>On 3/20/06, JBrown72073 at cs.com wrote:
>> I'd go further and say that it's nearly impossible to get little reforms
>> unless you have the threat of more sweeping change floating around out
there
>> somewhere. So, for those of us who favor sweeping changes, it's our job
to talk
>> about those possibilities as clearly and accessibly as we can, which may
turn
>> out to be a greater contribution to winning smaller reforms than simply
>> advocating them directly in all their maddening deficiency and complexity.
>>
>> Jenny Brown
>
>
>The problem with an argument about the impossibility of little reforms
>is that they are not only untrue, but obviously untrue. We have a
>large number of little reforms passed over the past decade, some of
>them in the past year.
I said impossible *unless* there is a threat of a more sweeping change. Right now there's a weak threat, so we're getting weak-assed reforms. But the threat is out there, and you better believe insurance companies are paying attention. One small example: When the Labor Party got on the ballot here a county-wide nonbinding referendum in 2000 saying we wanted to 'get health insurance companies out of our health care and create a 'simple, single system to cover everyone' it was attacked in court. We were able to forestall getting kicked off the ballot, got 65% of the vote, and later won in court. Years later a member of the teachers' union here was in a meeting about their annual 15% health insurance increase. He got pissed off at the two insurance company representatives who were explaining the new costs and said, 'Yeah, well what we really need is universal health care, like the people in this county voted for.' The ins. co. reps., both from a large city several counties away immediately spat back their pre-drilled talking point, "Oh, well, that vote was illegal."
>Little tweaks pass at the state level all the
>time. What I think is a fairer statement, and perhaps what you and
>Carrol intend, is that incremental *improvement* is impossible. As I
>said in my previous post, reforms everywhere, but things keep getting
>worse.
Yes. Such as part D the savings of which will be swallowed up by price increases before the decade is out. (D, according to stands for D-saster.) PNHP's Quentin Young says 'Incrementalism isn't the solution. Incrementalism has been the problem" and there is something to that. Take these limited categories of people and half-fix their problem. (They'll only find out years later that it's not really fixed.) It's divisive and attenuating.
>And I agree with two things; incremental reforms short of single
>payer won't solve the problem. If they are small incremental reforms,
>things will continue to get worse immediately. If they are large ones,
>you may buy some time; but even they make a short term improvment it
>will be a marginal one, perhaps not reversed immediately, but
>certainly shortly.
>
>But the fundamental problem is that people don't know about single
>payer. And you know there have been single payer activists around for
>quite some time, and we have not succeeded in educating people about
>it.
I think the approach that we want people to 'know about' single payer is probably not the strongest one we can use, except for a certain layer of intellectualized professionals who want their public policy efficient and logical.
I think that much of the blame needs to fall on us, as campaigners. The first thing nearly any speaker does is talk about the uninsured--around 16% of the population. Whatever happened to uniting the many to defeat the few? Instead we're uniting the many to feel sorry for the few, while everyone is getting ripped off in common. This sleight of hand allows every insured person, usually including the speaker, to continue to feel grateful that they are not among that blighted number. As someone who's been uninsured for big chunks of my life (and just got crappy expensive insurance again this past year), I'd rather have someone uniting with me for all of our benefit, rather than campaigning for something that will 'help' me while they think they've got it so good. Until large numbers of people take this personally, we're not going to get far.
Next in this standard speech, the uninsurance rate is apparently treated proof that we need 'single-payer' (a policy-wonk term if there ever was one). But obsessive focus on the uninsured leads you right into an incremental approach. If the problem is people who don't have insurance, why not cover them through various schemes. If the problem is job-linked insurance, and the profit requirements of private insurance companies, then you start to get into the idea that these incremental schemes won't solve the problem.
>So I'm looking at a possible change in tactics for single payer
>activists. Can we take some of energy to the incremental reform
>movements, and use it to support those incremental reforms in way that
>promote single payer health, as those currently leading such movements
>do not?
Well, this is Nathan's point, increments are good if the increments push employers such as Wal-Mart to stop opposing a fully public system because they are forced to pay either way. This is similar to the idea of living wage laws to protect the existing public union jobs from being outsourced. But Wal-Mart no doubt is hooked in with big insurance financially, and they want a more pliant working class (which you get with job-based health insurance). Also, successful government programs are just a terrible example, from their perspective.
This is why we don't see even manufacturing, far less retail, terribly interested in national health insurance, although it might seem to be in their short-term interests. They're hoping a combination of token patches and austerity will postpone a social solution.
>Is there any reason why going door to door for a tiny change
>can't be used as a door opener and conversation starter to educate
>people about the issue of single payer health. Is there any reason why
>a forum about single payer health can't include both support for an
>incremental reform, and an explaination of why any good in that reform
>will be undermined unless our current system is replaced by single
>payer one?
There's no reason except that at someone's door you have limited time to talk, so you have to make your point succinctly. Thing is, if you can show someone how the insurance industry is ripping them off and contributing no valuable thing to the whole process, making everything expensive and blocking needed care (which they may know from their own experience) then, if an incremental reform comes along, they're likely to be for that, too. It doesn't work the other way round. Persuade someone to vote for a half-penny sales tax to fund a small health care program for the 'working poor' (as they did in my county last year) and all you've got them thinking about is 'the poor' need more health care. Doesn't have to do with me.
>And a challenge for Nathan too. Incremental reformers pour huge
>resources into those reforms. If you folks are serious about single
>payer as a long term goal, how about putting a percentage (you name it
>20%? 10%?) in each campaign to educating the those you reach about
>single payer. Explain that this is a temporary fix, relieving some
>pain for some people, but leaving many others unhelped, and not
>reversing the slow deterioration in quality and increase in insecurity
>that affects everyone; explain while campaigining for "fair share" or
>smal business insurance or whatever that single payer is where we have
>to go in the long run.
>
>Doug started this list to try and promote this type of synthesis.
>Maybe this is not it; but I don't think I've not convinced by the
>arguments against it yet. I'm not suggesting diverting single payer
>health energy into incremental reforms. I'm suggesting that single
>payer advocates can use those campaigns to reach people they currently
>don't talk to with the single payer message - while also helping the
>incremental campaigns marginally, I'm also suggesting that the
>incremental reformers start diveriting a significant portion of their
>incremental campaign resources into single payer eduction.
Yeah, for example unions should give 10% of what they spend on D (&R) candidates to the Labor Party. That'd give us a warchest to fight for Just Health Care for sure. For unions mired in business-unionism, they could look at it as diversifying their investments.
>Think about medicare Part D mess. The right is actually benefitting
>from it, portraying it as an example of how "the government" messes up
>everything it touches. One way to structure a "fix part D" campaign is
>to yammer about donut holes, bulk purchasing, one wonkish thing after
>another. Or you could take the time to explain single payer, then
>point out that the problem with part D is that it works like private
>insurance rather than like single payer.
Yes, I agree. That has to be tackled. (Although I haven't seen, and have been waiting for, the attack on Part D as another example of how government screws things up. Have you seen that argument being made?) I think it needs to be tackled in the context of the attempted destruction of Medicare & Medicaid. We want private insurance companies out, they want private insurance companies to take over Medicare. We want Medicare for all, starting at age zero, they want Medicare drowned in the bathtub.
>A campaign like that would
>educate about single payer as well as a "pure" single payer campaign
>would. It would educate about part D as well (probably better) than a
>"Pure" part D campaign would. You get double the results for the same
>effort. Even if the incrementalists don't do this, tell me why our
>local single payer group shouldn't. Even if single payer focused
>groups don't do this, explain to me why incrementalists shouldn't.
>And a hell of a lot people are concerned about part D. A lot of the
>elderly are indignant; a lot of their younger relatives are too. Tell
>me that Part D, a specific problem is not an opportunity to educate
>and agitate.
It is. I think the problem here is that for 'single-payer' groups it's easy to fall into the incremental discussion because that's the context you're stuck into, tweaking this and tweaking that. So it takes extra effort to step back and make the case for abolishing private health insurance companies and delinking healthcare from employment. It can be done. But it won't be done by people who are staff of an organization that's doing incrementalism, as Nathan points out.
Summing up my response to your good questions Gar, lots of people are doing incrementalism (including lots of nonprofits and government committees dedicated to incrementalism), not so many are giving good, down to earth explanations of national health insurance. So that's our job. It has the nice side-effect of teaching something about how capitalism really works and for whom. So, in a way, you can't miss when you start getting down to the radical basics, while it's very easy to miss when you wade into a mire of small changes.
Jenny Brown (Alachua County Labor Party)