HealthCare should be a Basic Right and its' Service A Utility
Ultimately Healthcare should already be a basic right. It would be except the Right Wing pushes back against treating Health Care as a Basic Right. Not helping is the Left insisting on imposing pure socialism modeled on the Soviets and thinking this can be done by fiat.
We moderates believe it can be established by working with both left and right via incremental, strategic change.
In 1992 Bill Clinton was elected and instantly branded as a "neo-liberal" by the left for believing we could work with the Right. The result was that "the perfect became the enemy of the Good" and his initial efforts to establish Universal Health Care were defeated in his first year in Office. Both Ted Kennedy and Bernie Sanders gave a stiff shoulder to Hillary Clinton's efforts to get it passed and a combination of events blocked Bill's Bill from passing. There has been a lot of disinformation Since.
Background: Progress Under Roosevelt
The notion that healthcare should be a basic right can be dated to visionaries such as Thomas Paine and T. Roosevelt. Roosevelt saw the need for a National Healthcare System. The progessive wing of the Republican party was eventually rebuked by it's business core. His cousin FDR, articulated health care as a basic right as part of FDR's Second Bill of Rights in 1944. He did this late in his presidency, but died soon after. He did have success in pushing for healthcare to be treated as a vital public utility. His WPA and PWA built hospitals and clinics across the country, including in rural areas.
Soft Subsidies and Non Profits
The Conservative Wing of the Democratic Party rejected Henry Wallace for reelection as VP because they thought Roosevelt had become too pro-labor and middle class and put in Truman. Truman faced a post war surge in GOP power based on Fear of Communism and was unable to stop the roll back of some basic rights during his administration. Even so Democratic leaders including Truman and Johnson sought to implement this notion of healthcare, incrementally, through the creation of Medicare and Medicaid, which would act as soft-subsidies to the system. Soft subsidies encouraged private companies to provide healthcare as a basic benefit to their workers and so we made progress on providing universal healthcare during the 50s and 60s even without it being complete. They fought for this, often with opposition from conservatives, and ironically from doctors and some health care providers throughout the 40's and early 50s.
Finally On July 30, 1965, President Lyndon B. Johnson signed into law the Social Security Act Amendments. This act implemented medicare for retired persons and medicaid for the poor. The signing of the act, as part of Johnson's Great Society, began an era with a greater emphasis on public health issues. Medicare and Medicaid became the United States' first public health insurance programs. Following its signing the AMA cooperated in its implementation.
At the time Medicaid/Medicare were signed, most people in the country had some kind of medical coverage through their work. But not everyone. And so (us) the democrats continued to fight for expansion of coverage by some means. Even so the combination of Non Profit delivery, soft subsidies and Public availability for the Old and destitute seemed to Make the goal of Universal Healthcare Attainable
The Evil Empire Strikes Back
....But there was little further progress for years due to infighting in the Democratic party combined with determined opposition from the Right.... And sometimes from the left.
The Right Wing pushes back furiously, against the very notion that people should have any rights. Their leaders see healthcare access as a privilege and really have little sympathy for people who die because they are too poor to pay for medical care. The Left Wing sees even working with the private sector as a sin, sees profit as a sin and labels anyone who tried to do so as "neo-liberals." The real progress always comes from Pragmatic Progressive Democrats have been working to get a broad consensus from ordinary folks and so have tried to work with those who want health-care to be privately delivered. It also has always come from ordinary people who shame both left and right into working together rather than fighting. Even so, periodically the Right Wing and Left Wing conspire to block incremental progress in the name of their idealized abstractions. That is what happened in 1992 to Hillary Clinton. And both Bernie Sanders and Ted Kennedy ended up rejecting her efforts.
Bernie And Hillary
Bernie Sanders insisted during the 2016 political campaign that he had "helped" Hillary Clinton in 1992-1994. Bernie, surrogate Ben Shreckinger on 6/15/2015 claimed that it was:
"Sanders [who] reached out to Hillary Clinton...." [http://www.politico.com/story/2015/06/bernie-sanders-hillary-clinton-119082]
Shreckinger claims that despite this "reaching out" Bernie
"had been getting nowhere" [http://www.politico.com/story/2015/06/bernie-sanders-hillary-clinton-119082]
In his Efforts
Differing Point of Views
From the Point of View of Adamant leftists, Bernie was "trying" to work with Hillary, and had been. In their view:
"Bernie was playing the role of pragmatic progressive, making overtures directly to Hillary and working to pull her to the left."
He claims that from their Point of View, even up to 2016 Bernie, had:
"been doing that for more than 20 years."
She was referring to 1993-1994
Note the author says 20 years. If they'd been working well in 1992 that number would have been 23 years.
Shreckinger quotes extensively from Bill Curry and notes that:
“Bernie was the founder of the progressive caucus." [Shreckinger]
The mission of the Progressive caucus is to push progressive causes. The Democratic Party has always had a number of factions or clubs, and the progressive caucus represents those democrats who push for more radical action.
On the contrary, they claim that:
"In 1992, the lone socialist in Congress, Rep. Bernard Sanders, as he was then known, wasn’t wild about the centrist Arkansas Governor running for president, and he let it be known publicly." [Shreckinger]
Democrats have a habit of turning molehills into mountains.
Exterminate? Ships going in Opposite Directions?
Shreckinger (and Curry) spin:
"Clinton’s election in November marked the ascendance of the New Democrats and the ideological exile of progressives."
This is not entirely true. The progressives went into ideological exile in 1980 when Ted Kennedy helped shoot down Jimmy Carter in favor of fellow Irishman Ronald Reagan. The Right Wing exploited Religious authoritarian issues such as "right to life." Bill Clinton had run as a moderate Democrat. Everything he did was aimed at appealing to people who had been voting Republican and to win back the "Reagan Democrats" who'd been seduced to vote against their economic interests by racist fear, "law and order" and claims that "Socialism" would "kill jobs. Ironically, Bill followed the strategy the Far left is advocating now. He was able to appeal to working class white males.
Holding the Coalition Together
Bill Clinton represented a "return to the center" and the resurgence of the Democratic Party. I'll admit I supported progressives in both primaries (1992 and 1996). But this narrative exaggerates the divide to create a strawman. Bill Clinton was able to appeal to a wide spectrum of Democrats while pandering to "law and order" fears without coming across as Racist. Some of his policies, in retrospect, pandered to the neo-liberals too much. And some were sleazy. People of all ideological stripes made fortunes when the FCC auctioned off spectrum for what would be cellular frequencies.
Neoliberal Really? Who is Bill Curry?
For those reasons Bill Curry's claims are hyperbole that:
"[Bill] Clinton was the founder of the [Democratic Leadership Council], the whole point of which was to exterminate the progressives,”[Shreckinger]
Bill Curry said this, but Was that really true?
Of course not but that is the narrative on the left about Establishment Democrats. And that narrative is focused on painting Bill Clinton as a traitor to the cause. Bill Curry, apparently, is perfectly willing to feed that narrative 20 years later. He also exaggerates the difference between Bill Clinton and the Progressive wing of the party.
Ships Passing in the night
Even so he's half right about this:
“They weren’t even two ships passing in the night. They were two ships sailing in the opposite direction.” [Shreckinger]
The Progressive Caucus was focused on selling "Single Payer" and didn't care how long it took. Bill Clinton wanted to get some progress on the subject early in his first term because he knew the politics would (and did) become impossible later.
Was Bill Curry a Neoliberal?
Bill Curry didn't come on-board in the Clinton Administration until 1995. He served as a Policy Advisor. Does that mean that Bill Curry is a neoliberal too? Of course not. But by the logic of the left, if you were associated with Bill Clinton, or worked with business, you are a neo-liberal.
Before that Curry was heavily involved in Connecticut politics and thus his job with Bill Clinton was an interlude between efforts to defeat John C. Rowland for Governor. He never won the governorship. Since that time Bill Curry has become a voice for disruption and a fierce opponent of the Clinton's so his testimony is not unbiased: http://www.salon.com/writer/bill_curry/
Playing with Others makes one a Neoliberal?
The Democratic Leadership Council didn't aim to "exterminate progressives", it aimed to work with both left and right to implement policy improvement and to gradually beat back against the real neo-liberals in the Republican party. It was guilty of naivity maybe, but those weren't ships going in opposite directions. Maybe different speeds. The fights between the Clintonistas and progressives were real, but they needed each other.
And the unconscious misogyny of the era (and still now) shows in what actually happened. Shreckinger points out that Bill Clinton had ribbed Bernie. Shreckinger writes:
"In September, Clinton traveled to Vermont for a campaign rally in Burlington at Perkins Piers on Lake Champlain. Sanders was in attendance, and Clinton made sure to point out how and Clinton made sure to point out just how vast the gap was between Sanders and the Republican nominee on Sanders’ pet issue: health care." [Shreckinger]
Somehow those attacking Bill, always broadbrush Hillary as if she never had an independent thought.
It wasn't about Bernie
The Gap wasn't between Sanders and Bush, it was between Bill Clinton and Bush. Shreckinger doesn't even bother to put the word "Bill" in the Sentence. To him Bill and Hillary Clinton were a single entity. Whatever was hateful about Bill Clinton applied to Hillary. He doesn't give Bill Clinton credit for the fact that it was he, not Bernie, proposing a health care plan aimed at providing a right to healthcare at an affordable cost. Shreckinger implies that Bill was criticizing Bernie's plan, not defending his own plan:
"Now folks, there’s a lot of other things I want to say. But every time I say that old George Bush says, ‘Bill Clinton is going to give you a health care system with the compassion of the KGB and the competence of the House Post Office,’ I would remind you — maybe Bernie Sanders ought to be reminding you — I’ll remind you — George Bush has had the benefit of socialized medicine for the last 12 years,” [Shreckinger]
Bill Clinton was talking about his own plan and defending it from attacks by George Bush. That Shreckinger spins this as a dig against Sanders is problematical.
That Bernie might have taken this as a dig against him would be incredible!
Hillary Clinton is a Capable Woman
What we can agree on is what Bill Clinton did after getting elected:
"One of Bill Clinton’s first acts in office in January of 1993 was to appoint his wife to chair the administration’s Task Force on National Health Care Reform." [Shreckinger]
Hillary's Task force was under direction by Bill Clinton, and at that time her mission was to come up with a plan that they hoped would be comprehensive and acceptable to everyone. But they already had opposition from Sanders, and the Single Payer crowd:
"Sanders  convened his own, much-smaller task force pushing single-payer health care for Vermont, and he began trying to pull Hillary Clinton in that direction." [Shreckinger]
Incremental Change Versus Fiat
Vermont almost got Single Payer, in 2010, almost 20 years after the events of 1992-1994. After 4 years of trying to implement it, the Governor pulled the plug on it because he wasn't able to make the economics works. A Single Player plan in 1994 would have gotten nowhere. It would have been opposed by healthcare providers, hospital admins and insurance companies. Pushing it by mandate fails because the healthcare system is a major employer and any cutouts for more efficiency put employees out of work and cut bonuses to their bosses and profits for Stockholders.
Instead we've been pushing incremental change for a variety of reasons.
- because the Right Wing labels treating healthcare as a Public Utility as an affront to privateering principles.
- Because healthcare has massive utility and so utility principles apply to it's management.
- Once people are invested in receiving healthcare they object to sudden disruptive change.
- Therefor incremental change produces a base for advocating for further reforms and keeping current ones.
My Way Or the Highway
The primary difference between Democratic Leftist Democrats tend to be "my way or the highway", while moderates push incremental Change. Our plank on the subject hasn't changed since Roosevelt gave his speech on the Second Bill of Rights. Healthcare is a right. COTUS should acknowledge that. We need a Second Bill of Rights (amended since Roosevelt to include Voting reform & dealing with corporatism). see [Implementing Second Bill of Rights]
Limits to the Influence of the President
Shreckinger relates how Hillary sought to work with Sanders as well as other experts.
"In February, Sanders requested a meeting with Hillary, “to bring in two Harvard Medical School physicians who have written on the Canadian system,” according to the records of the administration’s task force. Those physicians were Stephanie Woolhandler and David Himmelstein, leading advocates for single-payer health care." [Shreckinger]
He recalls their dialogue:
“You make a convincing case, but is there any force on the face of the earth that could counter the hundreds of millions of the dollars the insurance industry would spend fighting that?” [Shreckinger]
“How about the president of the United States actually leading the American people?’” [Shreckinger]
“Tell me something real.” [Shreckinger]
Bill Clinton's Plan
In September, Bill Clinton announced a plan that relied heavily on an employer mandate to provide insurance for workers.
"The Clintons’ less ambitious health care reform package finally died – thanks in large part to insurance industry opposition – in the summer of 1994, right before voters swept Newt Gingrich and Republicans into power in Congress." [Shreckinger]
Letting the Perfect be the Enemy of the Good
To the left, this represented "lack of leadership". But the realistic view of this is that no amount of "leadership" is going to change social feeling until people are ready to accept the social change. Bill Clinton was up against powerful forces that were against "socialism" and trying to roll back democratic control [regulation] over utilities and functions we already had. Hillary and Bill Clinton were trying to come up with pragmatic and incremental change. They knew that once people were exposed to the ideas and saw how successful they were they might support them. But they also knew that there are limits to this influence, as proved to be the case. People on the left have trouble differentiating between pragmatism and being "compromised." The New York Times gives a more realistic assessment of what Hillary was up against:
"It was, at first glance, a move of remarkable hubris, a President elected with 43 percent of the vote expecting Congress to allow him to rearrange one-seventh of the American economy under the streamlined, fast-track procedures of a budget bill." [NY Times]
Sheer Will Fails
And that was the attitude of everyone except the far left, who seem to think that sheer willpower can make such change by imposition without consensus or majority approval. Bill did believe that he might be able to pull it off if he got backing from his own party. But he knew he needed incremental change and to acknowledge the countries obsession with putting a "free market" frame on everything. Unfortunately;
"Senator Byrd, ever the parliamentarian, demurred -- the rules could not be bent, he said, that way and that far." [NY Times]
Too Much Detail = Confusion, Too Little Also
And Delay, is how the Health Care Bill was shot down by its opponents too. Ironically:
"Just one Republican in Congress, Senator James M. Jeffords of Vermont, ever backed Mr. Clinton's bill. In the House, moderates were told bluntly by Republican leaders not to offer amendments that might make legislation easier to pass." [NY Times]
A successful bill would have paved the way for further reform. Which is why it was opposed so determinedly. The GOP demagogued the mandate, similar to what they would do to ACA 9 years ago. Ironically the Presidents plan was portrayed as threatening. The Republicans deliberately
"misread the mandate, read it much too broadly. Since people are very cynical about government and the President only had 43 percent of the vote, they wanted reform, but they wanted something easy to understand, something that did not look as threatening as the Clinton plan. The Clinton White House read it as much too broad in terms of trust in President and Mrs. Clinton."[NY Times]
The Power of Lobbyists
And they spent, spent spent!
"Lobbyists for every conceivable interest that could be affected by any version of legislation swarmed over the Capitol. And to influence the public, more than $50 million was thrown into advertising, most by opponents and much of it simply false." [NY Times]
Of course the media failed to bother to push back against lies or educate the public. Also like recent events. And real reform won't come until there is some consensus about what to do!
""You are not going to reform one-seventh of the American economy without business support and Republican support," Tom Downey, a former Congressman who is now a lobbyist, said in an interview this weekend." [NY Times]
Circular Firing Squad
And we never got even universal Democratic support. Bernie wasn't fighting the Clinton's. He was fighting Republicans, business interests and fellow Congressional Democrats. But leftist Democrats reserved their fire as always for their allies.
"The struggle for universal coverage began to collapse in the committees. Again and again, members tried to reach consensus on how to cover everybody without antagonizing the small-business lobby. But they always ran up against the same problem: without an employer mandate or a broad-based tax increase, how could they pay for it? 'You Can't Go That Way" [NY Times]
With Friends like these
Meanwhile people like Bernie tend to be, as the background assessment on Bernie notes:
“He is a cosponsor of Congressman McDermott’s single-payer bill and given his reputation for independence and his somewhat combative style may be one of the more difficult Members to get on board the Administration’s proposal.” [Shreckinger]
And he was. Representative Cooper would say about Bill Clinton/Ira Magaziner's plan:
"you had committee chairmen who were for the Canadian health care system, who were to the left of Clinton," he said. "And you had the average House member who was way to the right of Clinton, and the President's proposal -- the Ira Magaziner proposal -- satisfied no one." [NY Times]
And they lost a key consensus builder:
"Dan Rostenkowski of Illinois, who gave up the chair when he was indicted in May on corruption charges." [NY Times]
It takes Consensus
Democrats didn't back it, even in Vermont. Bernie's Single Payer Dreams were put on hold due to opposition from Howard Dean, then Governor. Private Insurance, Drug Companies, For Profit Healthcare companies, were opposed to change. And unless their concerns are addressed, they oppose it to this day. They can be defeated. But it won't be easy.
Bernie Doesn't stand behind anyone
Meanwhile Sanders had already decided to spend the next 6 years helping Gingrich undermine Bill Clinton. But at least he opposed impeaching him:
“while the president has behaved shamefully and deplorably, his actions do not rise to the level of an impeachable offense.” [Shreckinger]
Children's Health Insurance Program (CHIP)
Instead of holding out for the Perfect. Hillary fought for CHIP. Because the social basis for CHIP could be made, it had a ready constituency in parents and the working poor. A majority could be convinced to support it And:
"The Children's Health Insurance Program (CHIP) was signed into law in 1997 and provides federal matching funds to states to provide health coverage to children in families with incomes too high to qualify for Medicaid, but who can't afford private coverage. All states have expanded children's coverage significantly through their CHIP programs, with nearly every state providing coverage for children up to at least 200 percent of the Federal Poverty Level (FPL)." [Gov Web site]
Basic Health Program
Eventually we addressed the needs of working poor even more
"The Basic Health Program was enacted by the Affordable Care Act and provides states the option to establish health benefits cover programs for low-income residents who would otherwise be eligible to purchase coverage through the Health Insurance Marketplace, providing affordable coverage and better continuity of care for people whose income fluctuates above and below Medicaid and CHIP levels." [Gov Web site]
There are simple things we can do if our goal is to unify the system. But the argument for them has to be on a security and pragmatic base for the argument to carry. I've designed all kinds of ideas I know would work. Anyone with an interest in the subject can come up with their own. The ones that carry are the ones that can convince lots of people to go for them and have an enduring basis. We may yet get universal health care and education reform. But not for abstract reasons. It has to solve a problem.
Those who demonize pragmatism are wrong. The Republicans are finding that out now.
Sources, Related Posts and Further Reading
- Four Freedoms and Six Basic Rights:
- History of Health Care in USA
- Medicaid: https://www.medicaid.gov/about-us/program-history/program-history.html
- Note I started this post back in 2015 while fact-checking the primaries. But I had other more important concerns and it stayed incomplete in draft form til recently. I'm trying to clean up old posts. Others have written on the subject since then:
- by Adam Clymer, Robert Pear and Robin Toner. August 29 1994
- End Note
- I started this post almost 2 years ago while fact checking Sander's Camp allegations. But I needed to write about related stuff for my own take to make sense to me, much less to anyone else, before publishing it. So it sat in draft until I could form a coherent narrative. Bernie is Bernie. Hillary is Hillary. Neither are evil. But my way or the highway never works in Politics