From Protest to Coalition Politics in the Fight for Health Reform

In 1965, civil rights leader and thinker Bayard Rustin wrote a classic essay, "From protest to politics," that described the disorienting change brought about by the movement's own classic victories. (For the youngsters, 1964-65 was the brief but glorious political season that brought us Medicare, Medicaid, the Civil Rights Act, the Voting Rights Act, and more. Things burned out quickly. Yet before it was over, Lyndon Johnson, Hubert Humphrey, Martin Luther King, Wilber Mills, and millions of nameless other people made America a better place.)

At the peak of these successes, Rustin was wise enough to see that the easy victories had already been won. He could not foresee the worst agonies to come: the Tet offensive, assassinations, Richard Nixon's election. Rustin could see far enough to know that gaining the right to vote was easier than gaining the right to a decent job, that stupid and backward legal segregation was easier to overturn than the excesses of a high-tech economy that readily mistreats low-income workers.

Rustin could see two other things: One profoundly radical, one easily misconstrued as conservative.

The radical part was to foresee -- or at least hope to see -- the transformation of the civil rights cause from a protest movement over specific Jim Crow indignities into a larger and broader social movement concerned with attacking larger obstacles that 44 years later remain deeply-rooted in American economic and social life. Rustin notes current estimates that a successful war on poverty would require the then-unimaginable sum of $100 billion. Adjusted for inflation, that's $675 billion in today's dollars, a sum ironically close to that provided in TARP funds in the financial bailout. Rustin asked: "Where... are the forces now in motion to compel such a commitment?"

He realized that mobilizing resources on this scale requires more than a vanguard of nonviolent protesters putting their bodies on the line at segregated lunch counters. It requires a truly mass movement that could mobilize millions of Americans who were not part of the civil rights movement but who had much to gain from progressive economic and social policies. Such a movement could force, or at least empower, sympathetic but cautious politicians in Congress and the White House to support concrete progressive legislation. Rustin envisioned some familiar measures: aid for urban schools, job training, fairer tax policies. Some things would be different today. The list would more for the environment and urban transport, maybe fewer WPA-style physical investments.

Back to health care
Unavoidably, serious healthcare reform would occupy a central place. If any one of the serious Democratic proposals for universal coverage were enacted into law, this would be one of the most progressive pieces of social policy legislation in generations. It would help a huge number of Americans -- some poor, but also tens of millions of others, too, who remain vulnerable due to ill-health or the vagaries of private coverage. Health reform would help many other people, too, including millions of healthcare professionals who cannot currently care for their patients the way they were trained to do.

But don't kid yourself. Health reform threatens deeply-entrenched interests who go beyond the standard-issue bad guys in this debate. Serious reforms will require heavy lifting to control escalating costs and to impose meaningful market regulations. We can accomplish some of that through innovations such as pay-for-performance, improved electronic medical records, and comparative effectiveness research. Serious cost-containment will require hard bargaining with insurers, medical providers, pharmaceutical companies, and others who don't want this to happen.

A strong public plan -- such as the ones proposed by Jacob Hacker and by Helen Halpin -- puts us in position to accomplish this goal. Weaker versions, such as the one proposed by Len Nichols and John Bertko are less satisfying, but create valuable infrastructure that can be improved and strengthened. (We've had a lively discussion of this over at the New Republic's Treatment section.)

The public plan is one of two key proposals -- the other being the establishment of a strong National Insurance Exchange -- that will determine whether the 2009 health reform is a true milestone or another useful but ultimately modest incremental reform. The public plan is also a key dividing line between progressives and moderates within the broad coalition that favors reform. I don't know whether the public plan will survive. Its supporters are locked in a Senate knife fight.

We need help
This brings me to Rustin's second insight. Reformers need allies, and reformers must be committed and smart practitioners of coalition politics. Rustin excoriated moderates who refused to support genuine reforms. He also chastised reformers who adopt a militant posture, yet who fail to be effective allies or who fail to step up for allies when they are most needed.

I won't be subtle here. I count myself among those who aspire to some version of a single-payer (or near-single-payer) health system. From many perspectives, including my own discipline of public health, Medicare for all would be vastly better than our current financing system. Some single-payer supporters are sitting on their hands, because they believe President Obama's proposed reforms are too limited.

I share the fear that this year's bill will have gaps and shortcomings that will need expansion and repair. Reforming and improving one-sixth of the U.S. economy is a process, not something that will happen in a single bill. Once this bill is passed, many of us will become sympathetic critics, pushing the administration to move harder and faster to build on these reforms.

That's for next year. Right now is the time for practical politics. President Obama is pursuing the right overall strategy to ensure that we achieve an ambitious, if imperfect health reform. He needs help. The more allies he has, the more people stand up to be counted, the stronger this bill will be. By any conceivable measure, including the ultimate prospect of achieving the goals exemplified by a single-payer plan, passing health reform in 2009 would be a huge victory for progressive values. A loss would be a correspondingly stinging defeat.

This is the moment when politicians on Capitol Hill, and in the White House, too, are assessing the costs and benefits of fighting for particular pieces of contested legislation. They know that conservatives, insurers, and other interest groups hate the public plan. They are less certain about the political gains of really fighting for this component of candidate Obama's health plan. If a large group of progressives don't visibly and strongly value the public plan, you can guess how this thing will go.

This is also the moment when elected politicians are looking around to see who they can really count on to help get the best deal done. These are the moments in which people will earn or will lose a seat at the table moving forward.

As David Cutler recently noted, many stakeholders in 1993-94 really wanted reform, but preferred to see nothing happen if they could not get their preferred vision of reform. That was one reason we lost. We're in a different place now. We have a progressive President, a strong House majority, and a shaky but real Senate majority poised to do business.

If you care about health reform, if you aspire to a single-payer plan, don't sit on your hands. Now is the time to do everything you can to help.

Note to readers: I am cross-posting this (with permission and mild edits) from democracyforamerica.com. If you haven't checked out this website, you should. Founded by Howard Dean, DFA is a grassroots organization with more than 700,000 members nationwide. DFA has taken an active role in advocating for progressive health reform.

Comments

[MagnusAvarus]

Previous comments have pointed out that the majority of US citizens, Doctors and Nurses favor single payer. In this case the most involved are clearly the most knowledgeable. Check out: www.pnhp.org
www.ourailinghealthcare.com
Zeno's paradox also mentioned is, in this case, most appropriate. The authors of Clinton's disaster chime in advising caution? Right wingers laugh up their sleeves knowing that the compromise offered will be a poison pill, rife with chances for corruption and loopholes, that feeds even more money to the parasites of private insurance and to big pharma and will demoralize the public so thoroughly that the chances of anything better following will be nil.
Offering less than they enjoy themselves is little more than open criminality by our representatives and senators. Let them know we want single payer on a par with theirs and expect them to support SB 703, HR 676
Call them:(800) 828 - 0498, (800) 459 - 1887, (800) 614 - 2803

[blacknblue2]

Your links do not work.

[MagnusAvarus]

not sure how to make those links work but copy and paste will

[Linda Bergthold - Huffpost Blogger]

Great post, Harold. I too hope that progressives can unite and support health reform this year, even if it's not as perfect as they would like. As Drew Altman of the Kaiser Family Foundation noted last week, health reform opportunities come around about every 16 or 17 years, and if we miss this opportunity, much harm will be done to many folks who are really hurting from our present system. Too many cannot get insurance that is affordable, or find a doctor who will accept them as a patient. Health reform can't do it all at once -- but we could certainly make some major progress this year if we pull together.

[ProudLiberalDan]

I am a HUGE supporter of single-payer health care.

However, I have come around to the belief that if we can pass health care reform with a PUBLIC plan alternative, and have a mandate for universality, we can get there.

Obama has already conceded the mandate issue on his end. My fear is that the DLCers and Blue Dogs are going to ask him to cave on having a public plan competing with private plans to lower costs.

A mandate requiring everyone to buy private insurance is nothing more than welfare for the health insurance industry and will do nothing to lower costs.

As long as a PUBLIC plan is part of a universal package, I can get fully behind it this year, even though I prefer single-payer health care.

However, if the Democrats cave on the public option, all we will be doing is subsidizing health care corporations who will not doubt be paying big bonuses to their CEOs. I cannot promise to get enthusiastically involved to fight for that.

[GrahamInCanada]

Lets say that we have a goal, single payer public health insurance. How to get there?

Some reformers with a militant posture think that to get to that goal, what you do is you travel directly to the goal.

But then there's Zeno's dichotomy paradox for you, because others say, well, first we should get halfway to the goal, which is so much easier than going all the way to the goal. Then, we again have to get halfway to the goal, so much easier than going all the way to the goal. The paradox is, traveling like this, one will never reach the goal.

That jokester Zeno of Elea, still stopping us from getting from here to there after all these years!

[TJCole]

Universal Single Payer Full Coverage Health Care is for Civilized Countries...we're not there yet....by far...!

[Jimmy1920]

The missing coalition partner is that of the 21st century workforce.
What are the dominant trends in the 21st century workplace? Younger people are entering the workforce later. Mid-career people are leaving the workforce to upgrade skills or learn new ones. Oder workers are not interested in leaving the workforce entirely when they retire. Even before last fall, they wanted to work longer but to work part time or part year.
Employers are hiring more free lancers and part timers. That is in part to avoid paying for health care. But free lancing also suits the life styles of many. None of these trends support a continued reliance on an employment based health care system. In fact an employment based health care system impedes the very flexibility that drive these trends.
Small business is supposed to be the engine of our economy. Entrepreneurs have enough barriers to overcome to bring a bright idea to success in the marketplace. The status of his or her health should not be one of them. Should we continue to allow this?
How many people stay in dead end jobs simply because they can not afford to lose their health insurance?
Obama has it only half right when he says that fixing health care is an economic development issue. He is only looking at the cost.
He and others need to see a single payer health care system as a work force development issue and a small business expansion issue.
http://thehealthcaremaze.wordpress.com

[jonbw]

In 2007 during the immigration reform debate a call your congressman campaign literally overwhelmed their phone lines. The effort of several thousand people calling their representatives scared congress so much the whole bipartisan reform effort collapsed. We need to not just let our representatives know that we want a "public plan" we need them to be scared for their electoral future. Writing has no effect, emailing has no effect. It is only the sound of phones constantly ringing which really gets congress to take notice.

http://callforhealthcare.com/

[freelyb]

You've made some really good points here. Good food for thought...and action.

[tiotom77]

Health care isn't broken. America has the best health care system in the world. Health INSURANCE needs reforming. The fix shouldn't be that complicated.
If you have a car with a flat tire, you replace the tire, not the entire car.

[thebassguy]

the health insurance mafia, I mean "lobby" will fight every effort to cover uninsured and resist all changes to our "healthcare system" which has become a joke. When lobbying congress becomes illegal, only then can we reform our nation. Lobbying should be a crime, and all contributions to political campaigns and parties should be forbidden. Please tell me why I'm wrong and misguided, and that lobby groups and giving money to our fave candidates is best for our nation....

[seanparnell]

Lobbying should be a crime? Contributions should be banned? What rubish.

First of all, the First Amendment protects these acts. Second, what you view as 'best for our nation' is going to be radically different than what many other Americans believe. Who are you to say that only those who share your perspective should be allowed to petition their government?

Lobbyists represent the many and conflicting interests and perspectives of the American public. What you are lusting for a single-party state, where the Party represents the People and those who dissent from the party-approved orthodoxy are silenced. That model hasn't worked too well wherever else it's been tried (North Korea, for example).

Sean Parnell
President
Center for Competitive Politics
http://www.campaignfreedom.org
sparnell@c­ampaignfre­edom.org

[ProudLiberalDan]

We rate 37th in the world. Only a conservative would settle for 37th so long at the top 1% get what they want on demand.

[Jimmy1920]

I have to disagree with you.
We offer some of the most advanced health care services in the world. True.
We do not have the best health care. And it is certainly not a system. If we had the best health care, then we logically should have the best health, and I would like to someone make that case.
And almost everyone agrees that we don not have a health care system. In fact my main beef is that to many professionals focus on the broken care delivery side.
You point that health insurance is broken is part of a totally broken patient delivery system. We fragment the patient population into silos inside of silos. it is no wonder that there is no system of care delivery. We put old people into Medicare, poor people into Medicaid and say good luck to the rest. Since most of that rest seems to find some sort of employer insurance, too many people think the system works.
It is broken.
http://thehealthcaremaze.wordpress.com

[Jimmy1920]

If you have a tire with umpteen holes in it, you don't repair each whole, you get a new tire.
We have a system with too many holes in it. Scrap it and build a new one.
Take my word for it. I make my living in the current system.
http://thehealthcaremaze.wordpress.com

[pontesisto]

Why does the administration dismiss single payer? A majority of doctors and the American people want it yet it doesn't get any consideration in Washington. Public management with private delivery is the only sustainable solution to our health care crisis. If you would like to help pressure Congress to pass single payer health care please join our voting bloc at:
http://www.votingbloc.org/Health_Bloc.php

[PlaceboStudman]

There absolutely needs to be reform, but the last thing you do when you reform something as vital as health care is worry about how much it costs. And that is the ONLY thing that anyone is worried about right now. As much as I hate to admit it, and as many people as I anger by saying this, cost should be the LAST thing we worry about, when our system will be broken at any price. What is the price of haggling over the price of the bumper-to-bumper lifetime warrantee, when the car needs to be rebuilt from the ground up, and even when the car is rebuilt by the best mechanics we have, they are still only given diesel fuel to power non-diesel engines. That is the conundrum we face, and will continue to face until we rebuild the car, make sure the engine can run, and give it clean burning ethanol (or better yet industrial hemp oil)

[blacknblue2]

COST is the big reason people are complaining. Look at the stats and people are happy with the care but do not like the COST. Just because you say it needs a bottom to top fix doesn't make it true.

Odd we never talk about tort reform? Could it be that most people in government are attorneys?

http://politicalticker.blogs.cnn.com/2009/03/05/poll-do-americans-want-government-health-care-reform/

March 5, 2009
Seventy-two percent of those questioned in recent CNN/Opinion Research Corporation survey say they favor increasing the federal government's influence over the country's health care system in an attempt to lower costs and provide health care coverage to more Americans, with 27 percent opposing such a move. Other polls show six in 10 think the government should provide health insurance or take responsibility for providing health care to all Americans.

http://www.gallup.com/poll/102934/Majority-Americans-Satisfied-Their-Own-Healthcare.aspx

Gallup's annual Healthcare survey, conducted Nov. 11-14, finds 57% of Americans saying they are satisfied with the total cost they pay for their healthcare, while 39% are dissatisfied.

http://abcnews.go.com/sections/living/US/healthcare031020_poll.html
Among insured Americans, 82 percent rate their health coverage positively. Among insured people who've experienced a serious or chronic illness or injury in their family in the last year, an enormous 91 percent are satisfied with their care, and 86 percent are satisfied with their coverage.

[PlaceboStudman]

Cost is the LARGEST reason people are dissatisfied, does not make it the only reason. And yes, MOST people are satisfied with the care they receive. But that does not mean that the people like me who are disssatisfied with the quality of care we receive, or the people for whom cost is not our biggest concern should be shouted down, ignored, disrgarded, and all but told "sit down and shut up and let the big boys handle it". Minority opinions matter just as much as majority opinions, because sometimes the minority are doing our best not to become the majority, when being in the minority is a bad thing, such as when our health care system is literally and unnecessarily killing us

[iBlogWestHartford]

We need not search far for a model reform plan with a REAL public option - built around expansion of a state employee insurance pool.

In Connecticut, where we have more than 325,000 uninsured, HB6600, or “SustiNet,” just got a favorable report from the legislature’s Public Health Committee and is gaining momentum.

SustiNet ensures that the state wisely uses the dollars it is already spending on state employees, HUSKY (for low-income children) and SAGA by uniting them into a large self-insured plan.

SustiNet (Latin for “sustains” - from our state motto) uses this mass of insured residents to improve the health care delivery system (with cost savings) and to phase in the enrollment of more residents, including: the uninsured; people with unaffordable or inadequate insurance; sole proprietors and other self-employed people; small businesses, municipalities, and non-profit employers; and, finally, businesses of any size.

By a “real” public option, I mean that EVERYONE in the state will have quality, affordable health care. If they are employed and their employer isn’t offering insurance that gets them that care, then they ALWAYS have an effective public alternative.

SustiNet was developed with extensive input from health care stakeholders, including advocates, unions, faith leaders, providers, business leaders and consumers. It has the support of, among others: Connecticut AFL-CIO; Connecticut Nurses Association; Connecticut State Medical Society; Connecticut Public Health Association; the 18,500-member Connecticut Realtors Association: and Small Businesses for Health Care Reform.

For more information go to: http://www.healthcare4every1.org/sustinet

[blacknblue2]

iBlogWestHartford I went to your link but could not find the cost of a policy. They did disuss a lot of cost containment.

"improves health quality and outcomes, and effectively controls costs."

"SustiNet does more than offer access to health insurance, it invests in improving the health of Connecticut's residents while controlling costs. "

"SustiNet is designed to control health care spending and save money for those hurt most by our broken health care system - small businesses and individuals with no insurance or inadequate coverage. "

This is when the rubber will hit the road to see how well it flys in the long run. At the moment it seems to be a viable working arrangement.

Beginning in 2012, it will require an investment by the state. The costs will be primarily in two areas: the phase-in of an increase in Medicaid reimbursement rates that will more fairly compensate hospitals, health centers and health care providers to care for people enrolled in those programs; and, support for individuals buying into SustiNet who earn too much to qualify for public health care programs but too little to pay full premiums.

Do you know how much the premiums cost?