The Healthcare Debate of 2009: the Role of the Left

The US Left has a few different tasks in regards to situations of national political importance; among them are 1) putting out our politics about the situation, including a critique of the current state of things and a vision for a better world, and 2) supporting activists by giving them spaces to dialogue, make plans together, and develop themselves politically and strategically as organizers. We have other tasks as well, but these two are certainly important. Ideally, these two roles are complementary, but sometimes they may conflict, at least apparently or partially. I believe we are facing a situation like this in regards to the contemporary healthcare debate.

In Solidarity, discussions around the healthcare debate so far have tended to focus on the need to wave the banner of single payer healthcare high and proud. Doing this would be a good way of fulfilling our tasks in regard to the first task, putting out our politics. (It might be worth thinking about the fact, though, that most of the Left has gotten on board with talking about single payer, e.g. something like the Canadian system, rather than talking about nationalized healthcare, e.g. something like the British system, due to tactical reasons – single payer polls well, nationalized healthcare doesn’t poll that well – and relational reasons – there is a fairly significant layer of healthcare reform organizations in the US pushing for single payer, and virtually no one pushing for nationalized healthcare. Nevertheless, in our own educational materials it may be worth raising the fact that a single-payer, multi-provider system is not the only way to get away from for-profit healthcare.)

Unfortunately, merely continuing to make the case for single payer isn’t a very good way to relate to the second task, supporting and developing activists. This, I’m sure, will be a controversial claim. After all, many of us are active in organizing around single payer, and doesn’t standing strong for single payer support those activists against pressure that they should buckle and support the “public option” as part of a continuation of the current for-profit model? Perhaps it does, but if this is the only way we look at supporting and developing activists in regard to this debate, we are taking too small a view.

Healthcare reform is on the table, now, in such a way that its importance must be discussed in ways that go beyond the long-standing healthcare reform scene. It is of vital importance to union activists, public health advocates, and indeed, to working class people in general. The battle over healthcare also cannot be viewed outside of the political context: a virulent right-wing attack designed to stop any meaningful reforms from happening.

Almost all of the advanced activists in these arenas who aren’t long-time leftists or single-payer campaigners themselves think that if the Right is successful in stopping healthcare reform or reducing it to a next-to-nothing package, this will constitute a significant setback for left-leaning social movements in general. I’m inclined to think that this perception isn’t wrong at all. An element of politics has to proceed on the basis of an assessment of forces. We don’t have strong enough / militant enough movements to win single payer healthcare in this round of the fight. The movements’ goal should be to win as much as possible in this round of the fight while setting up favorable conditions for future rounds of the fight.

It would be sectarian for the Left to stand aside from this fight, which means that even as we continue to make the case for single payer or nationalized healthcare as the only real answers to the contradictions of for-profit healthcare, we should embrace efforts to win as much as possible in this round of the fight.

While we know the Obama / Congressional Democratic plans won’t resolve those underlying contradictions, it may still be possible for public pressure from the left side of the debate to have a positive effect: isolating the right-wing reaction, establishing a government-run insurance program (the “public option”) as part of the plan which would be adequately funded and able to achieve cost savings compared with private insurers, eliminating the ban on pre-existing conditions, ensuring adequate subsidies for those who can’t afford the cost of mandated insurance, etc.

We navigate these kinds of contradictions in union contract campaigns and fights over local public resources all the time. We understand the fact that reform struggles are limited by the size and vision of the movements in a given conjuncture, and we think that victories, even limited, compromised ones, tend to propel our struggles forward, and defeats tend to demoralize people. The healthcare debate is, in some senses, no different.

Fighting for reforms we can win, now, does not mean we have to support Democrats, but it does suggest that we ought to consider the political impact of our arguments. Is "exposing the Democrats' betrayals" a central task for conscious leftists in this period, and how do we balance that task with other tasks, such as supporting what was positive about the hopes that millions saw when they voted for Obama?

There's also a danger, among those of us who didn’t support Obama, of getting into “I told you so” mode when we see him failing to drive forward any progressive programs and backing all sorts of reactionary crap. We need to be honest in our analysis, including about Democrats and the problems of Left reliance on them. However, we need to be careful that what we say is in this regard is serving the purpose of political education rather than point-scoring vs. others on the Left who did support Obama.

Outside of hardened politicos, a great many people in the US who follow the news at all have already given up on the notion that Obama is bringing “change,” whether or not they still support him as a lesser evil or an alternative to right-wing reaction. The real political danger of this moment at a mass level is not that people will continue to have illusions in Obama – it is that as the hopes that surged to the fore with Obama’s election fade, left-of-center minded people will get disoriented and give up hope and a muscular if somewhat deranged Right will gain critical momentum and initiative.

In this situation, the self-conscious, non-sectarian Left should train our main energy on the dual focus I’ve suggested above: putting out some clear-enough, baseline politics which can serve as a pole of attraction and developing a fight within the current conjuncture to try to win some meaningful reforms that will benefit working-class and oppressed people. In the healthcare debate, that means 1) continuing to criticize for-profit, employer-based healthcare and calling for single-payer – while 2) recognizing that a single-payer victory is not in the short-term cards, lending our efforts to the on-the-ground fight for healthcare reform, and 3) opposing the tendency to water down the reforms to the point where they are no longer worth it.

Of course, a realist assessment of the situation would conclude that there is a better-than-even chance that healthcare reform will get watered down to the point where it isn’t worth it, and some single payer advocates think we’re already there. I believe there’s actually a chance that the Right has overplayed its hand – that public outcry against the rabid rhetoric and misinformation campaign could allow the Republicans to become somewhat isolated, which could also give an opportunity to throw cold water on Obama’s tendencies to give everything away in the name of bipartisanship and coddling conservative “Blue Dog” Democrats.

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