Why the Left Lost Single-Payer Health Care Reform

EDITORIALS BY RABBI MICHAEL LERNER T he substance of the “single-payer” proposal is incontrovertibly the very best plan. Aaron Roland convincingly makes this argument in his op-ed on page15ofthisissueofTikkun.Hisarticlealsogivesus agoodideaofwhatweshouldfightforwithinthecontextoftheactualhealthcarebattlesthatwillbefought 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 singlepayersystemhaseffectivelybeenruledoutbythemajorplayersin Washington. Herearesomeofthereasonsthathappened: 1.PresidentObamaNeverSupportedaSingle-PayerSystem Obamasaidonvariousoccasionsthatifheweredesigning ahealthcaresystemfromthestarthewouldchooseasingle-payer model,buthesaidthatsincewealreadyhaveaprivate-insurancebasedsystemhehasdecidedtoreformthatonebyaddingapublic component.Thelogicofhispositionwasalwaysthis:let’sdowhat seems“realistic”giventhecurrentalignmentofforces.Hegaveno indicationofbeingopentothenotionthatanewpresidenthasthe right to fight for a vision that makes sense and should attempt to usehisimmensepopularityforthatpurpose. Contrast that with right-wing presidents such as Ronald ReaganandthetwoBushpresidents .Itwillcomeasnosurprisetoyou that we spiritual progressives did not support the dramatic changestheyproposed.Butwehavealotofrespectforthefactthat they were willing to fight for changes that went against popular sentiment, and in the process they managed to move the national dialoguealongwaytowardtheirownsetofassumptions. 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 publicprograms.HewassosuccessfulthatBillClinton,representingthecentristsorganizedintheDemocraticLeadershipCouncil , pushed through an “end to welfare as we have known it,” provokingmajorliberalfiguresinhisadministrationtoresignindisgust . George H. W. Bush stood up to AIPAC and threatened Israel with an end to loan guarantees for new housing units unless it stoppedusingthatmoneytosupportexpandedsettlementsonthe WestBank,amovethatcontributedtothedefeatoftheLikudand the electoral victory of Yitzhak Rabin, who went on to sign the OsloAccords. George W. Bush pursued an unpopular war in Iraq and managed to hold on to his disgusting, immoral, and destructive-toAmerica direction, despite immense popular pressure for an end to the war, and managed to create conditions that have led the Obamapresidencytocontinuethatwar,embraceBush’sSecretary ofDefenseasitsown,andextendthewartoAfghanistanandPakistan . Bush even fought for privatizing Social Security, a plan that neverstoodachanceofpassage. Thesepeoplestoodbytheirconvictions,howeverreprehensible thoseconvictionswere.PresidentObamagivesgreatspeechesbut isunwillingtochallengeprevailingideasinasustainedfightforhis own principles. He is temperamentally opposed to ideological struggle: just look at how dramatically he compromised on his economicbailoutbeforethestrugglebegan,imaginingthatsucha compromise would gain him points with Republicans in Congress .Butwhentheyunanimouslyopposedhisproposalsanyway, 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 protectingthemfrommalpractice 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 defeatit. Obama promised when running to consult his supporters once he was in office about what they really wanted. He promised to change the Why the Left Lost Single-Payer Health Care Reform J U LY / A U G U S T 2 0 0 9 W W W. T I K K U N . O R G T I K K U N 9 editorial_1:Editorials+Columns 6/16/09 2:59 PM Page 9 EDITORIAL 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 Clintonsattemptedtodofortheirplan.Yethiselectoralorganization ,nowsetupintheDemocraticNationalCommittee,hasnever givenhissupportersanopportunitytohelpchooseamongthevarioushealthcareplans ,despite(orperhapsbecauseof)thefactthat mostofthemwouldlikelyrallyaroundRep.JohnConyers’ssinglepayerplan .TheWhiteHouseshouldhaveheldapublicdebateon 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,Obamawillnowhavetofightthesameideologicalfight 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 planwillstillbecalled“socializedmedicine.” 2.DemocratsinCongress 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 unwillingtogivethesingle –payerproposalaserioushearing. Again, it is the failure of...