councilor.org
| Source | Dave Anderson |
| Date | 09/07/10/00:26 |
| www.tikkun.org
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 Washington. 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 www.barackobama.com), 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 receive. 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 worked! 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 thing! 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 taxes. 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) NAACP 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 Powerlessness). 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 RabbiLerner@Tikkun.org). 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 way. 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 www.spiritualprogressives.org. |
Copyright (c) 1998, Joongpil Cho