Why the Left Lost Single-Payer Health Care Reform
Source Dave Anderson
Date 09/07/10/00:26
Why the Left Lost Single-Payer Health Care Reform
by Michael Lerner

THE SUBSTANCE OF the "single-payer" proposal is incontrovertibly the
very best plan. Aaron Roland convincingly makes this argument in his
op-ed on page 15 of this issue of Tikkun. His article also gives us a
good idea of what we should fight for within the context of the actual
health care battles that will be fought this summer in Congress. After
reading his article, please contact your congressional representatives
(particularly your senators) to let them know that you understand the
differences between the options, and that you want the ones that are
closest to the single-payer proposal: plans that have a serious
"public" health care component. Unfortunately, a truly single-payer
system has effectively been ruled out by the major players in

Here are some of the reasons that happened:

1. President Obama Never Supported a Single-Payer System

Obama said on various occasions that if he were designing a health
care system from the start he would choose a single-payer model, but
he said that since we already have a private-insurance-based system he
has decided to reform that one by adding a public component. The logic
of his position was always this: let's do what seems "realistic" given
the current alignment of forces. He gave no indication of being open
to the notion that a new president has the right to fight for a vision
that makes sense and should attempt to use his immense popularity for
that purpose.

Contrast that with right-wing presidents such as Ronald Reagan and the
two Bush presidents. It will come as no surprise to you that we
spiritual progressives did not support the dramatic changes they
proposed. But we have a lot of respect for the fact that they were
willing to fight for changes that went against popular sentiment, and
in the process they managed to move the national dialogue a long way
toward their own set of assumptions.

Ronald Reagan managed to popularize the notion that the capitalist
competitive marketplace could provide the economic security that
people had previously gotten through New Deal-era public programs. He
was so successful that Bill Clinton, representing the centrists
organized in the Democratic Leadership Council, pushed through an "end
to welfare as we have known it," provoking major liberal figures in
his administration to resign in disgust.

George H. W. Bush stood up to AIPAC and threatened Israel with an end
to loan guarantees for new housing units unless it stopped using that
money to support expanded settlements on the West Bank, a move that
contributed to the defeat of the Likud and the electoral victory of
Yitzhak Rabin, who went on to sign the Oslo Accords.

George W. Bush pursued an unpopular war in Iraq and managed to hold on
to his disgusting, immoral, and destructive-to-America direction,
despite immense popular pressure for an end to the war, and managed to
create conditions that have led the Obama presidency to continue that
war, embrace Bush's Secretary of Defense as its own, and extend the
war to Afghanistan and Pakistan. Bush even fought for privatizing
Social Security, a plan that never stood a chance of passage.

These people stood by their convictions, however reprehensible those
convictions were. President Obama gives great speeches but is
unwilling to challenge prevailing ideas in a sustained fight for his
own principles. He is temperamentally opposed to ideological struggle:
just look at how dramatically he compromised on his economic bailout
before the struggle began, imagining that such a compromise would gain
him points with Republicans in Congress. But when they unanimously
opposed his proposals anyway, he seemed not to have learned a lesson.
Instead he continues to present ideas that are ideologically
incoherent or contradictory to other parts of his program. He doesn't
seem to realize that no matter how much he accommodates their
interests (e.g., by protecting them from malpractice law suits), the
physicians, insurance companies, and other health care profiteers will
oppose any "public option" he supports, label it socialist, and use
their media dollars to defeat it.

Obama promised when running to consult his supporters once he was in
office about what they really wanted. He promised to change the
culture of Washington so that we, the people, would not be outgunned
by insider lobbyists. Now Obama is trying to mobilize his supporters
nationwide to back his plan by pressuring their representatives (see, which is more than the Clintons attempted to do
for their plan. Yet his electoral organization, now set up in the
Democratic National Committee, has never given his supporters an
opportunity to help choose among the various health care plans,
despite (or perhaps because of) the fact that most of them would
likely rally around Rep. John Conyers's single-payer plan. The White
House should have held a public debate on these options-coupled with
an actual authorized poll conducted in part by email and in part by
contacting a random sampling of Obama voters-before deciding which
plan to back. A public debate could have helped mobilize popular
support for a new plan and would have modeled the new politics we were
promised. Ironically, Obama will now have to fight the same
ideological fight that he tried to avoid by refusing to back
single-payer care, only now in favor of a plan that has less going for
it. And this weaker plan will still be called "socialized medicine."

2. Democrats in Congress

The Congress has been worse on this issue than Obama. Most of its
members (in both major political parties) are afraid to challenge the
insurance companies and health care profiteers. It should be no
surprise to learn that these special interests have donated huge
amounts of money to the key decision makers in both houses of
Congress, and the lawmakers in turn have been unwilling to give the
single-payer proposal a serious hearing.

Again, it is the failure of nerve on the part of progressives in
Congress that is most disturbing, because they are unwilling to use
their potential power. A solid progressive caucus could have made
clear to the president that he would not have their backing for
anything less than a single-payer system. That kind of message would
have given the president the kind of jolt that might have forced him
to actually include single-payer in the public discussion, and perhaps
even ask the country or at least those who voted for him to weigh in
on which of the various plans they supported. Instead, it is the more
conservative "Blue Dog" Democrats who have exercised their influence
by threatening to bolt unless Obama's administration capitulates to
the assumptions of the status quo. As we go to press, we find that
House Speaker Nancy Pelosi told the Huffington Post that a health care
overhaul that did not include a "public option" wouldn't make it
through the House because it "wouldn't have the votes." If this is
finally evidence of House progressives standing for something, even if
not for what they truly believe in (single-payer), it is good news
indeed; members of the Network of Spiritual Progressives are
contacting their elected representatives to encourage them to stand
firm on a strong public option.

3. Obama Supporters

Rather than vociferously demand a single-payer program, or an end to
the war, or anything else they believe in, most Obama supporters have
largely opted out of politics. They refuse to challenge the president
in any way, for fear that doing so would weaken him politically.
Moreover, too many of them have embraced a secular mysticism when it
comes to Obama, as though he were the messiah, believing that his ways
are not our ways, but that he must have a Grand Plan and know what he
is doing. Thrilled, as are we, by the valuable public discourse that
he has introduced; delighted, as are we, by the intelligence and
decency and sense of inner calm that he embodies; rejoicing, as do we,
that we now have a president of whom we can be proud, his supporters
have then closed their eyes to the actual details of the policies he
has backed.

Many Obama supporters intuitively and correctly suspected that if they
focused on his policies they would be deeply disappointed about issues
such as his prioritization of the needs of Wall Street and the
multinational bankers over the needs of the millions of people thrown
out of their homes or their jobs in the current economic meltdown. His
administration recently decided to let the big banks return the money
they received (interest-free) without making significant reforms or
capping the outrageously high compensations their upper managers

Other Obama supporters have watched those policies with private
disappointment, unwilling to turn that into public challenge.

As a result, without serious pressure from his political left, Obama
feels he must turn his attention only to his political right, and as a
compromiser and "builder of unity," he naturally will be pulled in
that direction. Without a clear and loud message from his supporters,
Obama has decided that there is no reason to shift from his original
health care plan toward a new openness to single-payer care. Will he
even stick to his campaign pledge to include a strong and meaningful
public option? He hasn't felt such an obligation with regard to issues
around torture and human rights and many other issues, but he is
clearly trying to stand up for his preferred health plan, at least at
this stage: he is making more bully pulpit speeches for it than the
Clintons did for theirs. It's up to his supporters not to abandon him
to the pressures of Washington. It is now, more than ever, that he
needs to hear our ideas.

4. The Insurance and Pharmaceutical Industries and Other Health Care Profiteers

Corporate America does not rely on the right-wing extremists when it
comes to central issues in their agenda, but rather on convincing the
political centrists that they must not allow any measures to
substantively interfere with corporate profits. Their strategy is to
label any plan that would weaken the hold of the profiteers, the
insurance companies, and the pharmaceuticals as "socialist"-and then
to use their immense financial resources, their powerful role in
shaping the media, and their financial support of many in Congress to
convince the public that people in the United States would have worse
health care if government got involved. And rather than focus on
single-payer plans, business leaders and their front groups have
attacked the mild plans of Democratic Party centrists as "socialist,"
thereby making single-payer proposals seem so extreme that anyone who
wishes to be "realistic" in the language of the corporate media and
the inside-the-Beltway pragmatists won't even bother to address it.

The only plausible response to that is for a significant section of
congressional progressives to say, "OK, well, given the evidence that
socialized medicine in Europe and Canada does a better job than
insurance company-based medicine in the United States, if you want to
call what we are for ‘socialized medicine' then we are for that. And
maybe we should socialize the pharmaceutical companies, as well."
Instead of letting the word "socialism" scare them, they could embrace
it and insist that the socialized medicine experiments have actually

Ironically for Fox News, when a Rasmussen poll released in April found
that 37 percent of Americans under age thirty prefer capitalism, 33
percent prefer socialism, and 30 percent are undecided, several
commentators suggested that a partial explanation for the
unprecedented numbers preferring socialism was the fact that the
conservative media had tagged Obama's ideas socialist, and since the
young people liked Obama, they reasoned socialism must be a good

5. Government Itself ... and How We Feel About It

But there's another problem. The fact is that unresponsive government
in the United States has made many people legitimately worried about
more government in their lives. Angry as they are at insurance
companies, they don't necessarily believe that government
bureaucracies are much better. It's time for progressives (and
certainly those who embrace single-payer) to take this concern
seriously. It is not a concern driven solely by anti-government
right-wing ideology, but by the actual experience that many people
have had of being disrespected by government bureaucrats and
frustrated by irrational regulations.

Even very liberal or progressive people in government may be
insensitive to the impact they are having on the public. The reason?
They believe that they are showing their caring by delivering services
(e.g., by providing unemployment benefits, or delivering the mail on
time, or getting someone's car registered quickly, or developing
efficient traffic patterns for vehicle transportation, or delivering
low-cost public transportation, or increasing the ease of recycling).
If they do that, they imagine, they've shown that the government is
caring. We at Tikkun call this "objective caring. " But too often the
public experiences government employees as delivering "objective
caring" in an uncaring way.

So we believe that government will remain an unpopular institution
until its employees are given a clear message that they must deliver
services in a way we call "subjective caring," that is, in a manner in
which people who interact with the government actually experience the
government employees as caring about the well-being of the people whom
they serve.

In the past, we've called upon liberals and progressives to advocate
for government employees to be evaluated for hiring and promotion in
part by the degree to which the public feels cared for by them. That,
of course, does not mean that government workers can simply respond to
every demand put upon them, But they can act in a respectful and
caring way, and most people will be able to recognize that, and say so
when asked to fill out a form evaluating the quality of care that was
shown to them each time they met with a government employee.

Years ago in Tikkun I wrote about my own outrage at how I was treated
by the department of planning in Oakland when I had to apply for
building permits. I constantly encounter people who have similar
horror stories about almost every branch of government with which
they've had to interact. Many of them come away saying to themselves,
"I wish I could defund these people-I can't stand how they treat me."
No wonder that they often will vote against any new bond or any new

Of course, when I worked as a psychologist for government employees,
they often told me that they would love to show more caring, but their
managers and higher-ups did not allocate adequate time for this, and
showed no appreciation when they took time for this kind of caring.
And that, of course, is precisely what many people worry will be the
case when there is a governmental health care program-that caring will
not be built into the structure of health care delivery. Never mind
that doctors already face the same kind of pressure to see more
patients and give each less time. The point is that people are not
going to fight for a change if they believe that the change will not
dramatically improve their experience in the hospital or in the
doctor's office.

So one of the elements that must be both built into the single-payer
care program and highlighted in the public arguments in its favor is
that the advocates recognize the legitimacy of people's suspicion,
distrust, and sometimes even anger at government, and support a
fundamental change so that all government employees' continued
employment will depend in part on their ability to show this caring
(for which they will be given ongoing training in how to show that
caring as part of their jobs). At the minimum, the public should be
assured that this kind of evaluation of employees, including all
medical employees, will be built into the system of care that is being
funded, as well as into all training of medical employees from doctors
and nurses to every other person working in health care.

One reason why this "service to the public" has often not been
present, even in doctors in the private sector, is that many of these
professionals developed a deep anger and resentment at having had to
put themselves in debt to be trained, and that debt has restricted
their lives for many years after medical school, internships, and
residencies. So another element in the single-payer proposal should be
a plan to give free tuition plus adequate financial support to the
families of medical students, as well as to students in nursing,
pharmacy, psychology, dentistry, chiropractic, and other related
health-care professions. In exchange, the remuneration of medical
professionals should be closer to that of other caring professions,
such as teaching, child care, and elder care. The point here is that
health care professionals should not be recruited on the basis of
their hope of making a huge amount of money in this field, but on the
basis of their desire to serve the well-being of their fellow
citizens. If we expand the number of medical schools and provide
funding, we may find that we could increase the number of competent
doctors even at the expense of losing some whose primary motivation is
to make more money than most other people. How well I remember my
senior year as an undergraduate at Columbia when we all discovered
that some medical students, business students, and law students had
ripped pages out of required readings that had been put on reserve in
the library to ensure that they would get higher grades than the
others and hence be in a better position to get into the highest-rated
medical schools and thereby get the highest-paying jobs.

With these elements firmly in place in the legislation and in the
public outreach, we would be in a much stronger position to make the
case that socialized medicine is nothing to fear. While some readers
may be saying, "but that won't work in 2009," the truth is that
backing away from this struggle is not going to work either, nor will
allowing the powerful to proceed with reforms that don't provide a
strong alternative to the private insurance- and profit-driven health
care system.

6. The Left (Liberals, Progressives, the Labor Movement, and Most of
the Social Change Movements and NGOs)

First, we need to express our gratitude toward the many individuals
and organizations that have been working for decades to develop the
single-payer concept and to build political support for it. I know
personally of the powerful work of the California Nurses Association
in this regard, and the courageous role played by Quentin Young and
hundreds of other physicians who have created and sustained the
Physicians for a National Health Program and whose ideas we adopted in
shaping our health care plank in the Spiritual Covenant with America
and in my own writings, particularly in The Left Hand of God. Rep.
John Conyers of Michigan has played a major role in Congress with HR
676, which is by far the best and most inclusive version of
single-payer care, and there are many other members of Congress
(though not nearly enough) who have signed on as cosponsors.


Many organizations, like Tikkun and the Network of Spiritual
Progressives, have endorsed single-payer health care.

Endorsers of HR 676

Keeping track of all the labor, faith, and organizational endorsements
of HR 676 is a tough job. Luckily, Physicians for a National Health
Program (PNHP), one of our partner organizations, is doing a pretty
good job of keeping an updated list. Below, you can find our list
combined with theirs.

American Medical Student Association (AMSA)
American Association of Community Psychiatrists
American Nurses Association
American Public Health Association
California Nurses Association/National Nurses Organizing Committee
National Association of Social Workers
General Board on Global Ministries of the United Methodist Church
Presbyterian Health, Education and Welfare Association of the
Presbyterian Church (USA)
Unitarian Universalist Association General Assembly
Presbyterian Church (USA) (Endorsed national, single-payer healthcare)
Union for Reform Judaism (Endorsed national, single-payer healthcare)
Women's International League for Peace and Freedom, U.S.
League of Women Voters
US Public Interest Research Group
Consumer Federation of America
Consumers Union
National Council of Senior Citizens
National Family Farm Coalition
The U.S. Conference of Mayors
American Library Association
Kentucky House of Representatives
New Hampshire House of Representatives
New York State Assembly
New York State Senate

Plus hundreds of locals of unions and social change organizations.


These groups deserve our enduring gratitude. We intend to work with
them in every way we can in the coming years to move the health care
debate from whatever comes out of the current debates (if anything)
toward the far more rational single-payer plan.

And yet, it is our contention that by failing to incorporate a
spiritual progressive perspective into the way that they've advocated
for these ideas, they've made themselves much less powerful than they
might otherwise have been (a phenomenon I describe in my book Surplus

The Left has a deep fear of talking in terms that seem soft, mushy, or
lovey-dovey. So its advocates thought that they could best sell their
approach to health care by emphasizing its economic advantages (e.g.,
that it will lower the cost of health care). Hence they chose the name
"single-payer" to emphasize their concern about who would be paying
for the care.

This has proved a huge flop. By emphasizing who pays and how it is
paid, the Left has focused on something that most people feel unable
to understand: how the economy works, what are the best economic
arrangements, who is best at cost reduction, etc. For a very large
section of Americans, these issues immediately pull for the following
response: "I don't really know much about economics, didn't do well in
high school math, have problems balancing my checkbook, and really
don't think I have the competence to make these judgments." In short,
the term "single-payer" immediately leads people into the wrong
conversation. Ask yourself this: how many of your friends can, even
today, explain to you what "single-payer" actually means and how they
understand it? You'll find that most really don't have a clue, even if
they know they are for it.

The right conversation would have been generated by terms like
"Caring-for-All Health Care" or "The Caring Society Health Care Plan"
or "Universal Caring" or "Caring Medicine." Or "Medicare for
Everyone," "Everyone Matters Health Care," or "Universal Medicare" or
"Generosity-Driven Health Care." And the slogan then becomes: "Caring
Not Profits in Health Care" or "Put the Care Back into Health Care."
We invite you to send in your suggestions for what we should be
labeling this campaign in future years and what slogans will be
helpful in increasing support for this approach (email

The problem was further compounded by President Obama's remarks in
June, when he indicated that the administration-having been influenced
by an article in The New Yorker, which tried to analyze why the same
health care costs more in some parts of the country than in others but
without better health care outcomes-would now consider cutting
benefits or federal financial supports to those parts of the country
that were spending most. This framing of health care makes it seem as
though cost-cutting is more important to the sponsors of health care
reform than maximizing our caring. It's exactly the wrong message. The
true message of that very interesting article (by Atul Gawande, June
1, 2009) was that where doctors collaborate to put the patients'
welfare first, costs are lower, even when private insurance is
involved, than it is where doctors prioritize their own profits, even
when it is Medicare that is paying most of their bills. Collaborative
caring is as critical as who pays.

So the right message is that we are seeking to change the system
precisely because it has given too much attention to the needs of the
profiteers and not enough attention to the needs of ordinary people
(including most middle-income people) for caring. This campaign should
not get itself involved in the issue of the over-technologization of
medicine or the extreme costs that come at the end of life when huge
amounts of money are spent in keeping people alive for a few extra
months. That issue should be addressed, but not in this first campaign
for health care reform-it lends itself too easily to being
misrepresented by the health care profiteers as "proof" that people
won't get as good care once we have a new system as they do presently.
Obama made a mistake in allowing the issues to get mixed up in that

For the Left to start to talk about health care not simply as "a
right" but also as a manifestation of our actual love and caring for
others would be a major paradigm shift. Its inability to make that
shift is a major contribution to the failure of the kind of health
care finance reform the Left correctly desires. Unfortunately, and
unless Obama suddenly changes direction (as we hope he will), the
reform that we need will still be needed after the health care debates
and legislative battles of 2009, no matter which (if any) of the
"realistic" plans is enacted. It remains to be seen if the Left will
learn anything from this defeat of the single-payer proposal and
whether that defeat might open it to considering the kind of spiritual
politics that we in the Network of Spiritual Progressives have been
advocating and which we hope you, dear reader, will support by joining
our Network at

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