Health Care Reform: Fighting to Win

Zoltan Zigedy | Marxism-Leninism Today | Feb/March 2009

The dog days of August are upon us. On the surface, this is the government vacation period before the fall legislative session begins to reconsider pending bills and initiatives like health care reform. Expectations are high and Democratic Party control of the executive and legislative branches of government foster both hope and apprehension.

Talk of the First Hundred Days has evaporated with little more than a few cosmetic and rhetorical advances to show for the new administration’s posture as an agent of change. Besides Bill Clinton’s intercession on behalf of two illegal border crossers in the PDR of Korea – an act apparently resented by his wife, the Secretary of State, little progress has been mustered on the field of international affairs. The wars continue to rage in Iraq and Afghanistan with further escalation promised in the latter country. Pakistan has been destabilized with Predator drone missile attacks assassinating leaders, family, and innocent civilians at a rate that would shock Senator Frank Church’s investigative committee of the 1970’s. Relations with Central and South America remain stressed with the Cuban blockade still in place and foot-dragging on the Honduran coup. Meddling in Iranihas weakened any secular resistance, though, happily, strengthening that nation’s anti-imperialist resolve. Vice President Biden’s visit to Eastern Europe has done much to stir mistrust and hostility in that region.

Domestically, the administration and its congressional allies have done a fine job of stabilizing the capitalist economy by encouraging the jacking up of the rate of exploitation of working people and by flooding the coffers of monopoly capital with public funds. The people’s economy, however, continues to sink with rising unemployment (the media shamefully hail the exit of thousands from the official count – workers who have exhausted their benefits – as an improvement), increased foreclosures and exploding personal bankruptcies. Nothing underscores administration’s policies more than the unprecedented profits of Goldman Sachs and the continued descent of cities like Detroit and states like California into economic hell.

The structure of domestic and foreign surveillance and repression established by the Bush administration remains substantially intact even without the demagogic hysteria fostered by the post- September 11, “War on Terrorism” mantra.

Still, illusions linger, though signs of impatience and doubt abound. The internet is abuzz with tales of betrayal, compromise, and unholy alliances.

The Single-Payer Fight

No single struggle has rightly occupied public attention since the Iraqi invasion like the issue of health care reform. US citizens elevated the matter to the top of their concerns in the early nineties only to be trumped by an enormous campaign of lies and confusion sown by the health care industry and the buy-off of politicians. After the smoke cleared, the Clinton administration offered a thinly veiled, corporate-friendly program that left health care even more dysfunctional than before “reform”. The lessons were clear: no reform is possible without a determined struggle to neutralize the industry’s influence and put the people before health care profits.

With a new administration puffed up with “hope” and promising real “change,” the possibility of finally achieving a rational, people-centered health care system brightened. The logical vehicle for achieving this goal was a single-payer system, a modest system modeled after the health care approach adopted by our sober brothers and sisters in Canada, that would sweep away the waste, profit-taking, and parasitism of the insurance industry. With all its flaws, the existing hospital-doctor-patient nexus would be kept intact, but with everybody covered and the government collecting and distributing health care dollars efficiently.

Yet such a simple and obvious remedy was predictably shunned by the same forces that demonized the earlier effort. And predictably, most elected officials hesitated before the huge pool of campaign financing and the incessant lobbying efforts of the industry. From the beginning of the health care debates initiated by the Obama administration, the single-payer option was shunted aside as unrealistic and unattainable. Many influential politicians recite a bizarre excuse: Single-Payer is the best solution to the crisis of health care (Obama’s stated position!), but neither realistic nor politically viable. This conclusion – drawn before the effort is made or the votes are counted – dampens the will to carry the fight to its conclusion.

Nonetheless, single-payer advocates have carried forward a determined and effective campaign to popularize and press the single-payer option. Led by Healthcare Now!, Physicians for National Health Care, and Unions for Single Payer HR676, as well as other organizations, activists have, through patient, persistent lobbying, dogged organizing, and militant, direct action forced single-payer into the national consciousness. Unlike the stagnant anti-war movement, much encumbered by political dependence on the Democratic Party and its agenda, the single-payer movement has demonstrably shaped the mass sentiment as reflected in opinion polls. Dramatic actions have broken the media black-out of single-payer, pressuring national media and pundits to take notice. This historic movement forced the House leadership, at the last moment prior to the legislative recess, to grant a debate and vote in the fall session, a bitter setback for those determined to keep profit-driven insurance companies in the health care game.

Yet as this movement grows in stature and influence, other forces are vacillating and compromising the goal of authentic health care reform, a result that would likely lead to a fiasco that would rival the Clinton-era disaster. History shows that as every progressive movement grows in strength, treachery, compromise and retreat accompany the advances. The lure of complacency, expediency, corruption, and self-interest threaten to choke the movement.

Such a moment has emerged. BusinessWeek crows that “The Health Insurers Have Already Won” in its cover story headline of August 6, 2009. In a carefully documented article, authors Chad Terhune and Keith Epstein expose health-care industry chicanery: influence-peddling, intense lobbying, and cozy industry-generated proposals. These readily embraced efforts have led the authors to conclude that “[t]he industry has already accomplished its main goal of at least curbing, and maybe blocking altogether, any new publicly administered insurance program that could grab market share from the corporations that dominate the business.” Ironically, Capitol Hill policy-makers show a decided preference for the data and studies offered by the industry over the more unbiased data of the Congressional Budget Office, their own research branch.

The BusinessWeek article describes in detail the machinations of the largest health care insurer in the US – UnitedHealth. With $3.4 million already spent on lobbying in 2009, the insurance giant enjoys a special relationship to most of the key players in the Congressional health care debate, despite the fact that UnitedHealth has been accused of “the overcharging of consumers by billions of dollars nationwide” by the New York State Attorney General. Apparently that practice does not disqualify the company as a major source of advice on health care reform to our legislative leaders.

Of course the health insurers do no oppose reform, provided that “reform” produces a significant number of additional people buying private insurance. Any changes beyond that are unacceptable.

Big Pharma – the major pharmaceutical companies – is also luxuriously enjoying the warmth of the August sun during the Congressional recess. The New York Times reported on August 5, 2009 (“White House Affirms Deal on Drug Costs”) that Billy Tauzin, the world’s sleaziest lobbyist, has secured a deal that with the White House that will guarantee little pain on the industry from health care reform. The deal, affirmed by key White House personnel, extracts a pledge of $8 billion a year in savings over 10 years from an industry that regularly chalks up sales of $300 billion per annum before the reform adds new bodies to the number of insured. No further action – like negotiating lower prices or buying from Canada – would be permitted. One can only recoil in shock from such an unholy deal – an enormous concession – that trumps any serious answer to the health care crisis to be crafted in the fall legislative session.

Rumor has it that another unholy alliance was assembled at a meeting of top labor officials in mid-July at the White House. Media accounts refer only to a discussion of health care and the Employee Free Choice Act (EFCA). But insiders have suggested that the labor leaders pledged their support to whatever health care bill emerges from the fall session and lands on President Obama’s desk, a premature and ill-advised opting-out of the health care debate. If the rumors prove true, the top AFL-CIO and Change to Win leadership have effectively surrendered the leverage of millions of organized US workers in shaping the direction of reform. If they believe that this fawning act of blind loyalty will help them in the fight for union electoral reform, they are in for a rude awakening. Years of class-collaboration have led too many down this road, a road that leaves them with no imaginative, militant or effective measures to affect change except the same kind of back-room deals that mirror actions of corporate lobbyists and corrupted politicians. By contrast, class-struggle unionism demands identifying the program that best serves the interests of working people followed by a broad, united, and full-scale mobilization of the members and friends of labor to achieve that goal. That labor is capable of such a mobilization is crystal clear from its electoral efforts on behalf of Democratic candidates. To move towards class-struggle unionism, the same effort must be placed behind issues vital to the working class such as single-payer health care reform.

Servile support of the administration’s Byzantine health care plan – a matter of the greatest concern to workers – will not be repaid with administration support for EFCA. Rather, it invites the same kind of horse-trading with corporate interests that the health care debate has generated. It demonstrates a weakness, a reluctance to fight, complacency in the face of a brutal class adversary, a posture that invites shunting labor’s cause aside. The essential lesson of the health-care debate is that labor cannot simply rely upon trusting its “friends” in the administration, but must apply every pressure to secure an outcome favoring working people.

Struggle: Ours and Theirs…

Progressives and many liberals are fond of quoting Frederick Douglass: “Power concedes nothing without a demand. It never did and it never will.” Yet in these critical days, we find too many of our allies willing to soften demands for the sake of compromise and bi-partisanship. Far too many are willing to trade-off the rational, sane, and humane positions for the sake of “winnable” or “realistic” or “expedient” compromises. In truth, winnable positions are determined when the battle is over, not when the battle field is in sight. The battle for health care reform is reaching a critical juncture that requires an all-out effort behind the best option and that option is a single-payer solution. Even the President concedes this, though he has shown no stomach for the fight (“If we were starting from scratch…”).

For some time, much of the labor movement and peoples’ movement have foolishly accepted the strategy of horse trading and back-scratching along with the consulting nonsense of “win-win” negotiation in lieu of fighting for the just outcome. The poverty of this approach is easily demonstrated by the persistent and deep decline in the living standards of working people over the last forty years.

Oddly, this is not the approach of the peoples’ adversaries: the Republican Party unrelentingly presses its agenda without a hint of compromise; the corporate world plays to win as witnessed by UnitedHealth and Billy Tauzin’s Big Pharma. As seductive as is the notion of bringing everyone together, as soothing as is the idea of bringing everyone to the table, they do not match the moment when the adversaries fight ruthlessly and own the table.

And ironically, it has never been the source of the great peoples’ victories from the War of Independence to the Civil Rights Movement.

Yes, compromise may be necessary, but not until the struggle has been exhausted and the outcome determined. Much remains to be done before we reach that point.

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About rico49

Writer, progresive activist, open source software developer. Working to meet the needs of under- and un-employed people globally and in the United States.
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