A while back I was having a conversation with someone here about whether it was better to advocate Medicare-for-All as opposed to just the public option. The conversation went something like this. I said, "You can't get something if you're afraid to ask for it." He replied, "I asked my mother for a pony. She didn't respond."
What is so sad about this mentality is that a majority of the population probably supports Medicare-for-All according to polls done this year. 58% supported "a national health plan in which all Americans would get their insurance through an expanded, universal form of Medicare-for all" according to the July Kaiser tracking poll, compared with 38% opposed. Earlier this year other polls put support at similar levels.
The question, then, is how can people become so depressed by the system that they think even speaking out for what a majority of the population likely favors is a waste of time? How can people become so caught up in the game of inside the beltway Washington politics that they decide that Americans' opinions are no longer relevant?
That may be the assumption of politicians in the Capitol, but we don't need to play by their rules. Just because politicians are bought off by lobbies with money, like Big Pharma, AHIP, the AMA, for-profit hospitals, and big business interests generally, doesn't mean we need to abandon fighting for what the public wants. We need to remember who our constituency is. There is no point in compromising our message just because Congress is unresponsive.
This is supposed to be a democratic country, although unfortunately democracy seems to have caught a flu in this case. We need to remember that Congress is supposed to serve the people - and that means us, partly - and not the other way around. What do we think we are going to lose by advocating Medicare-for-All? Is Congress going to vote us out or are we going to vote Congress out? I mean, really. Let's remember who needs to get elected here.
It seems to me that there has been an unwillingness to even seriously consider making Medicare-for-All the primary message, as opposed to the public option. There does not seem to be much debate about what we, meaning progressives, should be doing. Instead it is simply a kind of uniform marching to the beat of the public option drum. It seems to be a kind of unquestionable assumption that actually advocating what the public wants, as opposed to advocating what some elected officials want, is just pointless and futile.
What we really need is some optimism here. Not baseless optimism, because actually there are a lot of grounds for optimism given public attitudes right now. What we need is optimism that democracy can function. We need to understand that there is no need to play by the rules of inside of the beltway politics if we can succeed in changing those rules by bringing previously downtrodden, hopeless, and disaffected people into the political arena. And we can, by advocating a change in American health care that will not only lower costs and end predatory health insurance but reduce economic inequality to boot.
The big fights cannot be won with just the help of progressives. Big changes in America will have to be the result of popular movements created by bringing the disadvantaged and downtrodden into the fold, people who frequently don't have any political orientation at all, but precisely the people who would benefit most from change. And to bring those people into the fold, we need to outline changes that will affect those people. Not changes that will affect only a minority. Not changes that leave the system's problems mostly untouched. We need to advocate changes with benefits that are clear enough to inspire others.
For far too long I think that American progressives have lacked an independent message, and have instead concentrated on just blunting sinister and hateful attacks coming from the extreme right. And while there is no doubt that Glenn Beck and many other extremist pundits have intentionally and cynically spread fear and hysteria about health reform, and there is no doubt that Sarah Palin has no respect for the truth when she spreads rumors about death panels and other such nonsense, these lies will be impossible to refute as long as we lack a message that is bold and clear enough to build a mass movement. Glenn Beck and Sarah Palin can succeed precisely because they build their message on bedrock that already exists, like an extraordinarily concentrated corporate mass media and a misinformed teabagger movement that is acting against its own class interest. We cannot expect to counter them unless we can build a bedrock of our own, and we cannot expect others to help us build it unless we offer them hope.
The employer based health care system is a millstone around the necks of the American people. No other industrialized country has such a system, and most health care economists agree that so long as it exists our problems cannot be solved. Half measures will not treat the root cause of the problem, nor will subsidies that pump more money into an inherently broken system. If we want to help America, then our responsibility is to speak the truth. In fact that is not only our responsibility but it might also be the biggest hope for the progressive movement to expand right now. This isn't actually a sacrifice for us. It's an opportunity to be seized.
Here is what I think is a smart strategy for health reform. We should avoid joining any group, such as Organizing for America (OFA) or Health Care for America Now (HCAN), that refuses to advocate fully replacing the employer based health care system. This strategy is in no way intended to denigrate many of the brave, dedicated and well intentioned activists who currently comprise such groups, and it is also in no way suggesting that we should avoid cooperating with such groups at common rallies, speeches, and other events. But we cannot afford to spend our time advocating measures that will not help the public enough to draw them into the effort. The group that I would suggest we join instead is Healthcare-NOW! because it explicitly advocates a Medicare-for-All system. Though this seems to me the most obvious choice, others are certainly possible and I would welcome any suggestions.
I hope it's clear that this isn't a call for inaction. I am not saying that we should replace the current OFA and HCAN efforts with loafing and laziness. Instead, this is a call to change our message to one that has an immeasurably greater chance of actually building a mass movement and motivating disaffected and downtrodden people. I also hope it's clear that this isn't an endorsement of foolish all or nothing approaches, because we can be steadfast in pushing for what we want without ruling out making compromises if necessary. Instead, it's an endorsement of strengthening our bargaining position by advocating ideas that can bring incomparably greater change to the health care system while not actually losing much or maybe even any public support compared with current goals. (Nate Silver has public option support at 56 to 62 percent, which intersects the range of Medicare-for-All support.)
In the end, this is a call for having faith in the idea of democracy and that we can overcome the outrageous disparities between Congressional and public opinion that show perhaps twenty percent support in the House and three percent support in the Senate for a reform favored by a likely majority of the public. I think we can do it and I hope you will too.
Update: A request has been made to add this link the diary. It's to call in and support HR 676, the Weiner amendment and SB 703.