Saturday, January 16, 2010

3 Poles in the Health Reform Debate

There are at least 3 narratives driving the health reform debates that need to be articulated and challenged.

1. The right-wing anti-social killer pit-bull perspective. Deserves closer scrutiny and analysis, and I’m not close enough to those people or their organizational links to say anything illuminating.

2. The Obama administration and many conservative Dems in Congress have proposed policies rooted in neoliberal economics that undermine the likely success of reform, and support for it. They perpetuate the fallacy that we can control costs by making health care work like a free market, forcing individuals to make choices about our health care by paying more out of our own pockets, and by choosing from a blinding array of health plans and benefits. In fact cost conscious consumers have no power in a market dominated by mega corporations: hospitals, drug and insurance companies.

This viewpoint has driven most of the bad policy decisions the White House has made and has threatened to drive a stake into the heart of the support for reform. Americans may or may not be ready for Medicare for All but we are damn familiar with what the insurance industry is doing to us. Whatever the policy merits of the public option, abandoning it is, was and will be a serious misstep politically. The Administration may not have the power to get rid of the insurance industry entirely. But it is giving away plenty in subsidies and other forms of life support to AHIP members. It is not fighting for the public option and a standardized benefit package and progressive financing in part because the economic gurus at the White House don’t believe in them.

3. Liberals and progressives have worked hard this year. We might have come out swinging in January fighting for a Medicare-for-all, single payer system. We didn’t. Obama’s decision not to go that route was seen as insurmountable, so no one really tried seriously. Recognizing that we would not achieve single payer this year, progressives turned either to improving the bill, or to public education on single payer without any expectation of influencing the national bill. While many of us advocated both for single payer and for a better national bill, it was left largely to HCAN and various offshoots of the Obama campaign, both constrained by direct links to the Democratic Party, to fight for the merits of progressive proposals like the House’s bill. At this point there are three divergent themes that lead the discussion astray:

a. "It's all determined by corporate money." Corporations hold great sway over political life and decisions. And their money works in part through direct contributions to candidates. But voters matter too. Corporate money sways public opinion. We have a better story and so can we.

b. "We'll fix it in the states. The way to get around this problem is to get active on the state level, where we can more easily get rid of the health insurance industry." There are some progressive state campaigns, no question. But not surprisingly, corporations have figured out how to influence state houses too, many of which meet infrequently and briefly.

c. From one blogger: “The best thing that could happen to Obama (and America) is for Congress to FAIL at passing any health legislation. That would give Obama the chance … to say 'OK, we now know that the system is beyond any rational attempt to repair it. We are starting from scratch.'”

Proposing, at this point, that failing entirely to pass a reform bill will clear the decks for a progressive resurgence defies belief. It is quite clear what the result will be.

I believe that defeating the bill now would not open policy space for further progress. It would leave the insurance industry in the same powerful position it is in now. If we fail to pass a bill, the real dedicated and out front enemies of equity and community will be back in the ascendance politically. If we fail, corporate America has open season. We need to continue to build the power and vision of a progressive movement. I see no scenario in which defeating health reform would hasten that agenda.

If we pass it we get – if we fight for it – more standardization and regulation; more guarantees that employers will actually pay in to the system for benefits, the hope of fewer deaths and bankruptcies due to uninsurance.

The House Progressive Caucus has an agenda we should support. Loudly, proudly and actively. We can fight for single payer and fight for fair financing, progressive standards for affordability, and a stronger public sector – through expanded Medicare, a public option or whatever. It is not up to us to bail out a wrong-minded Administration but it is up to us to challenge their ideas and support our allies in Congress for the policies and strategies they actually believe in.

Won’t defeating the bill automatically generate a new progressive movement, with dynamic candidates, platforms and mobilizations? Nice thought. We certainly need all that. I admit it, here’s where my crystal ball gets cloudy. Ralph Nader’s recent novel imagines a bail-out by visionary billionaires like Warren Buffett. I think people like to win, and after they win they’re ready to fight for more. I felt that way on Nov. 4, 2008. It is going to take some serious thinking and working to get back to that place. There is, though, no alternative.


  1. Great article, Ellen. Thank you for your -- as always -- clear thinking and guidance.

  2. Obama's support for a public option was clear, until he saw that he didn't have enough votes in Congress (in the Senate, particularly)to pass it! Progressives need to sustain their outrage long enough to challenge(and defeat)conservative Democrats and GOP right-wingers who support the status quo, use reproductive rights as leverage, and propose funding options to impose costly, taxed insurance on those who already can't affort it, without doing anything substantive about containing costs! Those legislators need to be exposed as the sellouts and bigots they are! Only a storm of votes against them in 2010 will get them out of the way -- and if we manage it, Obama will have 2 (maybe 6 if we can "stay the course") years to improve on whatever gets passed in the next few weeks! Attacking Obama does nothing to alter the balance of power in Congress, where laws come from! AND we can't get it done if Progressives are too busy attacking Democrats!

  3. I wish it were true. Obama was consistently equivocal on the public option, including in his Sept. 9 speech, at the same time Joe Lieberman was still supporting lowering the age for enrollment in Medicare. Agree we need to elect better members to Congress, and to fix and pass the bill. The President needs to help, and I hope that pointing out the glaringly obvious is not considered an attack!

  4. "Yes, passing this bill leaves the insurance industry in place. So does
    failing to pass a bill."

    How I wish there had been a real public debate on the merits of single payer early on. Instead, many reform advocates bought into that "uniquely American" framing brought to us by a group of Madison Avenue/Mad Men "researchers." Why didn't the Dems listen to objective economists and health policy analysts instead of focus groups,follow proven cost-effective models (Medicare at home and abroad)?

    Single payer was declared dead on arrival, said to be not politically feasible. How feasible is the proposed legislation? How will our country pay for such a complicated multi-tiered system--profligate and punitive? We'll continue to pay much more for administrators than we do for doctors and nurses. So much for bending the cost curve!

    The insurers control a great deal now--What will happen when the mandate puts them in control of all patients? In our state there was a recent dispute between Anthem and Norton Hospital. The former refused to pay the latter's provider fees. During negotiations, Anthem simply played its trump card, telling its policyholders they could not use Norton services and physicians. What will happen when an insurer in the exchange tells its patients nationwide or statewide that they cannot access certain providers?

    When a friend of mine ran for school board, a mentor told her to respond to policy questions by saying, "Is it good for our children?"

    Well, our President and members of Congress should be asking a similar question about the proposed "faux reform" legislation: "Is it good for our people?" The answer is "No."

    If the legislation passes, I will get up the folowing morning to continue the fight for single payer Medicare-for-all.

  5. I finished my comment above then checked my e-mail. Don McCanne of Physicians for a national Helath Program has sent out the following quote from Martin Luther King, Jr. So very much on-topic.

    Washington, D.C.
    February 6, 1968
    A Proper Sense of Priorities
    A speech by Martin Luther King, Jr.

    Closing remarks:

    As we were marching today, some 5,000 strong, I thought about Selma because I could look around and see so many who have marched with us in Selma, and from Selma to Montgomery. And we are still marching and we are still moving. And I give you my commitment today that I plan to continue.

    Someone said to me not long ago, it was a member of the press, "Dr. King, since you face so many criticisms and since you are going to hurt the budget of your organization, don't you feel that you should kind of change and fall in line with the Administration's policy. Aren't you hurting the civil rights movement and people who once respected you may lose respect for you because you're involved in this controversial issue in taking the stand against the war."

    And I had to look with a deep understanding of why he raised the question and with no bitterness in my heart and say to that man, "I'm sorry sir, but you don't know me. I'm not a consensus leader. [Laughter - Applause] I don't determine what is right and wrong by looking at the budget of the Southern Christian Leadership Conference or by taking....[Applause] Nor do I determine what is right and wrong by taking a Gallup poll of the majority opinion." [Applause] Ultimately a genuine leader is not a searcher of consensus but a molder of consensus. [Applause]

    On some positions cowardice asks the question, is it safe? Expediency asks the question, is it politic? Vanity asks the question, is it popular? But conscience asks the question, is it right? And there comes a time when one must take a position that is neither safe, nor politic, nor popular but he must take it because conscience tells him it is right. [Applause]

  6. 1. Providers will fight with any negotiator that tries to limit their income, whether public or private. See the doctors' strikes in Canada, the history of MediCal contracting in California in the 1980s, and the fights with private insurance co.s today.

    2. I agree we'd be a lot better off with a public option. See our petition,

    3. The bill is better for us than the status quo. Of course we'll keep fighting for single payer, hopefully more strategically and successfully than we have done so far.

    4. We remember and celebrate today a visionary leader for justice, who knowingly risked his life to mobilize millions and did not shrink from the monumental injustices of the day: racial discrimination, the war against VietNam, and economic oppression, as well as our cruel health care system. While all of us are inspired by his life and vision, only with great humility would any of us claim his mantle as our own. - Ellen Shaffer