Lessons from the health care fight – and future directions.


by Mark Dunlea


Once again America has failed to join the rest of the industrial world in achieving universal health care – though in the best Orwellian tradition, the Democratic Party and many of their allies in the public interest and labor movement are declaring the health insurance mandate a historical victory comparable to social security and Medicare.


If you are looking for details as to how this bill is a defeat for universal health care, look elsewhere – such as the websites of PNHP, Healthcare-Now, firedoglake.com or just read the bill itself (hint – get a calendar).


The single payer movement demonstrated both major strengths and weaknesses in the recent Congressional struggle. But the blame for the failure to achieve universal health care lies elsewhere, starting with the political system, including the Democratic party and mass media.


Once again the will and needs of the American people were trampled on by the special interests. We have witnessed similar debacles in recent years with the peace, climate change and labor movements. Winning single payer means we have to fundamentally change our political system (starting with campaign finance) in coordination with other progressive movements. We have to unite with other movements for social change if any of us are ever to win. Changing the system is the only path to win any particular issue.


I will note that even public campaign finance reform will unfortunately not resolve our political problems as much as we think it will. Far more fundamental changes are needed such as proportional representation. But as the NY Times obituary this weekend of Mo Udall (former Congressmember and Secretary of the Interior), over time environmental protection went from one supported in some ways by both parties in the 60s and 70s to one largely opposed by both major parties in recent decades due to the role of campaign contributions. The role of campaign contributions actually resulted in Clinton and Gore doing more damage to the environment in their first term than Reagan and Bush I managed to inflict in their twelve years.


The futility of expecting the Democratic Party to help deliver real social change was once again aptly demonstrated. Unfortunately, this fact has been proven over and over again and yet many continue to cling to the Democratic Party as the only realistic hope for change. It will never happen. We need to build and support a progressive third party electoral movement / party independent of corporate America. The best hope for leadership on this is labor – but we have been waiting a long time for that and the recent efforts around the labor party were doomed by its unwillingness to actually run candidates. Half steps away from the Democrats won’t work.


Let us not forget that at critical moments single payer Congressional leaders such as Conyers, Kucinich and Weiner plunged stakes into the heart of the single payer movement. And that many Democrats – and many labor and community groups – that had publicly proclaimed their support for single payer never invested any time, resources or political capital to make it happen. Nothing more than lip service.


(This is in addition to the problem that the Democrats are not a unified national party and that no matter how many Democrats we elect to Congress, we won’t win. Success is somewhat more possible at the state level for that reason.)


The other systemic change needed is media reform. We have a corporate owned media system in the US that promotes a corporate right-wing agenda. Groups are working to develop alternative media such as the internet and social networking. But we have to fight to take back at least control to the tv and radio waves and to reverse the gutting of the restrictions on cross-media ownership. And unfortunately the independent media (indymedia) movement started after the Battle of Seattle has already peaked, especially in the US, though interesting local efforts still continue.


I attended a forum at the Bluestockings Bookstore in NYC which featured a wide ranging discussion evaluating the recent health care campaign. The panelists and audience members, many of them veterans of the fight, often contradicted one another (e.g., we spent too much time focusing on Congress vs. not enough), so there clearly is no consensus.


One challenge in making such analysis is to try to step back and take a broader view of what took place. There is a danger that one’s own experience plays too large a role in such an evaluation. I find this often with first time political candidates, who by election day invariably believe they are going to win since their own interaction with voters are uniformly positive, since the voters appreciate someone taking the time to ask their opinions. The problem is that the voter often forgets your name five minutes later. Since we closely track the developments with respect to single payer, we are impressed by how much attention and support was generated; for too much of the public however, single payer was invisible or misunderstood throughout the campaign. It was never a significant part of the national debate and seldom mentioned in the mainstream media, especially outside areas that were a hotbed of single payer activism.


I believe we failed to focus enough on pushing to make health care a human right. This goes to the need to transform the struggle into one with a strong moral core, akin to the struggle for the right of women to vote or the civil rights movement. It would also have been easier to build public rejection of the various Democratic health care proposals if the bottom line issue was whether or not everyone was included. Interestingly, a number of speakers at the forum came to the opposite conclusion, that we focused too much on health care as a right (rather than apparently the actual details of the proposals). It was also interesting that in the euphoria and backslapping in the Democratic party and their supporters, many of our liberal friends actually came to believe that Congress voted to make health care a right – even though that was not something I heard many Congressional leaders saying.


The question of making health care a right also seems to go to the point of whether or not we spent too much time focusing on Congressional members. On one hand, if you want to pass a bill through Congress, you need to be able to count votes. You need as many face to face meetings as possible to hold the members accountable, along with call-ins, letter, picket lines, etc. Many of us believed that the number of sponsors of HR 676 indicated a strong base of support within Congress to build upon; that was false. On the other hand, I agree with those who say that Congress is so corrupt and paid for by special interests, that we are never going to persuade them to vote against the special interests unless there is a mass movement so large that it is a tidal wave that overwhelms the political system. As one person pointed out at the forum, "my guess is that the Tea Party spends more time talking to their neighbors and other individuals than they do with individual Congressmembers."


It seems that both a strong inside and outside strategy is needed.


I also think we needed to hammer harder on the point that insurance companies are the major problem with the American health care system and they need to go. Obviously this was a point that the single payer movement embraced – but that message never reached a critical mass in the public consciousness. If the elimination of insurance companies was seen as a central issue by the public and the media, the insurance mandate  – and the public option – would have been in far more trouble. Instead, the insurance mandate was never a point of controversy.


Lastly there is the role of the public interest health care groups and the unions that promoted the public option. Perhaps there are examples in our country’s history where advocates have made a bigger tactical error from day one, but I will need an historian to point them out. While a weaknesses of the single payer movement was a certain naivety with respect to the realities of the public process, the public option was an incredibly ill-conceived campaign pushed by people who had a very high understanding of the political world. Too smart for their own good. It reminds me of all the bright political leaders who sought to save Vietnam and win the war by blowing it to pieces. What were they thinking? Were they the paid agents of the status quo (e.g., foundations financed by the drug and insurance companies?) Had they spent too many years getting cynically jaded or corrupted by lobbying elected officials?


A whole book could be written on the mistake of the public option. One does not negotiate or compromise with oneself. Support for single payer – by people who actually believed in it – would have made the public option more politically viable. How do you applaud as victories a series of Congressional bills that made the public option weaker and weaker? How do you argue that insurance companies are bad when you agree to give them a dominant market share? The public option movement also divided progressive forces; many supporters of both the public option and the groups that promoted it actually thought they were working for single payer. The public option also diverted resources and funding away from the single payer movement.


While the Tea Baggers protest during the summer Congressional recess was a complicated and multi-faced phenomenon (not the least of which was the promotion by the right-wing corporate media), they appeared stronger because of the disunity within the universal health care movement that the public option had created.


I also felt that a year ago that the prime strength of the single payer movement was their grassroots base. That didn’t turn out to be the case. And at the critical moment, that base was not able to change the public debate anywhere close to the impact that the Tea Partiers had. Putting aside questions about the integrity of the Tea Bagger’s message (dumb it down and lie, the ends justify the means) and their promotion by Fox News and the far right Republicans, some spark was missing from the single payer movement. I don’t really know what the problem or the solution was. Was it a lack of experienced organizers? Was the support for single payer too shallow, easily diverted and confused by the public option proponents and their tens of millions of dollars? Many called for a large scale mobilization in the nation’s Capitol in support for Medicare for All but others felt that we lacked the financial resources and organizational infrastructure to pull it off. Certainly the civil disobedience actions in the Senate and against insurance companies inspired many at an important moment and gave new life to the efforts.  But it wasn’t enough.


As always, the response to the recent Congressional vote is don’t mourn, organize. We need to continue to push for national action but we also need to support and build strong state level single payer campaigns. Organizers are often told to avoid preaching to the choir but much of the choir were singing the wrong song in the recent performance. We need to systematically go back to community groups and other organizations and explain why single payer is the solution. Many of course have said that we need a new phrase such as Improved, Expanded Medicare for All. I still like Health care must be a right for everyone.