Single payer isn’t just good, rational public policy, it is, or at least it should have been, the essential political lever to enact the “public option”, or dare I say …… single payer. By shelving single payer from the git go, Obama, the Democratic Party Establishment (here in Florida, the complacent state party, Nelson, Boyd, Castor, Kosmas, Grayson, Debbie and Klein, with the honorable exceptions of Meek, Brown, Hastings and Wexler), and allied interest groups like the Florida Consumer Action Network, slammed the window shut on this historic window of opportunity and broke the glass perhaps for another twenty years. As I write, Obama and the Democrats are on the verge of abandoning the linchpin of health reform — the public option — and it didn’t have to be this way. This is not just a problem with the Democratic Party, it extends to the wide swaths of the progressive movement in this country that won’t fight hard from the git go for genuine progressive principles but instead end up negotiating with themselves over mistaken beliefs of what is politically possible that create their own prophecy.
Maybe socialized health insurance, let’s call it that, socialized, just like our police and fire departments, streets and highways, schools and universities, the armed forces and Citizens was impossible this year, but no one thought the Berlin Wall would be dismantled block by block either by the communists themselves. And it doesn’t mean we shouldn’t have (and still should) tried. In January, in his inaugural address, Obama and the Democrats should have unveiled a single payer system and pushed very hard for it relentlessly. Even if it had eventually failed, it could have accomplished three critically important objectives.
First, executed smartly and relentlessly, it would have educated the American public on all of the many advantages of the system with endless stories of how well it works for everyday people in other countries. Obama created a great grassroots organization during his campaign, much of which remains in tact, and they would have been canvassing all the key congressional districts and Senate states for the inspiring vision of single payer: you don’t have to worry about getting fired or laid off or declining a great job because the company doesn’t offer insurance or just quitting a shitty job any more, you’ll be covered; you don’t have to worry about enormous deductibles and copays and coverage limits; you don’t have to worry about in-network, and out-of-network tricks to get your money; you don’t have to worry about convoluted paperwork and hours on the phone dickering with the insurance company. It would have moved public opinion forward dramatically, perhaps enough to intimidate the Blue Dogs and even a couple of Republicans into supporting it. If not, it would certainly have made the issue a major discussion in American society and planted the seed in people’s minds of a vision of the near future with which they would compare their personal experiences under the watered down health reform they would get instead.
Second, it would have pushed the national debate far enough to the left to probably win a strong public option as the fallback. Can you imagine how cowed the health insurance industry and other status quo interests and the Republican Party and the Blue Dogs would have been in the face of such an onslaught? Why they would have jumped on a strong public option just to save themselves from the fate of socialism! Instead, we watch, livid, as the Democratic Party trades the cop and the soul of their reforms away.
And finally, single payer could have defined the Democratic Party as the middle class and labor protector party, rather than the complicit party of Wall Street bailouts, multi million dollar bonuses and protection mafia for the superfluous health insurance middle man profiteers. It could have consolidated the party in the coming elections while weakening the Blue Dogs. It could have led to a more progressive Democratic congressional party two years from now. Instead, Obama in particular, extols compromising bipartisanship rather than portray the Republican and Blue Dog opposition for what they are: politicians representing the wealthy 5% elite of this country and the predatory insurance industry in particular who use diversions and even lies about socialism and hurting small business and all the other canards. Why isn’t there a unified chorus of the Democratic leadership painting the Republican attacks on health reform for what they are?
Oh and don’t forget the 100% public funding of campaigns, Dems. That maybe should have come first. How come it’s nowhere on the agenda?
Thank you for including FCAN with Obama, Castor, Klein, Wasserman Schultz, and Nelson. That is good company to be in. Unfortunately, the analysis of single payer depends on events that didn’t happen. Perhaps it should have been, but it wasn’t.
Many progressive activists have worked for decades to win health care reform. When the opportunity presented itself this year, a calculation had to be made. Many of us were part of the 1994 battle, and we didn’t want to lose again. Polling and focus groups were done, and strategy meetings were held. The decision was made to support the public option. Obama decided to go with the public option. Essentially, there is a fair amount of unity among unions, progressives, and others on this side, but not everyone.
I believe the decision was made based on the fact that “single payer” polled very badly, due to years of slander by the right, and a calculation that while “single payer” would wipe out the health insurance companies and hence, cause them to fight literally “to the death,” the public option would take away possibly 20% of their business, and they would not fight as hard. The perception is that with public opinion running strongly in favor of some kind of reform, they knew they would have to give up something. We determined to take as much as possible.
We also feel that a victory for a young, charismatic, progressive President will give momentum and credibility to our side and demonstrate that our assertion that government could serve people well (as in Medicare) was real and workable. This would be a bitter blow to the right wingers railing against everything the government does except for war. If the plan succeeds, it will empower the coalition and consolidate power in a way unseen in years. Clearly the Republicans are going all out to defeat the plan because they understand the stakes.
Finally, while it is tempting to lump the Democrats together, this issue has separated the Blue Dogs from the pack, and made them targets. Blue Dogs Boyd and Kosmas must take positions and answer for their campaign contributions from the health insurance industry. The industry and the Republicans must be listening to Glenn Beck calling on his followers to read Sun Tsu’s “The Art of War” because dividing one’s enemy is a solid tactic. It could very well work. If it does, our President and our movement will be badly damaged. As you say, it will be another decade or two before we can try for health care reform again.
The progressive wing of the Democratic party is only as strong as we make it. I don’t think anyone really believes that the Democrats accept our liberal ideology and are willing to go against their donors. But the stars have momentarily aligned and we have our chance. If we win, they will be more progressive and we will be stronger. We can move on to reducing the military budget and passing the Employee Free Choice Act.
We believe that the public option lays the groundwork for single payer. It is a kind of hybrid that just might be doable if we fight hard. I urge everyone that really cares about health care reform to help win what is winnable right now. We have to prove our strength and that our ideas about government will work. That will open many doors. Do not allow the enemy to divide us. Together we can make a difference and we can win.
Here’s my problem.
The “public option”… as I understand it to be defined by current versions of legislation being considered by congress, will be largely ineffectual in achieving any kind of cost savings or increased coverage because it being absolutely hamstrung by “compromises” with moderates in order to get it passed without the support of the Republicans, who will refuse to support anything that isn’t simply handing the insurance companies ever increasing freedom to do and charge anything they want . The savings that can be realized by a large public insurance entity, which are massive and undeniable, will be mostly unachievable by what is being proposed.
It appears the public option will not initially enroll a sufficient population to give the program the necessary leverage to negotiate reasonable prices for services with medical providers. Any attempt to do so by a program enrolling a relatively small number of patients will be met by doctors just telling them to take a hike and electing to only see the patients of private insurers who will pay more and pass that cost along contentedly to their customers in the form of ever increasing premiums. That’s problem 1.
The private insurers are still going to be infesting the insurance marketplace, and every single care provider is still going to need to deal with the administrative bureaucracy created by treating a patient population covered by 1500 different entities with their own paperwork and claims departments and billing staffs… so just adding the additional public provider to that giant mess accomplishes exactly nothing in helping them lower administrative overhead. That’s problem 2.
Due to problem 1 and 2, the ability of the system to appeal to new enrollees by offering them affordable pricing for decent care will be completely compromised. The only way to do it would seem to be for the program to pay the ridiculous prices doctors and hospitals are currently demanding, then take a huge loss and eat all that extra cost when they charge low premiums to the people in the program that simply won’t cover those prices for care. Which will then be pointed at by hysterical conservatives as evidence that any public 0plan will bankrupt the nation while pointing to the profit the insurance companies are making off well off healthy people who are easy to cover (and are the only people they have any interest in providing coverage *to*) as evidence the private sector does things better. Arrrgh! We must re- privatize!
What I want to know is why haven’t I ever seen a CBO scoring of HR676? Why aren’t people being told what happens to the operating budget when we do REAL public insurance instead of this hobbled, hamstringed mess that is being foisted on us?