At first glance, the two items--our current shutdown/debt ceiling fight with Republicans in general and the Tea Party/conservative movement in particular--has almost no resemblance to a doctors' strike. Indeed, the only doctors seen during the current congressional fight have been a few Republicans dressed in lab coats trying to look like they were the ones not at fault for the shutdown. (In reality, they kind of looked like rejects from L.O.V.E.M.U.F.F.I.N.)
As we all know, though, the shutdown/debt ceiling fight isn't about the budget, or deficits, or compromise. It's about the desire of conservatives to stop, delay, or squash like a bug the Affordable Care Act, no matter the method or the cost. It's an attempt to overturn law via nondemocratic methods, threats, and blackmail, and it was unprecedented in this country until the debt ceiling fight two years ago.
But it's not exactly unprecedented in the history of health care politics, which is what made me think of Woodrow Lloyd recently.
If you follow health care and health insurance discussions, you almost certainly know who Tommy Douglas is--the Premier of Saskatchewan who led the way in passage of the first single-payer plan in North America, leading first to hospital insurance and later medical insurance nationwide in Canada; the first leader of Canada's New Democratic Party; even the grandfather of Kiefer Sutherland, and declared the Greatest Canadian in a televised series in Canada a few years back.
What you probably don't know is that he left the premiership for the NDP leader position in 1961, and Saskatchewan's new medical plan didn't take effect until July 1, 1962--leaving his successor to implement it.
That was Woodrow Lloyd. And just before July 1, doctors' in the province forced a strike, a last-ditch attempt to end the plan once and for all. (This diary from four years ago, the only one with a Woodrow Lloyd tag, describes the situation of July 1962 well and served as a reference.)
Lloyd didn't succumb to their blackmail. He brought in doctors--from the UK, the US, other parts of Canada--to serve residents. And, as it turned out, the opposition didn't have as much support as people had thought; despite available buses from all parts of the province funded by the opposition, a rally against the new insurance plan expected to draw 40,000--a huge number in a province of less than a million--drew a tenth of that. The opposition also made wild claims that could not be believed (menopausal women could be confined to insane asylums? Really?), and gradually lost sympathy as the plan slowly began to take effect.
In the end, an agreement was reached on the 23rd, and the strike ended. But the key point was that the insurance plan stayed in effect, and would become the basis of national Medicare in Canada in 1971.
I've thought for years that whatever state passed single-payer first would have to face down a doctors' strike--that there would be a last-ditch effort to make sure the plan didn't take effect. As it turned out, the fight has come early, it's come at the national level, and it's here now. (And it's about a plan that came from the Heritage Foundation two decades ago. Strange politics these days on the right.)
But look at how the opponents--lobbyists, members of Congress, Fox news employees--sell that fear of the Affordable Care Act. It's a fear based on lies, wild claims, and the like. And in the end, they've resorted to blackmail and threatening to crash the economy.
It's a desperate fear on their part. Bill Kristol knew two decades ago that a good health insurance plan would be popular and help Democrats, and for all their talk about how badly the federal website is doing, the demand numbers tell the story. Even in places where advertising has been minimal, people are slowly finding out. Arkansas' expanded (and privatized) Medicaid plan had to send letters out to let potential recipients know, because their Republican legislature wouldn't fund anything else. Direct mail is a lousy way of letting people know about offers; returns of 5 percent or less are common. The response in Arkansas? Over 40 percent.
So why weren't doctors the linchpin of this fight, like I thought they would be?
Two reasons come to mind. First, the medical profession is very different from 1962. Single-person practices have become less common, and links to larger groups and organizations more so. Plus, Saskatchewan was the first to try it, and few people knew about government-funded health care here (remember, our Medicare didn't start until 1966 either). The result is that, while the AMA is still a really important medical organization, doctors are more splintered than they used to be. Even if the AMA opposed the ACA (or a future single-payer plan), groups like Physicians for a National Health Program would back it. And individual doctors would have their own opinions; it wouldn't be a single block of doctors opposing the plan.
Secondly, with the changes for doctors have come changes for medical organizations as well. They already know about single-payer options via Medicare and other government insurance. Some have combined the aspects of insurance and medical care together by employing doctors and owning hospitals (my medical provider, Kaiser Permanente, does this) and using that linkage to reduce costs. (The UK provides the insurance and employs the doctors as well, albeit on a much larger scale.) They've already adapted to government-funded insurance.
Some medical providers--for-profit clinics and hospitals, specialists--would probably oppose any move to single-payer. But would the already not-for-profit Kaiser, for example?
I thought about it and I truly don't know. And I don't think conservatives know either, and that has to worry them. If they don't have doctors and medical organizations, what do they have left?
The nutty right-wingers who believe in death panels, but who have enough money to scare Republicans in Congress and beat them (in theory) in primaries. Which is who are blocking funding for government. (But not funding for the ACA, since the exchanges are starting up. That's what the House gets for going on Cruz control.)
If they lose here, single-payer becomes closer. People see health insurance as a right. More people vote Democratic. And they become more marginalized.
That's why the right wingers started this fight. And deep down, they know that unless Democrats surrender, they will end up losing it.