The
opportunity to build a broad popular movement against mandatory
for-profit insurance comes not from the ideologues, but from the
millions of Americans who will not be able to pay the cost demanded for
private insurance. Think about any working-class family you know. Do
they have $1500
to $8600 socked away in a savings account, waiting to be handed
over to Humana or WellPoint? Of course not. Rather, millions of American
families are just one major car repair bill away from insolvency.
These people will disobey the mandate, not because they're being told
to do so by Glenn Beck, but because they simply cannot pay.
The key question will be whether those who cannot pay view their actions through a lens of individual failure -- the failure to earn enough to participate in the for-profit insurance market -- or as a political act and a collective act. Will they join with others who also cannot pay, and organize into a political force? Clearly, single-payer advocates have a role to play here.
The challenge for single-payer advocates like me will be that an opposition movement built of those who cannot pay will not, at first, be based on a desire to completely remake the system. Rather, it will form around a demand to make federal subsidies more generous, so that everyone can participate in the system. This is a demand we should heartily endorse, knowing that any changes that increase the federal share of premium costs will further drive in the wedge between Congressional corporatists and Congressional fiscal conservatives. Our short term goal should be to make the system more expensive, so that pressure in Congress to reduce costs by cutting private insurers out will increase.
But what is the chance that, even facing rapidly escalating costs, Congress would ever choose to cut their insurance-industry cronies off from the public feeding trough? Ironically, the health "reform" bill itself contains two small seeds of hope.
The first is in cuts to the Medicare
Advantage system, first established under President Clinton and
later expanded by President Bush, which provided government subsidies to
for-profit insurers to offer supplemental coverage to those on
Medicare. The entirely predictable outcome of this plan was that private
insurers profited at public expense, until the Obama administration
saw a ripe opportunity for cost savings with which to fund the
President's larger health care plan. In fact, the bulk of cuts in Medicare in the Obama plan come from cuts to
for-profit Medicare Advantage providers, which could lead to a
shifting of these services out of the for-profit sector and back into
the public sector.
The second seed of hope buried within the bill's 2000 pages has nothing to do with health care. It's in changes to the federal student loan program that would have the federal government lend directly to students, cutting for-profit bankers out of the very profitable (for them) student loan market. This common-sense change was helped along by several high-profile scandals in which bankers "partnered" with colleges and universities to steer students into high-cost, high-profit loan packages. As with Medicare advantage, and as I expect to be the case with mandatory insurance, the CEO's proved to be their own worst enemies - and our best allies.
Clearly, none of this is going to happen quickly. It will be six years before the individual mandate begins to take hold in a serious way, and a falling-out between corporate-government "partners" over escalating costs won't happen soon, either (It was nearly seven years between the Bush administration's massive expansion of Medicare Advantage in 2003 and the Obama administration's cuts to the program in 2010.) But, for those of us who demand single-payer, long-term struggle is nothing new. Our parents and grandparents joined in this struggle in 1948, and our children may be part of the struggle in 2020. Now is not the time to give up hope.
The key question will be whether those who cannot pay view their actions through a lens of individual failure -- the failure to earn enough to participate in the for-profit insurance market -- or as a political act and a collective act. Will they join with others who also cannot pay, and organize into a political force? Clearly, single-payer advocates have a role to play here.
The challenge for single-payer advocates like me will be that an opposition movement built of those who cannot pay will not, at first, be based on a desire to completely remake the system. Rather, it will form around a demand to make federal subsidies more generous, so that everyone can participate in the system. This is a demand we should heartily endorse, knowing that any changes that increase the federal share of premium costs will further drive in the wedge between Congressional corporatists and Congressional fiscal conservatives. Our short term goal should be to make the system more expensive, so that pressure in Congress to reduce costs by cutting private insurers out will increase.
But what is the chance that, even facing rapidly escalating costs, Congress would ever choose to cut their insurance-industry cronies off from the public feeding trough? Ironically, the health "reform" bill itself contains two small seeds of hope.
The second seed of hope buried within the bill's 2000 pages has nothing to do with health care. It's in changes to the federal student loan program that would have the federal government lend directly to students, cutting for-profit bankers out of the very profitable (for them) student loan market. This common-sense change was helped along by several high-profile scandals in which bankers "partnered" with colleges and universities to steer students into high-cost, high-profit loan packages. As with Medicare advantage, and as I expect to be the case with mandatory insurance, the CEO's proved to be their own worst enemies - and our best allies.
Clearly, none of this is going to happen quickly. It will be six years before the individual mandate begins to take hold in a serious way, and a falling-out between corporate-government "partners" over escalating costs won't happen soon, either (It was nearly seven years between the Bush administration's massive expansion of Medicare Advantage in 2003 and the Obama administration's cuts to the program in 2010.) But, for those of us who demand single-payer, long-term struggle is nothing new. Our parents and grandparents joined in this struggle in 1948, and our children may be part of the struggle in 2020. Now is not the time to give up hope.
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