Posted by rflacks on: December 23 2009

Everyone is talking about the healthcare bill in my circles. The argument about whether to support passage of some version of the senate bill reveals a pretty sharp divide among those who identify as ‘progressive' or ‘left'.

Those who claim to want the bill defeated are morally repelled by it. After all, the bill delivers millions of new customers to the rapacious private insurance companies, whose stock prices have soared since the public option was erased. After a moment of bright hope that Medicare would be expanded as part of the reform,  the outcome is bitterly disappointing.

Those of us who want the bill passed can concede all the above. The progressive argument for passage is strategic and practical. First of all, there is still some room, in conference, for some of the better features of the House version to be incorporated. Those voicing defeat tend not to be talking about how to use that room. For example, theHouse bill would enable Medicaid to embrace several million more lower income people (who would be government and not privately insured). It finances government subsidy by tqxing the rich rather than taxing high end insurance policies. And it includes a small scale public insurance option that may be competitive with private plans.  So one immediate strategically relevant effort would be to push congresspersons to insist on some of these things.

I think the internal progressive conflict revolves around a split in the very consciousness of  people on the left.  For many, to be a leftist is to stand for certain principles, to express a political identity--often coupled to an expectation that practical change in the world isn't likely. Back in the day, there were at times radical or revolutionary political alternatives to incremental reform, and an anti-compromise leftism had immediate relevance. These days, when no such radical political alternative exists, there's a danger that a moralistic radicalism turns into defeatism.

After more than 50 years of activist leftism, my experience and my sense of the current situation, leads me to urge that strategy is needed as well as values. Can we actually win reforms that will: a) improve the life chances of working people in the here and now and b) set the stage for  further democratic, egalitarian change? To ask questions like that is to compel you to think about strategy: HOW do we get from here to there? What are opportunities for what kinds of change? What progressive principles can be implemented in the face of what kinds of compromise?

I've wanted universal healthcare since, when I was 10 years old, I took the ‘pro' side in a classroom debate on socialized medicine. I was initially dismayed when a progressive coalition formed in support of a co tinued reliance on employer provided insurance, accepting a government insurance program as an optionalalte44rnative to the insurance corporations. My first reaction was that this was an unholy compromise. I still feel that way. But I came to accept the logic that passing a bill that promises universal health care and that would create benefits for many now denied them might be the most likely strategy for change.  And the logic goes further: the insurance industry would have to accept strong regulation in return for the vast new market it was being guaranteed.

The bill now in process embodies this logic. And I'm surprised to learn that the Senate bill would place a strong limit on insurance company profits, requiring that 85% of revenues be spent on delivering health care, limiting premium pricing in certain ways. 

But, no question, both the senate and house bills are weak and problematic even in their own terms. Financing subsidy by taxing ‘Cadillac' policies is a dubious way to assure workers that this is a reform for them (even though healthcare wonks think this approach will contain costs). The house bill's best feature is that it taxes the wealthiest to pay for the cost--just what Obama promised in the campaign. The planned subsidies may well fall short of protecting people effectively. The planned regulations may have loopholes that will lead to denials of coverage or exorbitant premiums. The start dates for benefits may shock a lotof people who were hoping for immediate relief. 
This bill could backfire if it's promises prove to be shams. And we can be certain that the medical industrial complex will be investing heavily in exploiting its weaknesses (although insurance company stock prices have gone up this week, there's indications that company insiders are realizing that the final bill may turn them into public utilities rather than profit machines).

So there are very real grounds for progressive moralists not only to be angry at the bill but wanting to kill it. But most progressives who are thinking strategically, who are focused on mobilizing real and effective movement, are accepting this bill. Joe Bader, who's been a doctors union organizer for decades (and whose spouse Cheryl has also spent her life in healthcare organizing) sent this the other day:

"the cold, hard, truth [is] that if this bill is defeated, it will be another decade or two until we get around to healthcare reform again...and THAT is morally unacceptable, given what we know are the consequences of our broken, and often cruel healthcare system.

One good thing about this dirty, "sausage-making" process called legislation is that many have been awakened to the manner in which our ruling, corporate elites and their servants in government exercise power (we already knew that intellectually, but being slapped in the face with it gives one new awareness). We will be continually reminded of this in the political battles to come, namely: climate change-carbon reduction, financial regulation, immigration reform, EFCA (remember that?), and the growing U.S military-economic involvement in overseas military adventures, among other battles.

So, after this "awakening" will our response be a new passivity in the face of adversity or a renewed activism? If we become cynical about the possibilities of reform and that leads to passivity and pursuit of a privatized existence, that leaves the field wide open for Wall Street, Insurance company executives, Big Pharma, corporate media, and the military-industrial complex to exert continued domination over our lives.

President Obama told us repeatedly during his campaign that the campaign was "not about him" but about "us" and that "we are the people we've been waiting for"..

Was he wrong?"

Joe's question is the right one. Here's the song I keep singing: we need a progressive movement that's strategically focused  on the goals Joe lists. Instead of hand wringing about sellouts and betrayals and disillusionments, on the one hand, or slavishly following the DNC party line on the other,  we need to argue for and organize for a progressive agenda (which in large part can be defined as a series of campaigns to fulfill the promises made in dthe2008 election).

Progressives nowadays glorify FDR as the great reforming president. But go back and read how he diluted, weakened and corrupted the great social security reform in 1935. To get it passed, the bill he pushed excluded two thirds of the black population from any coverage (it deliberately excluded domestic and farm workers), provided relatively small benefits, excluded health care, and took years before people started to get their checks. Yet it's passage provided the foundation for progressive organizing and program from then on, since it established the principle that all people were entitled to a social wage regardless of their fate in the job market. 

The health care bill can have a similar significance. I think the progressive leaderships bear some responsibility for its weakness. Instead of compromising at the start by pushing for the public option, it may have been more effective for the progressive coalition to have argued and organized hard for single  payer instead of marginalizing it.  On the other hand, those who've been active in for single payer haven't formulated a strategy for advancing it.  Instead of  feeling defeated by the passage of the current bill, we ought to start immediately to develop such a strategy--one   that will become urgent if and when the gap between the promise and the reality of healthcare reform  becomes evident

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Tags: healthcare reform, progressive coalition