Building The Mandate

by digby

Here's an interesting article from a single payer advocate about the "bait and switch" on the public plan, which says that although the original idea of a public plan might have accomplished the cost savings and reform that it promised, what's coming out of the HELP Committee and the House is a watered down version that won't accomplish any of it.

I don't disagree with a lot of this, although I do think that some of it is being willfully naive about the strategy. As TeddyKennedy says, the most important thing is to get a public plan by hook or crook and then expand it. But I would love to know why this fellow and others like him believe that, all things being equal (the same presidential campaign, the same economic conditions) single payer could have been sold more effectively than a public plan. If the medical industrial complex pulled out all the stops with this far less radical change --- and managed to successfully erode support for reform already --- is it reasonable to think they would have been stunned into paralysis if Obama had introduced a real government run program?

I don't think there's any question about that. Could the Democrats have put single payer on the table as an opening gambit and perhaps built more support for a public plan? Yes. They made a tactical decision not to. But that has no bearing on whether or not single payer was a feasible position in its own right.

I would certainly prefer single payer -- just expand Medicare and the VA to everyone and call it a day --- but I'm not married to the idea. (I'm married to universal health care and if there are other ways to attain that, then I'm open to it.) I just don't understand why anyone thinks there was any kind of mandate for such a plan --- or that there has been any kind of grassroots, bottom-up effort to build one over the past 16 years when the Clinton plan crashed on many of the same shoals the current one is heading toward. There was certainly no demand for this during the last presidential campaign, despite the fact that the crisis was well known and plans were discussed constantly.

This reform debate has been going on for 60 years now and every time an attempt to do it fails, liberals purse their lips and say the plan wasn't sweeping enough. We say that no reform is better than reform that continues to allow insurance companies to exist anyway and comfort ourselves with the notion that single payer will be inevitable the next time. And then the politicians suffer from their political failure and get wary of tackling the issue again --- and we go back to complaining among ourselves for another 20 years until another president gets an opening for reform and the same thing happens.

This person actually seems to believe that if the current legislation crashes and burns that all the politicians have to do is brush themselves off and go back to the drawing board and we'll get a single payer plan in 2010. That is a fantasy. It does not work that way and anyone who has observed politics in this country for more than five minutes knows this. The politicians will learn their lesson about failed reform --- again --- and that will be that.

At this point the situation is so grave that taking another 20 years to build that single payer mandate is an untenable position. The economics as well as the moral necessity argue for doing whatever is possible. But, if you nonetheless believe that it's better to have no reform at all then go ahead and agitate for this plan to fail. Maybe this time, in 20 years things will be so horrible that they won't be able to avoid enacting single payer. Heck, maybe we can come back to it in only eight years this time -- if Republicans don't come back to power that is.

but if you take that position, I would certainly hope that at the very least, if this push fails, everyone who has been holding out for single payer will not sit around and congratulate themselves on their victory but instead immediately devote their lives with single minded focus for as long as it takes to building that mandate for single payer because that's what it's going to take. Otherwise, it simply won't happen.


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