Top 10 Lessons from the Healthcare Reform War
Randall Terry (R), founder of the anti-abortion organization Operation Rescue, shouts as he is confronted by a supporter of healthcare reform during a town hall meeting in Reston, Virginia in August. (Photo by Alex Wong/Getty Images)
Labor Day will kick off the final and probably decisive stage of the fight for healthcare reform in 2009.
Hundreds of thousands of labor folks have gathered at Labor Day marches and rallies across the nation to scream their demand for fundamental healthcare reform. Meanwhile, the Democratic Party has another 500 pro-reform events planned.
It’s great to see all this action now, but it may be too little too late. The Right and Republicans successfully used the August town hall meetings to distort the debate. They shamelessly disseminated absurd yet memorably vivid lies (e.g. "death panels," socialized healthcare, etc.) to scare senior citizens and to manipulate mainstream media.
With labor and progressives’ capacity to turn out millions, the Right should have never been able to seize the initiative.
As we draw closer to the critical stage of the healthcare, allow me to offer my Top 10 lessons we have learned thus far, and need to act on in the coming weeks.
10. The gutting or defeat of healthcare reform will prove fatal to Democrats in 2010. After the Clinton administration rammed through job-exporting NAFTA and then failed to win passage of healthcare reform, demoralized and disoriented Democratic-leaning voters stayed home. The drop in turnout among these voters allowed the Gingrich-led takeover of Congress in 1994. This time around, with the health crisis growing more desperate, people are counting on the Democrats to deliver on their promise. And if the Dems don’t deliver, they will pay.
One danger is producing a plan that reinforces the evils of the current system. Comparing the failing Massachusetts "reform" plan and current Democratic proposals, Dr. Steffie Woolhandler of Harvard Medical School sees the same mandates to buy private insurance, unaffordable premiums, high deductibles, and large numbers of uninsured. "It’s Massachusetts writ large," she told me for a forthcoming Z magazine article.
9. Don’t replace one top-down plan with another: Conventional Wisdom preached by elite pundits attributed the 1993-94 defeat of the Clinton plan to a "top-down" White House proposal pushed on Congress. So Obama backed off, and allowed Congress to come up with its own plans–also "top-down" in ignoring the sentiment of ordinary Americans.
8. Don’t delay the onset of reform. The present Democratic proposals call for reform to begin in 2013, which would be after Obama served out his second term, should he be so fortunate.
With 14,000 Americans losing insurance daily and incalculable numbers being denied care by profit-driven insurers, reform must be delivered now. If Lyndon Baines Johnson could get Medicare up and running 11 months after he signed the bill in 1965–before computers were in wide usage– exactly what reason is there for any delay?
7. Learn a new language: As Dr. George Lakoff told me in a recent interview, both the Obama team and many reformers are speaking the language of policy specialists, not the values-based language that appeals to ordinary Americans. "They have a false view of how people think," says Lakoff. "They’re not drawing on values that people hold dear, and they’re not pointing out the villains."
For example, the term "public option" would have been much harder to fight, if as Lakoff suggested, the Obama team had called it "the American plan." Moreover, the early discarding of the single-payer plan by many reformers was based on the assumption that it would provoke charges of "socialism." "Well, that happened anyway, and now Obama has nothing on the Left [to use as leverage in negotiations].
6. Pull the plug on the bi-partisanship scam: Why have the Democrats dithered and delayed reform while trying to win over the likes of Sen. Charles Grassley, busy spreading the infamous "pull the plug on Grandma" lie? After all, if healthcare reform brings about substantial improvements in people’s lives as Medicare did, no one will punish the Democrats for overcoming Republican resistance.
So why are the Dems bothering at all? Any attempt to gain more than one or two Republicans’ support has obviously been destined for failure, yet it’s provided a convenient rationale for concessions to the insurers and drug companies., As Glenn Greenwald persuasively argues. "The attempt to attract GOP support was the pretext which Democrats used to compromise continuously and water down the bill."
5. Aggressively hold up Medicare as a successful example of public healthcare, and point out the Right’s constant efforts to weaken Medicare benefits.
By forfeiting the cost savings that would have been created by pushing a single-payer plan, Obama was forced to rely upon cuts in Medicare. This created a predictable opportunity for the Republicans to falsely and hypocritically claim that the uninsured would be covered by cutting the benefits of senior citizens, another of their ploys to frighten the elderly.
In fact, cuts in Medicare would be directed squarely at payments to providers and hospitals, (along with eliminating a 14% premium enjoyed by private insurers on the Medicare Advantage plan), Still, polling indicates that this has been an effective means of raising doubts about health reform among senior citizens. Reform advocates must target senior citizens with a truth campaign using credible spokespeople.
4. Yank the leash on the insurers’ Pet Poodle Democrats: With the Blue Dogs, we face much same problem that FDR did during the Depression with racist Southern Democrats who opposed programs that undermined the power of the South’s ruling class and created rights for workers and African-Americans. In 1938, FDR tried to run New Deal supporters in Democratic primaries against Dixiecrats, but the Dixiecrats unabashed appeals to racism was too strong to touch the class interests of Southern voters.
But things are different in 2009. AS David Sirota reports, even the potential of a primary opponent moved one opponent of the public option, Sen. Michael Bennet of Colorado to suddenly and ardently embrace the public option. Moveon.com has been running ads against the Blue Dogs’ fight against the public option.
Meanwhile, Rahm Emmanuel has been reportedly acting as the bodyguard for the Blue Dogs, ordering progressives to cease their attacks on the insurers’ Pet Poodles (a.k.a. Blue Dogs.) The Progressive Caucus and its allies in labor and Moveon.org should emphatically tell Emmanuel to get out of their way.
3. Insist on a strong public option" as a line in the sand for supporting any healthcare reform plan. Many committed progressives, like Sen. Bernie Sanders, have reluctantly concluded that with single-payer having been excluded from public debate (thanks in no small part to DC-based lobbying groups, not just Max Baucus) that the second-best alternative is a "strong public option." By that, progressives mean a Medicare-based plan that is open to all who seek to rely on it instead of private insurance, using Medicare’s ability to negotiate reasonable prices with providers. The aim: an alternative system that could be used to measure and discipline private for-profit insurers.
(Meanwhile, a number of thoughtful experts, like Dr. Marcia Angell, economist Robert Kuttner, and Dr. Steffie Woolhandler have raised credible concerns about the public option’s effectiveness in a system still dominated by private insurers).
But thus far, no Medicare-based "public option" provision has been actually introduced in any of the Democratic bills being considered, Dr. Woolhandler of Physicians for a National Health Plan told me a couple days back:
As you know, I don’t think any of the public options we’ve seen would be effective," she states. "However, I’m not sure how important the specific language of various bills is. What matters is what gets out of committee, and nothing with a ‘strong’ public option got out of committee in the House, nor seems likely to get out of committee in the Senate.
An Aug. 28 e-mail by Dr. Gordon Schiff, a Boston reform advocate, indicated that even the Kennedy-Dodd bill has a public option based on Medicaid, not Medicare, making it infinitely weaker.
2. Beware a bait and switch on the public option. One immediate danger is President Obama and Max Baucus trading off any public option, as Obama has downgraded the public option to a "small sliver" of healthcare reform.
But there are other dangers as well: ineffective versions of the public option–like the laughable co-op idea advanced by Sen. Kent Conrad–may get labeled as a genuine public option. Sen. Olympia Snowe is talking about allowing no public option until unsatisfactory performance by the private insurers "triggers" a public option. More proof is needed?
1. The insurers are pure poison, not partners for reform. No industry is more justly despised than for-profit health insurers. They impose a $400 billion bureaucratic cost annually to screen out those who need care and thereby helped to rack up a 428% increase in profit for the top 10 insurers between 2000 and 2007, with these fortunate few insurance CEOs averaging $11.9 million in compensation.
As Dr. Marcia Angell of of Harvard Medical School states, "Private insurers maximize profits mainly by limiting benefits or by not covering people with health problems. The United States is the only advanced country in the world with a health care system based on avoiding sick people."
Insurers are regarded as "honest and trustworthy" by 7% of Americans; only 4% believe that insurers want healthcare reform; and Gallup polls have found them less popular than the tobacco industry. In light of public opinion, it appears counterproductive to declare the for-profit insurers, as Obama has done, partners in reform who deserve a "seat at the table."
In fact, for-profit entities like the insurers should be expelled from the table, and eliminated from any health system that hopes to be humane.