CounterPunch Diary

T'was a Famous Victory

By ALEXANDER COCKBURN

"Cleopatra's nose, had it been shorter, the whole face of the world would have been changed.” So wrote Pascal, remembering how Caesar and Mark Anthony, those mighty generals of the Roman Empire, were captivated by Cleo’s commanding schnozz. This time Cleopatra’s nose took the form of Ted Kennedy’s brain tumor.

If the tumor hadn’t finally done in Massachusett’s senior senator last August, then there wouldn’t have been a special race for his seat. A former Cosmo nude pinup called Scott Brown wouldn’t have stunned the Democrats by capturing the seat for the Republicans this past January.

Obama wouldn’t have been hauled rudely from the supposed security of a filibuster-proof majority in the U.S. senate and, instead, faced with the prospect that the health insurance bill on which he’d squandered more than half his first year in office was about to go down to defeat, leaving the victorious Republicans to trample him and his party to death in the fall elections this year.

It was a very, very close thing.

Why did Obama blow his first year? Politicians have a touching trait of often coming to believe their own campaign rhetoric, even when it’s being greeted with cynical guffaws by the cognoscenti. Having made his name and won his votes by pledging to rise above faction and draw the American people together, Obama extended the hand of bipartisanship to the Republicans and spent the following months seemingly fuddled as the Republicans chewed off his arm, inch by inch.

The whacking they gave his stimulus package in February of 2009, cutting it in half, unnerved the White House. Just when they should have been drawing lines in the sand, they opted for pliancy. It’s debatable whether they should have touched health reform at all in 2009, but suppose Obama and House Democrats had put forward a tough, progressive plan, centered on a government-underwritten “single payer” model and then challenged the Republicans to come at them, forcing them to go through the arduous exercise of actual filibusters, item by item. The whole terms of the debate would have been different.

Instead of which, Obama handed off reform to Congressional Democrats who came up with five plans. The Republicans wheeled their artillery into position and opened up with heavy salvoes about “death panels.” John McCain and other Republicans like Senator Chuck Grassley started denouncing as “Obamian socialism” the very provisions they themselves had advanced a year earlier. The left, furious at the dumping of single-payer, or even a vestigial public option, was deeply demoralized.

Then, as the year turned, came three strokes of immense good fortune. The first was Republican Scott Brown’s defeat of Democratic favorite Martha Coakley in Massachusetts, leading to the blare of panic klaxons in the White House. Next came a February announcement by Anthem, California’s largest for-profit insurer, to hike individual rates by as much as 39 per cent, vividly dramatizing the extortions of the present system and giving the Obama administration the cue to call on Anthem to justify the hikes. Finally, Jim Bunning, a Republican senator from Kentucky and former Major League baseball pitcher heading into retirement, single-handedly blocked for five days a measure to extend eligibility for enhanced unemployment benefits for laid-off workers. “Tough shit” was Bunning’s retort to complaints that his unfeeling obstinacy would plunge hundreds of thousands into truly desperate straits. Finally, amid a firestorm of public rebukes, the Republican leadership forced Bunning to back down.

It was a reprise of the face-off that gave Bill Clinton his great victory against Newt Gingrich and the Republicans in November of 1995. Gingrich, Republican speaker of the House, said he’d shut down the government unless Clinton agreed to budget cuts in social services. Clinton refused. Without necessary funds voted by Congress, federal workers started to get laid off. Then Gingrich destroyed himself and Bob Dole’s chances in 1996 to be president. He told reporters that he forced the shutdown because Clinton had made him and Bob Dole sit at the back of Air Force One House. A stand on principle shriveled into pettiness, as with Bunning.

By early March of this year, the Republicans were looking not only mean-spirited – the Party of No – but also the Party of Nutsos, hooked to the Tea Baggers who themselves have been getting crazier by the hour.

The tide turned. At last the Democrats played hardball. Nancy Pelosi, Speaker of the House, twisted arms, stacked up votes. The long-brandished, never used filibustering weapon stayed in the armory as Democrats rediscovered procedural weapons to push the bill forward. The Tea Baggers spat on a black Missouri congressman,the Rev Emanuel Cleaver II, and taunted Barney Frank, the House's only openly gay member. On Thursday night, they threw in the towel.

The struggle commenced last June has produced, by way of health insurance reform, a Republican bill – mostly bad, with a couple of positive features. It’s certainly not reform of health care. Its decent provisions could have been passed easily early last year. It could all have been different.

But now Obama and the Democrats have put a big one up on the board. It’s still a long way to the fall elections, but Obama may last have learned the benefits of partisanship – even populist partisanship. Next comes financial reform, which is what Obama should have started with last year. But at least he has a win. As Southey’s poem “The Battle of Blenheim” put it:

“It was the English.” Kaspar cried
Who put the French to rout;
But what they fought each other for
I could not well make out.
But everybody said,” quoth he,
“That t’was a famous victory.”

Closing Time

A Historic Confirmation of Corporate Power

By CHRIS FLOYD

It looks like heaven but it feels like death;
It's something in between, I guess:
It's closing time.
-- Leonard Cohen

Official transcript of remarks by President Barack Obama after the March
21 vote in the House of Representatives on H.R.3590: Motion to Concur in
Senate Amendments to Patient Protection and Affordable Care Act:

My fellow Americans. As many of our more serious commentators have noted,
Democrats and progressives have sought genuine reform of our broken,
bloated, unjust health care system for almost a hundred years. Today, I am
proud to say that we have brought that century-long struggle to a close.
Together with our visionary partners in the House and the Senate, we have
finally killed genuine health care reform for many years to come --
perhaps even for another century!

The struggle is over, the deal is done, the fix is in, and corporate power
-- unbridled, unchallenged, coddled, protected, and larded with the
endless pork of government-guaranteed profit -- has triumphed at last.
This is an historic achievement. This is a mighty legacy we will bequeath
to future generations.

This, my friends, is what change looks like.

Now, you know and I know that such change never comes easily. It never
comes without opposition. It never comes without controversy. Even in this
hour of victory, we know that the doom-sayers will be out in force.

And I'm not speaking here of the Republicans, whose opposition has simply
been a lurid, baseless "Red Dawn" fantasy about "communism" coming to
America. "Communism" -- in a bill that has been written by our visionary
partners in the corporate community, by our hyper-capitalist friends and
patrons on Wall Street, by the lobbyists and bagmen of Big Money! It's
true there is a tinge of socialism in the bill, but it is, of course, the
only kind of socialism that is tolerated in America: socialism for the
rich, where the masses shoulder the risks -- and the costs -- while the
wealthy reap the profits for themselves. The health-care barons, the
bailed-out banks, the farm-devouring agriconglomerates, the war profiteers
... we've got plenty of boardroom bolsheviki out there -- but it sure
ain't "communism" like Castro used to make! So let them hoot and holler
down this false trail all they like; for as I learned back in my Senate
days, when I was considered part of the "anti-war" faction, opposition
without substance only entrenches the status quo.

No, what we must look out for are all those -- or rather, those very few
-- nattering nabobs of negativism who have opposed our historic corporate
empowerment bill out of -- get this -- principle. Like barnacles hanging
onto the butt of the Titanic, they have clung to the idea of truly
universal, equal, single-payer health care, a system that is less
expensive, more efficient, more secure, more democratic, more popular and
more effective than the heroic measure we have passed here today.

These poor wretches -- who now must face the wrath of Kos and the wroth of
Rahm for their tragic apostasy -- are simply not savvy enough to see that
our 2,000-page boondogglepalooza, riddled with fine-print exceptions,
toothless regulations (which we will 'enforce' every bit as rigorously as
Wall Street has been regulated all these years), impenetrable phase-in and
phase-out schedules, and mild benefits that won't even begin kicking in
for years -- and that even after a decade will still leave millions of
people uncovered -- is much better than a simple, streamlined system that
could be implemented by the end of this year, bringing genuine relief from
intolerable, life-degrading financial burdens and medical problems to
millions and millions of people in dire need right away.

Or as that avatar of negativity, Ralph Nader put it:

"The health insurance legislation is a major political symbol wrapped

around a shredded substance. It does not provide coverage that is

universal, comprehensive or affordable. It is a remnant even of its own

initially compromised self — bereft of any public option, any safeguard

for states desiring a single payer approach, any adequate antitrust

protections, any shift of power toward consumers to defend themselves, any

regulation of insurance prices, any authority for Uncle Sam to bargain

 with drug companies, and any reimportation of lower-priced drugs." 

Hey, Ralph, thanks for reciting my credits! All those "berefts" you cited
were the result of my own super- savvy negotiations! It's 11-dimensional
chess, man, a really heavy-duty Matrix Zen Jedi Master use-the-Force kind
of thing, where you win the game by giving away everything you have in the
opening move! But you're too much a dinosaur to understand. 'Anti-trust
protections!' Hey, Teddy Roosevelt -- your horse-and-buggy is waiting!
Just listen to this guy:

"Most of the health insurance coverage mandated by this legislation does

not come into effect until 2014, by which time 180,000 Americans will die

because they were unable to afford health insurance to cover treatment and

diagnosis, according to Harvard Medical School researchers."

Well, what can I say? 180,000 is a lot of dead people. This is a very hard
choice, but the price — we think the price is worth it.

Then there's this Chris Hedges guy. He used to be a "serious" journalist,
reporting on the imperial wars for our corporate partners in the
stovepiping community -- what old-timers and barnacles still like to call
the "news media." But he went off the rails a long time ago and joined the
carpers and cranks on the sidelines, those malcontents who, unlike so many
of our progressive partners today, have never imbibed the timeless wisdom
of Warren G. Harding: "Don't knock, boost!"

Just get a load of Hedges here, making the big-whoop observation that our
 historic bill is just a bloated version of the already-failed,
Republican-created Massachusetts plan:

"Take a look at the health care debacle in Massachusetts, a model for what

we will get nationwide. One in six people there who have the mandated

insurance say they cannot afford care, and tens of thousands of people

have been evicted from the state program because of budget cuts. The

45,000 Americans who die each year because they cannot afford coverage

will not be saved under the federal legislation. Half of all personal

bankruptcies will still be caused by an inability to pay astronomical

medical bills. The only good news is that health care stocks and bonuses

for the heads of these corporations are shooting upward. ..."

Again with the credits! Stocks going up, corporate heads filling their
pockets, pols gorging on backroom baksheesh, Big Money controlling the
debate ... Earth to Hedges: That's what we're here for! That's the whole
point! You're an old Seventies guy, aren't you, Chris? You remember ZZ
Top? "Jesus Just Left Chicago"? (If you'll pardon the immodesty.) What do
they say? "Taking care of business is his name." They got that right.

So who cares if the plan "fails"? Who cares, if, as you say,

"[the plan] will not expand coverage to 30 million uninsured, especially

since government subsidies will not take effect until 2014. Families who

cannot pay the high premiums, deductibles and co-payments, estimated to be

between 15 and 18 percent of most family incomes, will have to default,

increasing the number of uninsured. Insurance companies can unilaterally

raise prices without ceilings or caps and monopolize local markets to shut

out competitors."

Listen, Hedgie: If the plan was to reform the health care system for the
benefit of the people, then we would have, like, reformed the health care
system for the benefit of the people. You follow? The plan was, is, and
will always be to appear to be reforming the system -- to make the rubes
believe that something is being done to alleviate their pain -- precisely
to avoid really reforming the system, which is just too good and greasy
for too many of us at the top of the imperial pyramid.

And when this plan fails -- as it will, as it will -- then you rig up
another boondoggle, another "great debate" full of sound and fury,
signifying zilch, to keep the rubes at bay. Meanwhile, we can get on to
the real job our corporate colleagues and patrons want us to do --
bringing that other old dream of social amelioration for the common folk
to an end at last: Social Security. Scalpel, Nurse! The doctor is in!

Chris Floyd is an American writer and a frequent contributor to
CounterPunch. His blog, Empire Burlesque, can be found at
www.chris-floyd.com.

What I Learned From the Health Care Debate

Making them want to...

By LAURA FLANDERS

So this is what I learned from the last weekend of the health care reform
debate.

First, lay a coffin at a White House fence and you're subject to arrest.

Spit and yell abuse at members of the Black Caucus as they enter the
Capitol and you'll be left in peace. The same goes for screaming epithets
at Barney Frank.

If you're going to mass half a million strong for immigration reform,
don't expect coverage on CSPAN when they're covering live events in and
around Capitol Hill -- not if there are hundreds of epithet throwers
somewhere close to cover.

And I learned that after all, it has to be said, some Democrats do have
spine. Unfortunately the rest could take some lessons in how to negotiate
from the teeny weeny criminalize-abortion caucus and Rep. Bart Stupak.

Finally I learned that Nancy Pelosi is one hell of a house leader. She
really can corral a majority when she wants. In fact, she and President
Barack Obama can be really persuasive, when they want to be.

So let's not hear any more bunk about the impossibility of the
aforementioned immigration reform, or repealing Don't Ask Don't Tell, or
actually coming up with some real financial regulation.

They can do it when they want to.

The one thing that remains a mystery is how to make them want to. If you
don't have a mountain of cash, that is.

Laura Flanders is the host of GRITtv, which broadcasts weekdays on
satellite TV (Dish Network Ch. More...9415 Free Speech TV) on cable,
public television and online at GRITtv.org and TheNation.com. Follow
GRITtv or GritLaura on Twitter.com.

QUACK CARE BILL PASSES

Sam Smith
I ended up supporting the health care bill. Not because it was a historic
measure, or the most important piece of legislation in four decades or as
an icon of Obama's greatness, but for the same reason one hands over a
wallet to a robber. There are times when principle takes the back seat.
But when it's all over, the robber is not your hero, but still a thug.
Obama essentially said that if you want 16 million poor people covered,
you have to agree to heavily subsidize the insurance industry either
through your taxes or through the individual mandate. Remember that about
a third of that money will go for marketing and other superfluous industry
spending that might have been avoided under a public plan.
The Maine Owl put it well: "The health bill neither is the Armageddon that
the Republicans claim, nor the greatest social legislation since Civil
Rights and Medicare in the 1960s. Rather, it's a warmed over version of
Republican Bob Dole's individual private insurance mandate proposal from
1994. It is what Barack Obama campaigned against versus Hillary Clinton
and later John McCain in 2008."
I can't recall a major piece of Democratic legislation that was so coated
with corruption, intellectual dishonesty, cynicism and political
disloyalty by those pushing it. Obama and the Democrats have offered us a
quack cure - full of corrupt, ineffective and even unconstitutional
provisions - neatly moderated by some good provisions. And we'll be years
straightening it all out.
The liberal groupies at Move On and the like didn't notice or weren't
bothered by all this, but much of America was, and because neither side
was being honest, the public predictably floundered. The irony is that the
Tea Party that the liberals love to hate built itself in no small part on
the indefensible way in which the Democrats have behaved on health care.
Thus, we are not only getting a badly designed bill but a future in which
the right will thrive even more than it already has.
WHAT'S GOOD
Center On Budget Policy Priorities: The plan would expand Medicaid up to
133 percent of the poverty line for all children and adults younger than
65 who are lawfully residing in the United States and not eligible for
Medicare. This would mean that millions of low-income parents, as well
non-disabled low-income adults who do not have dependent children (and who
are generally ineligible for Medicaid today except in a small number of
states with waivers), would become newly eligible for health coverage
through Medicaid. Medicaid is the most cost-effective way to provide
comprehensive and affordable coverage to people with very low incomes and
thereby ensure that the low-income uninsured gain coverage.
Reuters - Within the first year of enactment Insurance companies will be
barred from dropping people from coverage when they get sick.
Lifetime coverage limits will be eliminated and annual limits are to be
restricted.
Insurers will be barred from excluding children for coverage because of
pre-existing conditions.
Young adults will be able to stay on their parents' health plans until the
age of 26. Many health plans currently drop dependents from coverage when
they turn 19 or finish college.
Uninsured adults with a pre-existing conditions will be able to obtain
health coverage through a new program that will expire once new insurance
exchanges begin operating in 2014.
A tax credit becomes available for some small businesses to help provide
coverage for workers.
In 2011, Medicare provides 10 percent bonus payments to primary care
physicians and general surgeons.
In 2011, Medicare beneficiaries will be able to get a free annual wellness
visit and personalized prevention plan service. New health plans will be
required to cover preventive services with little or no cost to patients.
In 2012, The threshold for claiming medical expenses on itemized tax
returns is raised to 10 percent from 7.5 percent of income. The threshold
remains at 7.5 percent for the elderly through 2016.
In 2012, The Medicare payroll tax is raised to 2.35 percent from 1.45
percent for individuals earning more than $200,000 and married couples
with incomes over $250,000. The tax is imposed on some investment income
for that income group.
In 2014, State health insurance exchanges for small businesses and
individuals open.
In 2014, Health plans no longer can exclude people from coverage due to
pre-existing conditions.
In 2014, Employers with 50 or more workers who do not offer coverage face
a fine of $2,000 for each employee if any worker receives subsidized
insurance on the exchange. The first 30 employees aren't counted for the
fine.
Crooks & Liars: Authorizes early funding of community health centers in
all 50 states. Community health centers provide primary, dental and vision
services to people in the community, based on a sliding scale for payment
according to ability to pay.
WHAT'S BAD
There is a huge subsidy for health insurers, paid for out of either taxes
or required purchase of health insurance.
The bill doesn't take insurance and medical cost inflation into adequate
account. For example, between 2000 and 2007, health insurance went up
100%. Under such a rise, the policy subsidies would become less valuable.
Congress tends to lag badly in correcting such situations.
Major provisions of the bill don't got into effect for four to nine years.
This is a considerable con, because it allows politicians to say they've
passed something that may not go into effect until they are either out of
office or, as with the president, safely in his second term. As a result
they don't have to take responsibility for any failure or unanticipated
cost.
The individual mandate is unconstitutional. If the Supreme Court doesn't
strike it down, it will open the door to major new intrusions by the
federal government into individual freedom of choice.
Many healthy people may prefer to pay fines than to purchase health
insurance. Others would have no choice. Just because you're making a
middle class wage doesn't mean you can afford all your expenses. What
effect this will have - including on health insurance costs - is unclear
but it's not good
Medicare will be hurt one way or another, probably most deeply by cuts
recommended by an appointed budget commission with unconstitutionally
broad powers.
Because of the delay in programs, the election of a Republican Congress or
Senate could drastically change things. As the LA Times pointed out:
"Insurance industry experts say there is no way to fully gauge the effect
because of its extended time frame. Four years from now, they say,
Congress and the White House could have new occupants who may try again to
reshape the healthcare landscape."
There will be cuts to the Medicare Advantage plans that could reduce
enrollment by as much as one third.
The bill does not deal with state actions. For example, budget cuts in
Arizona may slash $385 from the state's Medicaid program and end Kids Care
for 39,000 poor children. Writes Casey Newton in Arizona Central:
"Programs benefiting low income individuals and families, such as Medicaid
and CHIP, are politically vulnerable to the whims of conservatives
wielding budget cleavers. Gov. Jan Brewer of Arizona has just provided us
with a prime example of that. Yet popular programs benefiting everyone,
such as Medicare, are relatively impenetrable to the weapons of the
conservatives. Suppose Congress had included single payer in their
deliberations and eventually decided that the benefits were too great to
pass up ,and so enacted an improved Medicare program that covered
everyone. Gov. Brewer and her ilk on the state level would be powerless to
stop it. "
One of the big sleepers in the bill is the plan to "institute
efficiencies" in Medicare programs. In fact, Medicare is far more
efficient than any private insurance plan in the country. Consider this
snippet from CBPP: "The legislation would reduce annual payment updates to
hospitals, skilled nursing facilities, hospices, ambulatory surgical
centers, and certain other providers to account for improvements in
economy-wide productivity. It would also reduce payments to home health
agencies, skilled nursing facilities, and inpatient rehabilitation
facilities." And just what will happen to service and its availability?
Remember: one person's efficiency is another's lack of service.
--
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Obama's Flawed Case Against Single Payer

By ALAN NASSER, COUNTERPUNCH

The liberal imagination has broadened the scope of what it wants to dismiss as unrealistic, utopian and unpragmatic, i.e. as for all practical purposes impossible. These claims have typically been accompanied by the assurance that “This is not something that Americans would go for – it’s not the American way.” There are countless variations on this theme. Obama’s case against a single payer health care system is a conspicuous case in point. What distinguishes Obama’s position on this issue is not merely the weakness of his “arguments”, but the straight-ahead factual falsehood of the some of the counterclaims he has put forward in order to turn the desirable into the impossible.

The Alleged Impossibility of Universal Health Care

In May and August, 2007 Obama stated his position on single payer:

"If you're starting from scratch, then a single-payer system'-a government-managed system like Canada's, which disconnects health insurance from employment-'would probably make sense. But we've got all these legacy systems in place, and managing the transition, as well as adjusting the culture to a different system, would be difficult to pull off. So we may need a system that's not so disruptive that people feel like suddenly what they've known for most of their lives is thrown by the wayside." (May, 2007)

" [W]hen we had a healthcare forum before I set up my healthcare plan here in Iowa there was a lot of resistance to a single-payer system. So what I believe is we should set up a series of choices....Over time it may be that we end up transitioning to such a system. For now, I just want to make sure every American is covered...I don't want to wait for that perfect system...” (August, 2007, at an Iowa roundtable)

Obama offers 5 reasons for not supporting single payer.

First: “..we’ve got all these legacy systems in place” simply means that our system is not single payer, and we’ve had it for a long time. Obama has turned himself into a bent sort of Burkean conservative: we have been marinating in a tradition which so permeates our way of being in the world that to do away with it would upset social life as we know it. This tradition includes…. insurance-industry-based health care! More mundanely: we haven’t got it, so we can’t have it.

Second: it would be hard to “manage the transition” from a deeply flawed system to a much better one. Harder than it was to effect the transition to Social Security, Medicare, Medicaid, desegregation, etc.? In each of these cases, what many people had “known for most of their lives” [was] “thrown by the wayside”. It belongs to the nature of any move from one way of doing things to a very different one that the transition will take some doing. That fact alone settles nothing. What matters is how urgent is the need for change. The US’s irrationally costly system which leaves millions uninsured, a fate suffered by the citizens of no other developed capitalist country, is surely intolerable. We have been given no reason to think that the cost of a transition to universal coverage is so great as to outweigh the massive benefits of this tried and tested arrangement. Obama’s excuses amount to a cleverly disguised a-priori argument against any consequential transformation of the status quo.

Third: the “difficulty” [i.e. costs] of “adjusting the culture to a different system”, given that there is “a lot of resistance to a single-payer system” , outweigh the benefits of single-payer. But what matters is not what a few selected Iowans are alleged to have felt about universal coverage. The demonstrated preferences of the democratic majority can’t be irrelevant.

On this issue Obama clearly means to imply that “Americans” don’t support single-payer. This is factually false. It’s improbable that Obama is unaware of the results of many surveys on this issue, the most recent, to my knowledge, having been conducted between December 14-20, 2007. The results of this Associated Press-Yahoo poll are worth reproducing as they were reported:

Subjects were asked which of the following 2 views comes closest to their own view:

!. The United States should continue the current health insurance system in which most people get their health insurance from private insurers, but some people have no insurance.

2. The United States should adopt a universal health insurance program in which everyone is covered under a program like Medicare that is run by the government and financed by taxpayers.

A majority of 65% supported 2, 34% supported 1 and 2% did not respond.

Those polled were also asked “Do you consider yourself a supporter of a single-payer health care system, that is a national health plan financed by taxpayers in which all Americans would get their insurance from a single government plan, or not?”

55% answered Yes, 44% No and 2% did not respond. Single-payer still has a majority here, but a smaller one, probably due to the pollsters’ use of (what is to some) the red-flag term ‘single payer’. [View the full poll results at http://news.yahoo.com/]

Taxpayer funded, government-run health care insurance for all is a public, not a private, good, and it is the only political project that most Americans are on record as willing to pay higher taxes to achieve. There is in fact not “a lot of resistance” to a rational health care system. Obama knows this. But the interests of those who have heavily invested (literally) in him carry more weight than do the most pressing interests of the rest.

The Ideology of Individual Choice and the Logic of Solidarity

Fourth: Obama claims that a health care plan based on “a series of choices” is superior to one that leaves no choice but instead saddles everyone with the burden of full and affordable coverage. Pity those poor Europeans, deprived of their right to liberty by forced access to first-rate health care. In the City on the Hill, few things are more important than the right to choose: which health care system gives us the most choice? This way of thinking is saturated with the ideology of individualism and its private goods, and functions to obliterate solidarity, as opposed to self-interest, as a political and moral value. This is especially pernicious since, as we shall see, it is only concerted action motivated by solidarity that can bring about a health care system from which no one is excluded because they can’t afford it.

When Obama contradistinguishes choice from universal coverage he unwittingly underscores the irrelevance of individual, self-interested choice to political goals motivated by a commitment to solidarity. Preoccupation with the choice between one doctor and another, one plan or another, conceals a crucial assumption, namely that the fundamental issue underlying the health care debate is one about choice and liberty. An individualist ontology implies that our collective fate is a function of whether or not each individual member of society is savvy enough to make the free choices most likely to promote his or her self-interest. But are people who worry about access to health care really concerned with choice? What weighs upon them is that they can’t afford health care. No individual can make on her own the choice to turn the US into a country that makes health care affordable, available to all. Such a choice is not a choice by an individual about her own well being. It is not even a choice about the aggregate sum of each and every individual’s well being. It is a choice we make together about the kind of society we want to live in. To worry about health care because one cannot afford it is, on reflection, to lament the non-existence of a public good, universally accessible health care, one that can’t be reduced to the sum of all individual goods. The survey discussed above indicates that most Americans implicitly know this. The majority endorse a universally applicable measure, taxation, as a means to institute a universally available, i.e. public, good, access to health care. A universal tax, as for education, roadways, health care, is not an individual cost; it is a social cost. Correspondingly, universally accessible health care is not an individual good, it is a public good. The majority would prefer to live in the kind of society that features that public good. It’s a different kind of society from the one we’re currently stuck with.

That kind of society, and the public goods it prioritizes, can be achieved only if it is pursued as a goal by people acting in concert. That’s where solidarity is on display: in collective action motivated by the desire to achieve a public good.

The kinds of goals/goods in question typically involve bringing about a certain kind of society. For example: the kind of society that provides all with affordable health care, the kind of society that makes access to the means of life -e.g. a living wage- available to all, the kind of society that makes the meeting of human needs the principal motivator of economic production, the kind of society that assigns sufficient resources to the reduction of pollution and the preservation of nature,… Prattling on about individual choice creates a conceptual space within which considerations of solidarity and public goods cannot arise. Talking about solidarity in the language of individualism is like trying to score a field goal in baseball.

Obama references affordability in spite of himself when he claims (falsely) that he wants to “make sure that every American is covered”. The fundamental virtue of single payer is that it detaches insurance from employment and thereby from one’s level of income, so that everyone can afford health care. The question of choice doesn’t even arise if you can’t afford to keep yourself healthy. And come to think of it, were health care universally available, the question of affordability would not arise. Talk of being able to “afford” access to health care would be as misplaced as talk of being able to afford access to elementary education.

Solidarity As a Familiar Phenomenon

The issue is worth dwelling on. In everyday life we are all familiar with the pursuit of irreducibly social goods. Think of a family with kids. A rare and highly desirable work opportunity, but far from home, arises for spouse #1. Spouse #2 has come upon a comparable golden opportunity, also far from home. The family wants to stay together. A decision based on the good of either individual spouse would break up the family. What to do? It’s not uncommon in such a situation for the adults to look to determine what would be good for the family. And what’s good for the family is not the sum of spouse #1’s good plus spouse #2’s good, plus the goods of each individual child. We cannot commensurate and then sum up these different and sometimes incompatible goods. The good of the family is irreducibly social, just like universally accessible health care. Families and households act in solidarity all the time.

Obama’s repeated insistence on the market as the primary agent in distributing resources precludes consideration of questions of solidarity from the outset. He is the instrument of domestic advisors benighted by preposterous economic theories hailing the efficiency and liberty-promoting virtues of the market. For these wags the pursuit of individual self-interest, plus competition, makes the world go round and secures for us all the freedom we (are allowed to) want. As we have seen above, the restriction of human-welfare-enhancing political choices to the realm of competition and self-interest deprives us of the freedom collectively to choose to live in the kind of society that provides copious public goods. That’s a big freedom lost.

The Political Psychology of Solidarity

A sense of solidarity is far more prevalent in much of Europe than it is in the Land of the Free. In a New York Times article titled “For the French, Solidarity Still Counts” (by Youseff M. Ibrahim, Dec. 20, 1995), the author describes public reaction in France to a three-week strike by public workers supported by “hundreds of thousands of demonstrators who filled the streets of every major city in France.” Workers were protesting then Prime Minister Juppe’s proposal to slash medical, social welfare and benefit payments. According to the Times:

“Polls showed an astonishing amount of sympathy on the part of those who did not participate in the strike and who suffered the paralysis of mass transit and essential services. Many people explained that they supported the strike because the Government’s austerity programs are stripping layer after layer of subsidies that permitted French families of even the most modest means to sample the cultural and culinary treasures that only the rich can afford.”

One recipient of the social wage was a woman receiving the standard subsidy extended to pregnant women. The subsidy will continue, for each child, until the child reaches 18. Said the woman: “This is the foundation of our Republican system… Equality and fraternity are not mere slogans here. For me the engagement by the state is an expression of solidarity that gives us values… I think most French people want France’s values to be decided by this spirit, not by cold, remote, economic summits that speak of deficits and competition. That was the message of the strikes.”

This past March one million demonstrated across France in protest of proposed cutbacks in the wake of the financial crisis. I am currently living in France for a stretch of time and have witnessed frequent strikes and other expressions of resistance to neoliberal austerity measures. A sad and stark contrast to the sitting-duck posture of so many US workers.

The Times article provides an implicit explanation of why it is that in France and other European countries there is no general resentment of social benefits available, for example, to single mothers, while in the US more than a few working people oppose this kind of support. The Times reports that the subsidy offered to the woman quoted above “is extended to every mother in France regardless of economic or marital status.” In France benefits to single mothers are not regarded as “special treatment” denied to the responsible and hard-working. There is neither social nor psychological soil in which to plant the seeds of resentment, since the single mother is the recipient of a public good available to all mothers.

Fifth and finally: “I just want to make sure every American is covered...I don't want to wait for that perfect system...” If the president truly wanted to guarantee universal coverage he would not have taken single-payer off the table before discussions began. Whatever is finally settled upon, government will neither negotiate drug prices nor regulate premiums, so we know now that millions will remain uninsured. Obama has known that all along.

Obama rigs the game by characterizing single-payer as “that perfect system”. One of the major weapons in the party-liners’ arsenal is to portray those who believe in greater possibilities as naïve utopians blind to the truism that a “perfect world” is impossible in what William F. Buckley liked to call “this veil of tears”. The logic is fine: since there are no finite limits to the greater possibilities of goodness, and perfection is conceived, as Anselm reminds us, as that greater than which none can be conceived, it follows that perfection is impossile down here. But whoever introduced mumbo-jumbo about perfection in the first place? Isn’t the elimination of a great deal of unnecessary suffering enough? Last I recall, single-payer advocates claim merely (sic) that it is way better than what we are offered. That’s pretty good.

Obama’s case against single-payer frames health-care priorities in the language of atomic individualism. Hence, the range of possible outcomes is determined for the worse before discussion begins. I am suggesting that a good part of our resistance and organizing should consist in reminders that an alternative way of thinking and acting is already on display in some of our common practices, and in already existing benefits won for other populations by aiming at public goods to be achieved by concerted action in solidarity.

Hope that helps.

Alan Nasser is professor emeritus of Political Economy and Philosophy at The Evergreen State College in Olympia, Washington. He can be reached at nassera@evergreen.edu