Health Care and “Political Feasibility”: A Patient Responds

Health care reform is contentious, and requires a good deal of historical knowledge. Moderating debates so that enlightenment prevails over static is justified, but the history of health care movements includes the efforts of patients to find a public voice and be heard.

If PNHP truly wants to create a movement for equality in health care, then the debate should also be opened to health care activists who are not health care professionals. For this reason, the gatekeepers who posted this message might reconsider allowing more health care activists beyond the gate:

“PNHP welcomes comments on its blog by its physicians and medical student members, and other health professionals active in the movement for single payer national health insurance. Comments by other readers are welcomed but may not be posted.”

Kip Sullivan is correct in arguing that “political feasibility” is itself a circular argument if we simply accept the ACA as an act of God, rather than as the outcome of a flawed political process. Though Sullivan does not make clear (to me, anyway) what he would propose as a countervailing political movement, or a practical point of leverage to move the “immovable” object of our present corporate political system.

Barbara Power comes much closer to speaking my own mind by asking:

“Who still believes we even have a 2-party system in the US? References to democrat or republican players are quaint, but useless to those affected by the decisions made and inflicted on citizens. The terms which best describe our method of governing in the US are: oligarchy, plutocracy, or better yet, syndicate-based.”

The ACA proponents were not simply pragmatists, which is their own view of themselves. They were also partisan apparatchiks who put their party above honest debate and the best practical solution.

Most of them are ready to walk away from the ACA to some other partisan gig, saying, “Our job here is done.” If they are within White House circles, of course they have to defend the ACA. That goes with their jobs.

Kip Sullivan wrote his article in good faith, but the damage is done. And the people who need their noses pressed to his text will not pay attention. Sullivan is arguing that the public understanding of health care reform would be much more advanced now if only more people had fought for what we really needed, and not just for what was deemed “politically feasible.”

He’s right, but he will also be trapped in the congressional circles of hell unless he (and we) find a way to put the worst career politicians out of business. The worst cases are emphatically bipartisan, so any political diagnosis that simply tilts against Republicans will also tilt at windmills. Democrats in Congress were also very effective in shutting down any open debate about a single payer system, and finally excluded even discussion about the much weaker “public option.”

One big factor missing during the health care debate and “reform” was a healthy labor movement. That made a huge difference in gaining national health care in Canada, but unions were deliberately and systematically downsized in this country. In consequence, this country lacks a principled electoral party of basic social democracy. That is no accident. That is the strategic consequence of a bipartisan consensus against social democracy.

The Clintonian wing of the Democratic Party, still quite strong, deliberately reduced “liberalism” to a nineteenth century doctrine of the “free market.” Thus Hillary Clinton dismissed David Himmelstein’s arguments for single payer many years ago with her flippant comment, “David, tell me something interesting.”

My view is that the republic is endangered, and I am a fairly square creature of the Enlightenment and of the radical republican tradition. A class conscious approach to basic social democracy (in education, housing, health care, transportation, energy, foreign policy) is part of the unfinished business of the Enlightenment.

Now and then I meet outright anarchists, mostly youngsters, who regard Washington, DC as a remote marble mausoleum. If I told them their vote counts there, they would laugh in my face. And in fact I do not believe that argument myself. It belongs in a Civics 101 class, among the other hermetically sealed illusions.

So I am 58 years old, living with HIV (diagnosed in 1986), a veteran of ACT UP, and can only advise the young that basic democracy may require a second American Revolution. Peaceful, if possible.

Though I wish the good doctors of PNHP well, you will never break out of your professional isolation without making practical common cause with a wide spectrum of other health care activists who are not health professionals. Including veterans of the movements for women’s health care and veterans of the AIDS activist movement. That is one path of solidarity to pursue, while also avoiding the path of congressional “feasibility.”

Create the citizen movement for health care, and the career politicians will follow. But they will not lead. There are just too many corporate lawyers and millionaires in Congress to expect any kind of social democratic leadership from the class and the interests they represent.

My husband and I met Dr. Don McCanne at an early meeting of the Santa Monica chapter of PNHP, and my interview with McCanne (in the form of a conversation, since we are both health care advocates) was published at . McCanne is providing one bridge of communication between health care professionals and other health care advocates, so I am glad to promote his wonderful daily columns known as Quote of the Day. This is where I encountered Sullivan’s column, and that’s what brought me to knock at the door here at the PNHP site.

My husband and I only went to two of the PNHP meetings, since it became clear that much of the funds, time and energy would be spent lobbying politicians in Sacramento. Well, each state of this disunited union is a special case, and in California there are indeed career Democrats who introduce decent health reform bills. Each PNHP chapter is free to pursue a chosen course.

How we, the people, decide to spend our time and resources in public life is finally both a matter of conscience and a strategic political choice. For myself, my real vote must be cast against the whole corporate system, including both of the big capitalist parties.

The brutal experience of the AIDS epidemic taught many patients that we had to take our fight to the streets, the courts, and yes indeed, the hospitals. In the early days, we often educated doctors in the Standard of Care. Some doctors became allies, but some doctors lent their professional credentials to their bigotry. We will never forget the deeply entrenched medical resistance from many doctors who had never encountered patients advocating for our own lives and health before.

The health care system in this country is a class divided system. The political movement necessary to win health care for all must therefore be a highly class conscious movement, rooted in the daily experience of people well beyond the strictly professional circles of doctors. Politics is not a science in the strictly empirical sense of a laboratory experiment, but we can still take an empirical view of what does and does not work in social movements for basic public goods such as health care. The two party system does not work for our public good. That is an objective political problem that the good doctors of PNHP will recognize sooner or later. Better sooner.


Scott Tucker

Scott Tucker is a writer and a member of the Socialist Party.


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