You’re Either At the Table or On the Menu

Originally published in New Ground 123, March — April, 2009. In retrospect, too many of us in DSA spent time defending Obamacare, I think mainly because it had such a rogue’s gallery of enemies. In any case, I also regret my ambivalence in this article.

by Bob Roman

Having spent a week in the hospital recently, I followed the Obama Administration’s White House health care summit with some interest. That the principles Obama hopes Congress uses in drafting health care legislation emphasizes lowering the cost of health care over everything else (despite his remarks that bowed toward universality) was no surprise. Obama made it clear enough while campaigning for President that he had no interest in pushing for a universal publicly run health insurance plan (a.k.a. “single-payer”). What was a surprise was his Administration’s hostility toward advocates of such a plan. That they did not invite a single advocate for the “single-payer” option until pressured to do so is hardly likely to have been a mistake. It was instead a message.

The usual lefty narrative for why repeated attempts at a national health plan have failed is to blame the medical and insurance industries (or more generically the “capitalists”). We’re not wrong about that. But the fact is that our government is structured to discourage any legislation that is not supported by some degree of consensus among all the interested parties. The need for a super-majority in the Senate to end debate is simply the most obvious aspect. There is also the committee system within the House and the Senate, the need for the co-equal House and Senate to negotiate their differences, the possibility of a Presidential veto and the super-majorities needed to over-ride it, and ultimately review by the courts. At each step along the way, there are opportunities for a willful party to kill outright or fatally sabotage a proposal.

During the last significant attempt at systemic health care reform during the Clinton Administration, advocates of a “single-payer” approach to health care were every bit as enthusiastic in opposing Clinton’s proposal as the usual suspects from industry and finance were. With no consensus, none of the competing plans went anywhere. “But. . .,” Obama said, “this time will be different.”

So should advocates of “single-payer” get with the Obama program? Certainly Obama is correct in that the air of desperation that exudes from the less well off on this issue has not only grown but also spread to business and to health care providers. This gets politicians’ attention. The aggravated distress provides a perfect rationale for some past supporters of “single-payer” to accept whatever comes out of the process and proclaim victory.

But it also makes sense to continue demanding the whole loaf: in this session of Congress, HR 676 “Medicare for All” for example. But failing that, would we settle for legislation that allowed for and supported experiments in “single-payer” health care on a state level (HB 311, currently being considered by the Illinois General Assembly, for example)? Or would a reform that would gradually erode private insurance in favor of a public system suffice? At what point, if any, should advocacy for civilized social medicine become part of the veto process?