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The Hill reported this morning that many of the biggest healthcare interests in the country, including pharmaceutical companies and health insurers, have formed a coalition to fight single payer. The group, the Partnership for America’s Health Care Future, includes major trade groups like “America’s Health Insurance Plans (AHIP), the Pharmaceutical Research and Manufacturers of America (PhRMA), the American Medical Association and the Federation of American Hospitals,” according to the Hill.

The article gives us a good sense of what PAHCF (a shit acronym, by the way) will say about single payer and what their strategy is. They are going to argue that single payer will threaten people’s existing coverage:

“Most Americans support commonsense, pragmatic solutions that don’t interrupt the coverage they rely upon for themselves and their families,” said Erik Smith, spokesman for the Partnership. “We agree — and that’s what we’ll be supporting.”

And they are going to go after moderates in the Democratic party, to try and stop single payer from becoming a litmus test for Democrats in the 2020 primaries:

The industry source said insurers are more focused on the 2020 race than the midterms, and hope to use the new group to “splinter off the moderates” to oppose single-payer.

This must inform single payer advocates’ response to attacks by this group. First, they must work to ensure that the consequences of opposing single payer for moderate Democrats are known to those Democrats, and that they are significant. It must be made very difficult for Democrats to oppose federal single payer, to the point where support from PAHCFHCHFHC is no longer enough to counteract it. This means starting right now to solidify support for Medicare for All among Democratic voters in early presidential primary states, make it a major issue for them, and enroll them to pressure candidates on the issue, too.

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Second, single payer advocates need a good response to the threat (the lie, really) that Medicare for All would interrupt their coverage. Of course, this is a ridiculous warning given how fragile life on the private insurance market is—oh, sorry you got hit by a bus, but we’re going to need that whole $6,000 deductible now, thanks—but it’s important to work the response to that into their messaging before they get a chance to blast ads with that threat into homes across America.

Single payer has gone from a fringe position to approaching litmus test status for 2020 Democratic candidates in an incredibly short time. That speed has given advocates an advantage: the big healthcare profiteers have so far been caught off guard by this rapidly-emerging consensus. They’re now acknowledging it’s a real threat to their existence, which is extremely encouraging—but it’s also a whole new phase of this fight.

Things are getting real now. It’s not just a matter of proving that single payer isn’t a fringe idea anymore; our enemies are not just shitty columnists or weak-willed Democrats. They’re now an incredibly well-funded coalition of groups with billions and billions on the line, who are therefore able to hire the most experienced and revolting DC types to help it kill single payer. AHIP has already launched a “six-figure advertising campaign defending employer-provided health insurance,” according to the Hill.

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It is vital that politicians and the media do not treat this group’s arguments as legitimate concerns offered in good faith. They are making these arguments because, as the Hill said, “Pharmaceutical companies, hospitals, and doctors would likely be paid less under a government-run health insurance system.” They are doing this because it would reduce their profits; health insurance companies are fighting for their existence. No amount of money is too much for them to spend on securing the survival of their vile industry, and they’ve got plenty to spend: The five biggest insurers saw profits of $4.5 billion in the first three months of 2017.

Don’t be put off by the inclusion of doctors on that list, too. It feels difficult to argue doctors should be paid less, given the important job they do, but they’re paid far more in the US than in other countries. It’s also important for the media not to misrepresent comments made by doctors who make a lot as representing doctors as a whole: Younger and student doctors, for example, are increasingly supporting single payer, but so are doctors as a whole. 

There are many reasons for all kinds of doctors to favor single payer. It would eliminate the time-consuming interactions with insurance companies, and make it easier to treat their patients based on what’s best for their health, rather than what they can afford. Doctors who make $500,000 a year might oppose single payer if it threatens their vast salaries. The question is: do we care what they say? (Doctors in the UK, where healthcare is nationalized, make a pretty tidy salary on average.)

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The fight for single payer is vital. It will be a fight that’s unfair and full of lies. It will be David versus dozens of Goliaths, Inc. But there is no alternative but to fight them, because what’s happening right now—because of these people—is unjust, untenable, unacceptable. It must end.