mardi 3 février 2009

Single-payer support: A tale of more than one point of view

Yesterday was a second (or third) difficult day for this ardent supporter of single-payer. Having benefited from the single-best single-payer medical system in the world for nearly 7 years, married to a doctor practicing in it (heart and soul) for more than 25 years now, I have become single-minded in my support: single-payer or bust. But, I was shaken in my sense of justification and virtue in that position by someone for whom I have a very great admiration and appreciation, and I had to do some considering.

It helped me to see that all of us gathered around the single-payer hearth are not of the same way of thinking, but none of us can be spared, and our conviction that single-payer is the best solution economically, morally and in terms of social justice and our commitment to seeing it written into law in the USA cannot be measured and parsed according to the time-frame in which we see it becoming law realistically, nor the number of steps or compromises that we understand (or accept) will be needed to get there.

The debate

The tension rose in the exchange on SiCKO Universal Health Care H.R. 676, as one called out the faults in the 30-page bill as written, concluding that it cannot be passed as it stands, that this is among the reasons why it has failed every time since 2003, and that with all the best intentions, Rep. John Conyers does not have the clout, not even being a member of the House Energy and Commerce Committee with jurisdiction over heath care reform -- without Waxman and Pallone, he said, from a position of greater experience with Washington, it's a non-starter --, and those who said that this is our only bill, that it can be perfected, and that they did not appreciated being taken for a fool, or a wedge, politically, as it was suggested that they have just joined the equivalent on the left of the right-to-lifers in their single-issue fervor over single-payer.

The points of view

Mark --

Baltimore, Maryland. Retired. Former Director, Common Cause, Maryland, 1978-80. Previously uninsured, presently receiving Medicare.

Priorities: first, let's get you (and all my other uninsured brothers and sisters) healthcare. Exactly how it is delivered is important, but not as important as covering you somehow.

Now, step up with me to the top of Mt. Olympus, and see our country in the broadest view. Our top-level problem isn't healthcare, or home loans, or global warming. It's values. We have a lousy value system. Our civilization is seriously askew from what it should be.

Digression: During the 1970s, early in my career, I held several very high level leadership positions on energy and the environment and government ethics. The Carter White House assigned a staffer to attend my meetings (I traveled first class; staffers traveled coach - very heady). Carter had the right approach to energy-environmental issues and proclaimed energy policy "the moral equivalent of war." I told the assigned staffer, "no, the energy issue is the forum for debate of the value system of Western civilization." I spent many happy hours thereafter inside the White House. But all too soon, we lost everything to a succession of presidents variously lacking in brainpower, vision or ethics.

Now we have a president who has it all, I sincerely believe. The structure which once was the United States lies in absolute rubble at his feet. Rebuilding began in earnest at 12:01 PM January 20 - but what to do first? What is the master plan of to-do's for today, this month, next 3 months, this year, this term, next decade, this century? How do these to-do's interact ... which is a foundation block and which a load-bearing beam and which a higher floor, etc.

Short-term compromises are needed now, not for "the art of the deal," but to ensure our very survival while likewise facilitating long-term construction. This involves the most sophisticated strategic planning in our history. The first foundation block is re-establishment of the Rule of Law. (Unnoticed by news media, Obama has appointed Elena Kagan, Dean of Harvard Law School, as Solicitor General (decides which cases to bring before the Supreme Court) and Neal Katyal her principal deputy, to prosecute and argue the cases selected. Katyal is internationally famous as the guy who single-handedly brought down Bush's views about "the war on terror," personally defending a Guantanamo prisoner and arguing the case of Hamdan v. Rumsfeld before the Supreme Court. He won.)

The value system of Western civilization is, at last, undergoing reconstruction. Hopefully soon we'll cobble some kind of healthcare compromise which will better serve our needs. We'll also do a glue-and-paste on education and other issues. Later - my guess would be maybe 20 years out - we'll be able to complete the construction of a human rights-based society, in which entrepreneurship is valued but truth and justice are held sacred.


Lauren --

Connecticut. Younger, uninsured.

i agree with your assessment on the state of western values. unfortunately, the philosophy of our culture has done little to promote the dignity of the individual above all; instead it promotes a rugged individualism which is not the same thing as respecting human dignity.

my mentor, daisaku ikeda has stated, "the reformation within one man can transform not only his karma, but that of a nation as well", meaning that a single individual can spur and encourage positive changes in others, which then extends and spreads throughout society. i understand your reasoning for a gradualist approach; however, i am wondering if it is sufficient to redirect the current of our times.

i get the impression from some of your remarks that i am placing my healthcare priorities ahead of some strategy for the construction of a more just and equitable society. perhaps i need to reflect on my discourses. sometimes it is hard to say what needs to be said, but if you never say what needs to be said then what will ever change? i, like you, have watched our government deteriorate into a system of fraud and waste. unlike you, i am too young to ever remember a united states of america that ever lived up to its promises, until maybe, just maybe now. i have chosen to support my newly elected president by saying what i believe20to be right. i do so, not in a spirit of criticism toward him, but in the spirit of supporting him and the change he hopes to accomplish. obama has stated that he wants to hear our ideas and i don't think he meant ideas that we have modified because the ideas seem like an impossibility.

the most sophisticated strategic planning in all the world will not accomplish anything if people are not encouraged to stand up for what they believe to be right. hopefully, we can use both planning and encouragement as a means to create, one goal at a time, the type of society that you and i see in our hearts.


Myself --

Architect, currently not employed. Have received employee medical coverage and been uninsured as the mother of a young child, during which time I accepted a 20-hour a week job with Starbucks -- which turned into a 40-hour+ week of hourly-paid hell -- to get health benefits for us. Presently covered by the French National Health Program, La Sécurité Sociale.

I thought for a moment after reading those two emails, and -- first -- I felt a tremendous respect for the tenor and the tone of the exchange, as well as the quality of the thoughts and the expression given them. Second, I understood that both are true for me, and I wrote the following reply:

I am tempted to continue to stand back and listen. I have often found in these fora that it is more interesting to listen and let what I hear interact with my own thoughts and convictions, feel those begin to shift, catch on something that I will not name that settles some element of them back where it was, while another changes. I welcome the debate because it is reflective of a wider slice of the society in which we are members, which is democratic and inclusive, and the changes we are discussing are for all of us. I prefer to hear dissent and engage it than to remain secluded with those who see things the way I do because sometimes I have forgotten that there are others who agree with me on the broader issue, but not on the frame in which I present it. This is one such case.

I am in need of reflection right now. I am of both Lauren and Mark's mind, I realize, but that necessitates an intellectual choice because I cannot be both. I am most tempted to use a precious conjunction in structuring and expressing my own thoughts (I am an architect). For example, I believe, like Lauren, that I am supporting President Obama by thinking through my beliefs and my values and giving them voice, working for the realization of what I think is needed for my society's betterment, but I can see Mark's point and understand why it is important, and this gives me pause: there is a very significant element made up of several components, from private insurers and health groups to lawmakers on Capitol Hill, who will openly oppose single-payer, and there are components from lawmakers to the president who have "seen the tea leaves" and will not support single-payer now, even if they believe, as I do, that it is the right solution, and this is because they know that the killing field isn't between citizens, but will be under the dome of the Capitol building itself, and if we go that far, no heath care solution -- as imperfect as it might be in our minds -- will come of the debate. What do we prefer? What is possible, given all of the elements present and interested in health care reform or maintaining the status quo, or nothing, like in 1992-1994?

It occurs to me that I can make room for both by allowing myself the use again of a conjunction in another expression of my beliefs: I will continue to work for single-payer because I believe that it is sound economically and that it is reflective of the true values of our country -- and any society that places humanity and justice above corporate profits --, but I will soften my rhetoric and place the decision of the president -- for whom I voted -- in that persepctive, believing that he would appreciate that from any of us, that we think for ourselves and work for that in which we believe, but that we acknowledge that all things take time; it was not with his election and occupation of the Oval Office that all would be set right. Indeed, he did not promise it. He never called himself a progressive politician, but a pragmatist who would seek bi-partisan solutions -- and this can mean conservative and progressive more meaningfully than right and left -- which choose their allegiances and camps most often in Republican and Democrat.

The work of setting things to right has begun, and of course our voices and our work in support of single-payer is necessary, but by working with respect and care and by taking our time, we might bring along the greatest support as we continue to change the tenor of our country, and the young will hear you, Lauren, just like we hear Mark today. It's like wind across the Plains, from one end to the other. The wind is blowing, but it hasn't reached the far side of the tall grasses. We will see them move, too, later, as the winds continue and reach farther.

Single-payer, yes, but I will -- while watching the Daschles with a careful and critical eye -- allow for what is possible and support what can be now, while adding a soft "but single-payer is my ultimate goal for our American society, and I will keep working."


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