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Activists march on Capitol Hill during a rally for single-payer healthcare on July 30, the 44th birthday of Medicare. (Photo Alex Wong/Getty Images)

Who’s Got the Power?

Progressives find themselves outmaneuvered on healthcare reform.

BY David Moberg

‘Medicare for All’ has been demonized by the right and hidden away like an embarrassing relative at a family reunion by mainstream journalists and Democratic politicians.

After decades of playing political defense and suffering defeats to an increasingly arrogant and reckless right wing, it’s not surprising that American liberals and progressives suffer from “a culture of impoverished politics,” in the words of Jeff Blum, executive director of USAction, a coalition of citizen groups.

In many ways, progressives are still catching up to the changed political landscape, starting with Democrats holding power in Washington. More importantly, longer-term possibilities have been created by the failure of the Bush administration, the narrowing Republican base, the economic crisis, the shift of independent voters toward liberal Democratic views and the demographic trends favoring a growing progressive bloc of voters. Political analyst Ruy Teixeira argues in a new report that the right wing is losing its culture war, especially with the new generation. That could strengthen prospects for a progressive political and economic revival.

In his campaign, Obama tapped into frustration with the country’s impoverished politics with his ambiguously progressive rhetorical flourish of “yes, we can.” But as initiatives from both the White House and Congress have unfolded, the slogan seems to have been modified to “maybe we can–if big money and big business don’t fight us.”

Judging from his ambitions and much of his rhetoric on domestic issues, Obama is clearly the most progressive president since Lyndon B. Johnson, with his Great Society. But many major administration or Congressional initiatives that had good intentions (or at least were necessary)–from the bank bailout and initial financial reforms to climate change and healthcare–have been weakened, deformed and delayed through the influence of big money interests and their servants in both parties.

The Democrats’ reward for seeking compromise and bipartisanship has been Republican party-line obstructionism and rabid attacks, including not only a mendacious scare-campaign strategy to kill health reform and weaken Obama, but also personal assaults such as Fox fulminator Glenn Beck’s accusation that Obama is racist.

What to do?

Under these conditions, how can the left best take advantage of the opportunity presented by Obama and a large, if undisciplined, Democratic majority in Congress?

There’s no easy answer. Politics is an exercise of power, its effectiveness often dependent on how artfully it is used. And the greatest potential power for the left has been mobilizing people, both in large numbers and with passion.

Having the best ideas for realizing the greatest common good works to the advantage of progressives. Clever policy ideas are useful, but above all, progressives need to focus on how those policies fit with their long-range goals–a deeply democratic and egalitarian society that limits the private power of wealth and, creates a socially just and environmentally sustainable economy.

But, as the healthcare debate makes painfully evident, politics is more about narrow self-interest and fears than about hope for the long-term common good. And short-term greed and fear serves the long-range agenda of the right.

There’s no question that the best solution for healthcare is national health insurance–a single-payer, “Medicare for All” plan with comprehensive care, emphasis on prevention, patient choice of doctors, professional guidelines on optimal care and progressive financing.

“Medicare for All” has been demonized by the right and hidden away like an embarrassing relative at a family reunion by mainstream journalists and Democratic politicians. But the American people strongly support the idea when it is posed as an option: In a June New York Times poll, 72 percent supported a plan like Medicare for everyone under 65.

But over the past few years, many progressives became convinced that Congress would never pass it, and many Americans–especially those who vote–liked their health insurance plan, making them easy marks for insurance industry scare tactics. Yet if health insurance reform included the option of a government plan, they argued, that option would quickly prove better and cheaper, expanding to cover much of the market. It seemed a clever way to finesse political obstacles and move toward single-payer.

As the public option gained politicians’ support, however, it was repackaged as simply guaranteeing competition in the insurance market. Then the insurance industry and conservatives began complaining that it would offer “unfair competition” and drive private companies out of business–a remarkable, little-noted admission of the superiority of a well-run government insurance plan.

Then legislators’ attention turned to “leveling the playing field.” In practice that meant tilting the playing field to preserve private insurers by so drastically restricting the public option–for example, who could enroll or how prices could be controlled–that it would lose much of its potential to out-perform private insurers.

In the end, if it even survives, the public option risks becoming a dumping ground for high-risk, costly patients, thus fattening insurance industry profits and discrediting public insurance. That’s precisely the opposite of the original intention. Now, with millions of people required to buy insurance with public subsidies that conservative Democrats are trying to restrict, reform becomes an insurance industry preservation act, sweetened by some useful regulations.

Public option lobbyists

The main progressive coalition promoting the public option, Health Care for America Now (HCAN), is big, well-funded and staffed, sophisticated, and capable of both insider lobbying and putting outside pressure on politicians, including wayward Democrats. HCAN started early, laying the groundwork when prospects looked bleak for Democrats, found its champions, and continually argued that it represented, in USAction Director Blum’s terms, “the limit of the possible.”

Progressives continue to fight for both “Medicare for All” and the hybrid public option. Over the August recess, HCAN, unions and other progressive groups mounted an air and ground war in defense of a “robust public option,” against taxing employer-provided insurance and in favor of progressive financing.

After a late July concession to the conservative Blue Dog Democrats by House leaders on the public option, the Congressional Progressive Caucus reiterated its refusal to vote for healthcare reform without a public plan. Progressive Congress members will also need to show similar resolve to protect the right of states to set up single-payer plans, including an amendment from Rep. Dennis Kucinich (D-Ohio) approved by the Committee on Education and Labor.

Go back or go on?

In the crunch, progressives will be pressured to support any bill, no matter what kind of ingredients have been ground into the legislative sausage. Failure on healthcare threatens the broader progressive agenda and would likely put off major reform for years. The weaker the bill–that is, the further from “Medicare for All”­–the more likely reform will fall far short of universality, fail to control costs, and even backfire politically.

How might prospects look if the progressive movement had embraced “Medicare for All”? Given the resistance of conservative Democrats and fear-mongering from the right for even a more modest reform, two conclusions are possible: (1) the public option is indeed the limit of the possible; or (2) progressives might as well have fought for “Medicare for All,” since the attacks would have been the same (“government takeover”), such a plan would have been less costly, more universal and easier to understand, and a compromise or hybrid would have been stronger than what’s emerging.

Campaign for America’s Future (CAF) co-director Roger Hickey argues that fighting for single-payer would require a 10-year campaign, but influential actors, including most labor leaders, felt action was needed immediately.

Progressives have to be–and increasingly are–taking the long view. Even in the Bush dark age, CAF’s Apollo Alliance began laying the foundations of a labor-environmental coalition for green jobs as a response to global warming, helping to shape current policy.

As they make those long-range plans, they should not worry about public opinion, which is increasingly progressive. The enduring obstacle–as well as the short-term problem–for the progressive vision is concentrated corporate and financial power. Not even Wal-Mart’s partial support for healthcare reform should obscure that fundamental reality. 

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David Moberg, a senior editor of In These Times, has been on the staff of the magazine since it began publishing in 1976. Before joining In These Times, he completed his work for a Ph.D. in anthropology at the University of Chicago and worked for Newsweek. He has received fellowships from the John D. and Catherine T. MacArthur Foundation and the Nation Institute for research on the new global economy. He can be reached at davidmoberg@inthesetimes.com.

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