. The goal is to capture vibrant student idealism for health equity and pull it into a larger political formation with progression and skill-building. PNHP believes so much in this mission that SNaHP members could attend a bonus half-day of the conference dedicated to organizing during medical training. The 151 who attended on Friday represent the far left of healthcare— future doctors who already have multiple years of experience organizing for Palestinian liberation or abolishing ICE and demand change now. Their very existence demonstrates a keen ability to jump through the hoops of high-stakes meritocratic testing while maintaining a robust bullshit detector against all the pageantry of co-opted social movements professed by medical school deans.

The Friday afternoon SNaHP Summit at nearby Roosevelt University included breakout groups teaching students how to write testimony, build campaigns, and organize medical school events to teach fellow classmates about single-payer policies. I appreciated how these organizers had deeply analyzed the structure of medical school curricula to maximize impact. “Spreading propaganda is super-important to us,” said one presenter while discussing essential rules to prevent the message from falling flat; for example, never host an event on the week of an exam, host events after mandatory lectures when classmates are already on campus, always offer food for students, and give every member who commits to organizing an event a named position in that SNaHP chapter for their résumé. “Your medical school, as a rule, wants you to do their work for free,” noted another presenter while pulling up a slide with the national curricular requirements for what medical schools must teach students about health policy. It’s an open secret that if you design a lecture that meets a teaching requirement, your professor will probably use it to cut costs even if it contains a pro single-payer message. 

The most well-attended SNaHP breakout session was a packed room of over 40 students who wanted a chance to hear from labor organizers. For doctors, clinical training includes a mandatory 3-7 years after medical school in a hospital-based program called residency. These programs are notoriously exploitative, often expecting trainees to work 24- to 28-hour call shifts and up to 80 hours a week without overtime pay. Since 1957, several waves of resident unionization have occurred in response to these conditions, first at public hospitals in New York City, Los Angeles, and Chicago, and followed by other cities predominantly across the West Coast, Midwest, Mid-Atlantic, and New England. 

Currently, the SEIU (Service Employees International Union)-affiliated Committee of Interns and Residents (CIR) represents the nation’s largest physician union with over 33,000 residents, and it’s estimated up to 25% of the resident trainee sector are now unionized. In recent years, CIR members passed resolutions in support of a national single-payer program and a ceasefire in Gaza. Recently unionized members spoke highly of their relationship to the Emergency Workplace Organizing Committee (EWOC), a joint venture between the United Electrical, Radio and Machine Workers of America and DSA as a way to build up organizing capacity before CIR took on their case. I met several doctors familiar with or members of DSA which speaks to the growing networks between health justice projects and labor organizing. 

The union organizing session had been held at previous SNaHP summits, and this year’s version was attended by current CIR president Dr. Taylor Walker. Dr. Walker made a clear pitch that medical students should join the labor movement to propel health justice projects like abortion care, medical debt relief, and Palestinian liberation into a democratic debate at the workplace. This vision would serve both medical workers and their patients, and the rising leadership who will pilot PNHP in the coming years agreed. Talking to both current CIR members and doctors who have completed residency, a SNaHP-to-CIR-to-PNHP pipeline represents a promising model for maintaining an organized formation of progressive physicians. Each organization would contribute to a doctor’s organizing skills parallel to the steps of their medical education. 

Dr. Arya Zandvakili, an infectious disease physician in Iowa who is now approaching the final hurdle of his sub-specialist training, is one such representative of this new batch of mid-career doctors who remains motivated to show up for PNHP. “People are going into financial ruin and debt,” he told me when I asked him what draws him to the organization. “Single-payer is a way to get universal healthcare that’s economically efficient.” However, even if we count on a burgeoning labor movement and a rising generation of radical doctor organizers, it’s still unclear how to translate power into politics. 

State or Federal

Though all PNHP members have made the same conclusions as Dr. Zandvakili given the data at hand, the conference did not clarify a best path forward. One flyer being passed around called for organizing state-managed single-payer insurance plans. This would allow progressive states to bypass federal roadblocks and roll out a one-size-fits-all plan for their populations. This is far from perfect. Some fear a small state like Vermont or Rhode Island would go bankrupt under such legislation and set a bad example for the national project (full disclosure: I have previously testified at the Rhode Island Statehouse in favor of a Medicare4All-style bill). For the New York Metro chapter of PNHP, which has its own staff organizer supporting their campaign for the New York Health Act, it would mean leading the country with an exemplary model of universal coverage. Even this project requires federal backing, however, as the CMS would have to be granted permission to deliver its federal insurance money as a lump sum payout to New York, which would then dispense care.

Debate within PNHP chapters about state-based programs remains contentious. Dr. Cheryl Kunis, a nephrologist from New York, told me she’s skeptical of state-based single-payer legislation. “It’s unethical for New York to have it, but the rest of the country does not have it.” No one knows if a single state could bear the burden of a democratic experiment, or how citizens in neighboring states would respond to the free care next door. Nothing from the lecture about PNHP’s triple aim— stop profiteering, improve traditional Medicare, and win single-payer— supports or disavows an alternative state-managed path to victory. By side-stepping the all-important question of implementation, it feels like PNHP has held off from the big unknown at the center of the project: who is actually going to wield the democratic power that commands private insurance companies to get lost? 

At the end of the day, it seems doctors who’ve stuck it out the longest have seen enough suffering that they’ll take any win they can find. Former PNHP president Dr. Johnathon Ross recalled being snubbed by then-Governor Bill Clinton alongside several thousand activists in Little Rock, Arkansas while trying to pressure him to support single-payer. Back then, he told me, PNHP was much smaller, without formal elections, an active national board, or a SNaHP wing. The organization’s growth over one professional lifetime has been tremendous, but it still doesn’t seem like we’re any closer to a national project succeeding before a state project passes. As we were filing out of a conference room breakout session and back to the main auditorium, Dr. Ross confided in me: “When you look at the history of doing hard things in America, a state always does it first.”

Joey DiZoglio, MD, is a practicing OB/GYN in Wisconsin. He was a former leader of his medical school’s SNaHP chapter and a current dues-paying member of PNHP and DSA.  

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