Undernews is the online report of the Progressive Review, edited by Sam Smith, who covered Washington during all or part of one quarter of America's presidencies and edited alternative journals since 1964. The Review has been on the web since 1995. See main page for full contents

July 7, 2009


Michael Lerner, Tikkun - The substance of the "single-payer" proposal is incontrovertibly the very best plan. . . 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. . . 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. . .

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. . .

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. . .

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. . .

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. . .

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. . .


Anonymous Anonymous said...

How did the health care develop in the rest of the world? Why did everyone catch on forever ago? Did they have to go against this kind of resistance?

July 8, 2009 2:17 AM  
Anonymous robbie said...

"the Left" who? Does anyone think that the Democratic party can be considered "Left" anymore?

July 8, 2009 7:26 AM  
Anonymous Obvious Man said...

The rightwingers' simple-minded reactionary fear of big government is mis-placed fear.

It is - as we have today - big government that has been devoured by superwealth that'll kill this planet and every species. Until a majority of people develop the elemental good sense to stop funnelling 99% of their wealth and power and freedoms to a few and outlaw unlimited personal fortunes, you cannot have good government.

July 8, 2009 10:10 AM  
Blogger Hamster said...

Here's my health care story

For the past 4 years my wife and I been saving up all our medical and dental problems and making the 18 hour journey Thailand where the medical care is excellent and the cost…just a fraction of what it costs the US. For example, last November I had an Endoscopic balloon dilation for a condition known as dysphagia performed in Bangkok. The specialist in the US said the operation would cost me $2500. (His bill for the 15 minute consultation was $250.) I decided to wait until I got to Thailand and had it done in at Chulalongkorn public hospital…cost $100 including biopsy. (all I needed for ID was my US passport. No questions asked!!)
7 months later I am happy to report that I am doing fine.

Why do we have to travel half way around the world for a procedure that we could have done here in America?
My wife and I are in our 60’s and self employed. Unlike the lucky Americans who work for an employer who foots a large portion of their medical premiums, we pay 100% of everything. And at our age, the best policy we’ve been able to find so far is a Blue shield plan that costs $900 a month and has a $8000 deductible.

So we are basically “self insured”..that limbo state where we are too rich to get subsidized medical care but too poor to be able to afford the typical $50,000 bill for a couple of nights stay in a US hospital

America is divided into two groups. Those who have adequate health insurance and those who don't. So in essence, the US has a rationed health care system where those who can afford insurance get good medical treatment..and those who cannot afford insurance go without.

I highly recommend any American who can’t afford US medical care to look into going overseas. Countries like Thailand, India and Singapore are gearing up to provide top notch medical care at a fraction of the cost in the US citizens like me who are either uninsured or underinsured.

July 9, 2009 10:51 AM  
Anonymous ? said...

Goddamn, talk about taking offshoring to the limit. Call it the Donald Trump plan. The reason US won't let Mexican laborers in is they can't afford the co-pay. They're threatening to deport me, but I can't afford it.

July 9, 2009 8:18 PM  

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