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Many activists have worked tirelessly for decades to win single payer, aka national health insurance, aka Medicare for all. Rallies, letters to legislators, binding and non-binding referenda in many states have all been tried. The one clear result is that 66 per cent of the public now favors single payer. The battle of ideas has been won. And now at this moment of opportunity when the health care system is in a very deep crisis with increasing numbers unemployed and hence in need of health insurance, all may be lost – and that due to the very man, Barack Obama, whom so many of these same activists worked so hard to elect. Such a betrayal is breathtaking.
Obama betrays single-payer movement to insurers.
At the White House Conference on Health Care Reform several weeks back Obama made it abundantly clear that single-payer was off the table. Not so much as one single payer advocate was invited while the room was stuffed to the gills with representatives of the insurance industry and CEO’s of every stripe. Several weeks earlier at a White House meeting of the Congressional Black Caucus, Rep. John Conyers, the author of H.R. 676, the House single-payer bill asked Obama if he might attend along with a physician advocate of single-payer. In an email reply, Obama said no.
In response Physicians for a National Health Program (PNHP) and other organizations threatened a demonstration of docs in white coats in front of the White House on the day of the conference. Obama quickly reversed himself and admitted Conyers and PNHP president, Dr. Oliver Fein, to the conference. So far so good. The threat was an exercise in power and it worked. It also demonstrates that Obama does respond to pressure – but not to polite requests. Very important.
However, Obama also made it clear Conyers and Fein were to sit down and shut up, unlike Karen Ignani, spokesperson for the insurers who was a prominent speaker,. Unfortunately Fein and Conyers obeyed. In my estimation, this was a mistake as was the decision to cancel the demonstration without gaining more from Obama. Imagine if Dr. Fein had spoken up; imagine if he had to be forcibly excluded from the conference. Single payer would have been put before the nation right then and there. The admission of Fein and Conyers to the forum has been presented as a victory and I suppose it was a small and partial one. But it was certainly a lesson, one that should not be forgotten or have to be relearned.
Obama has organized a series of regional health care forums and at none of them have single payer advocates been invited to address the room or join the discussion – the forums are by invitation only. I was part of a single-payer demonstration at the one for New England in Vermont hosted by Obama’s buddy, Mass governor Duval Patrick. As at the White House, some single-payer advocates managed to get in but they did not challenge Patrick or by extension Obama. With two hundred others we demonstrated outside for single payer. I was bowled over when the principal physician speaker at the demonstration proclaimed, “President Obama is on our side. But he cannot put his foot in the water for us because it is shark infested.” As she explained, the sharks in this case are the insurers. Is that not another way of saying that Obama has sold out to the insurers?
Our group joined the demonstration with a banner reading:
On Single Payer.
2003: “It’s the Best.”
2009: Get Lost. (1)
And so it is. Obama rose to prominence in Chicago in part by pledging to labor and to prominent activists, like national PNHP coordinator, the wise and witty Dr. Quentin Young, once upon a time Obama’s personal physician, that he was committed to single payer. And you can be sure that Obama was thoroughly educated by Quentin Young on single-payer. But Young somewhat ruefully admitted to Amy Goodman that Obama was “dishonest” on single-payer (2). That is another word for liar. And here is Dr. David Himmelstein, a founder of PNHP and one of its leading thinkers, on Obama: “The President once acknowledged that single payer reform was the best option, but now he’s caving in to corporate healthcare interests and completely shutting out advocates of single payer reform,” Himmelstein said. “The majority of Americans favor single payer….” And yet if one looks at the PNHP web site home page there sits a picture of Obama embracing Quentin Young. Strange tribute to a sworn adversary, but a sign of confusion about Obama that reigns in all too many quarters.
So let us be clear. Obama is not on the side of single-payer – far from it. He has actively sought to remove it from public consideration. It may be hard for some to see Obama as the enemy since he is an appealing persona, a physically attractive man in appearance and speech, a politician of color, and one who looks especially good after years of Bush. But the Bush standard is a low bar indeed, and persona is no substitute for policy. Health care reform is not a matter to be judged according to the values of People magazine or by wishful thinking or a desire to be “part of the crowd”; it is a life and death matter for millions of people in this country.
How to win the Medicare-like option in the Obama plan. Make the perfect the ally of the apparent good.
Some now argue that Obama must be supported, because he will include a public sector, Medicare-like option for everyone in his “reform” plan. The insurers will not be able to compete, or so goes the argument, and hence they will eventually be driven from the scene. So do not give Obama too much flack, we are told. However, it is unclear whether this option is presented by Obama in a serious way. Jack Beatty of the Atlantic said on April 17 on NPR that the White House is sending out signals it is backing off this option in the face of insurance industry opposition. And the Wall Street Journal and others are already assailing this option as a disguised assault on the health insurance industry and the American free enterprise system and liberty itself.
Let us suppose that you are a supporter of this public sector, Medicare-like option and that you are interested in the tactics to win it. What is the best path? I submit that the best path is an all-out battle for single payer. In that way, the public sector option is the compromise position between all-out insurance company domination and single-payer. It permits politicians who might want single payer to say to the insurers: “Give me this public sector option, because I need to give my constituents that – at the very least.” It is horse trading, of course – but that is what tactical politics is all about. In other words the perfect can well be the ally of the apparent good – to alter a well-worn phrase used to discredit single payer. To give up on single payer or to fight for it half-heartedly will only make the eventual outcome worse. And of course this strategy also opens the possibility that single-payer might prevail. And would that not be sweet.
So job one now is to get single-payer back on the table. This will not be easy. In some sense we are now in a worse state now than we were in the early 90s when the Clintons raised the issue of health care reform. At that time there was much debate about single payer, and the newspapers were filled with charts comparing it to the convoluted plans put forward by the Clintons. Obama has been much more successful in serving the insurance industry and paralyzing the single-payer movement than the Clintons ever dreamed of.
Now the question is how to get single payer back on the table. It would be a profound mistake to see the main effort as educational. Single payer, aka Medicare for All, is easily understood; and 67 per cent of the American people already support it. The battle of ideas has been won. Now we must win the political battle. And that cannot involve polite discourse alone. Obama needs his progressive base to win election again – as do many congress members. Simply put, we must tell Obama and company that this base will desert them if we get only McCain lite from them. That is the key; without that we have no leverage.
Militancy will be necessary. Non-violent civil disobedience must be considered. Congressional offices and Obama appearances must be targeted for forceful and plain-spoken demonstrations – not polite tete a tetes out of the public view. And there is urgency to this. The Congresspeople and the president must be put on notice that we will not support them if they do not meet our demands. No more Mr. Nice Guy on the movement’s part.
Many people have worked for many decades trying to win single-payer. What a tragedy it would be if we allowed ourselves to be diverted by a deceptive Messiah at a moment of possible breakthrough. Both PNHP and SinglePayerAction.org are willing to continue the battle, but too many others are not. This must change. The specifics of the struggle will demand imagination, militancy and more. But if we do not fight, we surely will not win.
John Walsh is an activist in PNHP. He also ran for Congress twice in the early 90s on a single-payer platform, inter alia, but lost each time by about 1 million ….dollars. He can be reached at email@example.com
For picture see: http://www.makethemaccountable.com/
http://www.democracynow.org/2009/3/11/ You can also get a link to Obama’s 2003 speech praising single-payer to an AFL-CIO meeting in Chicago.