THE REAL REASON SINGLE PAYER IS INEVITABLE

                                                                                         
                                                                               

                                                                                 
A recent Associated Press article by Ricardo Alonso-Zaldivar outlined a number of problems with the Affordable Care Act (ACA) that “are leading some to wonder whether “Obamacare” will go down as a failed experiment.” Paradoxically, news that Obamacare is in crisis should be encouraging for anyone who understands the economics of health care.  Until people heavily invested in defending it against unfair attacks see that it won’t work, they won’t understand the need to demand a health care system that will.

While it’s a shame that the number of uninsured will rise before the problem can be fixed, that is the inevitable cost of dismissing the only real solution to rising health care costs and decreasing access:  a single payer system. Robert Reich recently argued this, but he missed the main point. He was right that Obamacare has led to decreased competition as insurance companies consolidated and took over state markets, but this is not what will kill it.  The real reason was evident before the debate on health insurance reform began. It’s called the “death spiral” of health care costs.

The death spiral is simple to explain. The more health care costs rise, the fewer people can afford it. This leads insurers to increase premiums and deductibles in order to maintain profits, leading in turn to fewer people buying insurance, and the cycle repeats. A 2005 study published in American Family Physician projected that the average individual would pay 100% of her income for health care at then-current rates of inflation! This trend started before Obamacare. It was built into the system. It is the reason 45 million Americans were underinsured in 2008. It was the inescapable consequence of a system of private insurance.

Of course, no one will pay all of their income for medical insurance. Very few would pay half of that. However, that’s exactly what the AFP study predicted that would have been the average cost in 2015. That hasn’t happened, but it isn’t because Obamacare has decreased the rate of health care cost inflation. The relative stability of health care costs over the last few years started before ACA’s main provisions took effect, and the rate of inflation has picked up again, worse than before.

ACA manages to mask some of the astronomical cost of medical insurance by providing billions of tax dollars to prevent large premium subsidies for a significant segment of the market.  According to the AP article cited above, over 80% of Healthcare.gov customers get subsidies of about 70% of their premiums. That’s tax money going straight into private pockets for a “service” that adds nothing of value to the provision of health care. Obamacare was, more than anything else, a bailout of a failing Wall-Street owned medical insurance industry. The question is, at what point are Americans going to catch on and realize that pouring all that money into the system just to maintain shareholder profits is a fool’s game?

Obamacare only delays the day of reckoning for a system that is pricing itself out of existence.  If the ACA had not passed, it would be on the verge of collapse now. As it is, insurers are dropping out of exchanges due to unanticipated costs of meeting the standards of ACA that are hurting the bottom line, despite large rate increases as the major provisions of Obamacare kicked in. Rates for individual insurance outside the plan continue to rise by double digits. It’s so bad that the largest provider in Tennessee is requesting increases averaging 62%. In part because of uncontrolled costs, the ACA has also left 29 million uninsured. According to the Congressional Budget Office, that number is not expected to change much even if states currently resisting Medicaid expansion join the program.

There are many other major problems with Obamacare, almost all of which arise from the fact that it is insurance-based. For instance, subsidies still leave a 40 year old man earning $25,000 per year liable for up to $5000 in copays and deductibles. Such costs deter many from seeking needed care.  Those trying to minimize premiums, especially young, healthy adults, often opt for high-deductible plans that could leave them responsible for the first $10,000 in bills and a share of anything over that. In case of catastrophic illness or injury, almost anyone can end up bankrupt. Medical expenses are estimated to be the cause of 60% of bankruptcies. Single payer health insurance thus amounts to bankruptcy insurance as well. That is just one of many benefits of such systems, in addition to the fact that they can provide universal health care at a fraction of the cost of our current non-system.

It’s time to face the facts. Obamacare may have been the best that Democrats could produce, but it is not even close to a solution to the problem of rising costs and declining access to health care. There is no excuse for claiming that single payer is not possible, as Clinton has. To say this is an admission that it is impossible to address the corrupting influence of money in politics. That is not acceptable in a nation that claims to be a democracy. The vast majority of Democrats favor single payer. It’s time they stand up and demand it. Waiting until a Congress awash in Wall Street money to do it on its own is never going to work. We can wait for the system to collapse of its own dead weight, or we can work to make our members of Congress force a real debate on health care reform.

THE VAST LEFT WING CONSPIRACY TO DEFEAT SINGLE PAYER

                                                                              

It’s dismaying to see Hillary Clinton still repeating the discredited idea that a single payer health care system would be too expensive.  Although we already know it provides comprehensive and universal health care at a fraction of the cost of American’s non-system everywhere it has been tried, some of her supporters continue to find various justifications for opposing what polls show 85% of Democrats say they want. There has never been a better example of the self-defeating nature of establishment thinking in the Democratic Party.  Attitudes about Clinton are so fixed that you have to wonder, if the primary were a referendum on single payer, would Democrats actually reject it?

Of course, the election is about much more than that. Sanders has opened and closed the last two debates with well-honed arguments that taking on the corrupting influence of Wall Street would be his first priority. What he has not said in his comments about single payer is that concern for their Wall Street patrons was the reason Democrats took it off the table at the beginning of the health care reform debate in 2009. Their excuse was that it was “unrealistic.” Instead, they offered a bait-and-switch in the form of the Public Option. It was billed as a step to single payer because everyone would choose cheap, comprehensive Medicare-type over the spotty coverage of overpriced private insurance. However, Senator Schumer quickly ended that vain hope when he made a deal to handicap the Public Option so it could not compete with private insurance.

Those who understand the economics of single payer know that the “reform” debate was primarily aimed at bailing out the Wall Street-owned medical insurance industry that was in the process of pricing itself out of existence. This is the “death spiral” of insurance costs: Increasing costs drive people from the market, requiring further increases to maintain shareholder profits and industry executive bonuses, resulting in more people unable to afford insurance. Unchecked, this would soon have led to a situation where average Americans would be paying 50% or more just for insurance premiums. Obviously, this is unsustainable. Enter corporate Democrats, with a “reform” that guarantees millions more customers for the insurance industry, subsidized by taxes that go directly into the pockets of Wall Street investors.

Many rank-and-file Democrats failed to ask themselves what the suppression of the debate about single payer said about the chances of eventually electing a Democratic majority that would put the interests of people over profit. The answer is that the Democratic leadership, being dependent on Wall Street to control the White House, is insufficiently willing to challenge the corruption of the system. Until we find leaders in the party who will, there is no reason to expect anything to change.

Reforming campaign finance would make achieving single payer and accomplishing the rest of the progressive agenda possible. The alternative is abandoning hope of getting what we need in exchange for what we can get, in the name of “pragmatism.” In using this as a selling point for her candidacy, Clinton is apparently arguing that truly representative democracy is a naïve notion.  Elect her, she says, and she will use her experience navigating the existing corrupt system to fight for small, incremental victories that do not challenge the corporate takeover of American government and the economy.

Clinton claims that her experience will enable her to guide us gradually in the general direction of where we need to go. It would be very interesting to hear how she plans to do this in the face of a hostile Congress that is likely to continue to be dominated by Republicans who have a visceral hatred for her. Would Democratic chances be any worse with a “socialist” who has explained that all he means by the term is someone who will fight for all Americans, rather than compromise principle on the altar of expediency?

Sanders cannot pass single payer by himself, but neither can Clinton honestly promise to deliver any meaningful reforms of the Byzantine, unaffordable and woefully inadequate system of Obamacare. It will take a mass movement of Americans demanding their government put their interests over corporate profit to get real health care reform.

SETTING GOALS FOR REAL GLOBAL REVOLUTION

This is the second essay in a series exploring a strategy for building a united international front against fascism and war. The first outlined a possible strategy and how to develop it around an overall goal of ending the corruption of governments as a means of establishing representative democracy. As strategic planning starts with establishing intermediate term objectives, that is the main topic of this essay.



For all the hopeful talk about the possibility of global revolution, little has been accomplished that will lead to one unless the threads of change can be woven into a pattern discernable to average people. Real change requires strategy based on common goals that have yet to be agreed upon. When there is general agreement on many of the things that must be changed, a way must be found to articulate these aims in such a way that a substantial majority understands and agrees with them. This means making the arguments in a non-ideological manner to the extent possible. Only then can a strategy be designed to reach these goals that will have broad enough support to succeed in overthrowing the existing order.

While we want to change the world, we have to start by realizing that the critical battles will be fought in the US. It is the center of global economic and military power. As the radical right plays out the strategy it began developing when Goldwater was humiliated in 1964, liberals have increasingly asked why they cannot seem to create a similarly united progressive movement. While a number of theories have been offered to explain the problem, they offer few practical suggestions about how it might be overcome. No progress can be made until liberals and conservatives can agree on the goals of such a revolution. That is not as hard as it sounds.

Occupy brought together a wide range of activists from those with mainstream political backgrounds to young Libertarian and Socialist anarchists at opposite extremes of the political spectrum. Together, they had amazing success at bringing media attention to the fact that people around the world are being systematically oppressed by a global elite often referred to as the “corporatocracy.” In the end, however, its effect was a mere ripple in the collective consciousness. The central message was lost in the babble of voices of people who were more often focused on the symptoms of the disease rather than the sickness, which is corruption of the political process by the economic elite.

As a result, most Americans are back to talking about Duopoly politics. The details of the shutdown and the upcoming debt ceiling showdown are all-consuming topics, even though they are merely manifestations of the larger problem.  The critical fact that is largely ignored by both the corporate and “alternative” media is that the debate has been framed in such a way as to justify the same austerity measures on the United States and other western nations that the international banks through the IMF have been imposing on less developed nations for decades.

The recent government shutdown epitomizes the corruption that is at the heart of everything that is wrong with American politics, which has become an existential threat to civilization as we know it. In this grotesque bit of theater, one side of the Duopoly allegedly threatened the US and world economies to prevent the implementation of Obamacare. That is a preposterous bluff, since the program is a bailout of a bankster-owned insurance industry that was pricing itself out of existence and thus welcome by corporatists with very deep pockets. The insurance industry might want more than it got, but they are not going to start over after winning millions of new customers and taxpayer subsidies that will keep profits rolling in for years before the real costs become apparent. The only possible rationale for this game of chicken is that Republicans wanted to use the threat to give Democrats an excuse to bargain away even more of the social safety net.  How else will Congress continue to provide corporate welfare to the economic elite who support both parties? Democrats stood firm for the moment, but if history is any guide they will capitulate when the question of raising the debt ceiling comes up again soon.  

If corruption is the problem, then any strategy for revolution has to provide a means of striking at the power of the economic elite over the US government. This was clear to the editors of Adbusters when they called for an Occupy movement. They suggested that protestors organize around the issues of Wall Street criminality and the need for a constitutional amendment to reform campaign finance, cutting off a vital source of their control. Their advice was ignored.  Instead, local Occupy leaders were so paranoid about co-option that they refused to work with any established organizations, to give a platform to truly sympathetic politicians or even to make a serious effort to prioritize issues. This guaranteed that the overall message would be lost and that the movement, built more on hope than strategy, would stumble.

It is not possible to change society by cacophonous protest. There has to be a unified message simple enough for the average distracted American to instantly recognize. The most universal and fundamental message that we can have is that America is not a democracy.  For those who fear rule by popular will, it is not even a Republic, because it is not representative democracy.  The systemic corruption by Wall Street of our “representatives” has put the “mock” in democracy. That is the root problem we must attack by consistently pointing out both the role of Wall Street in virtually all of the problems Occupy protested. A constitutional amendment is the first giant step to solving them.

Whether individuals choose to focus their efforts on ending war, dealing with climate change and other environmental issues, establishing universal health care, working for a just economy or any of the myriad other problems Congress refuses to address, they must become part of the effort to tie these issues into the root problem of corporate control of the US government. Until this problem is addressed, all other efforts serve no purpose other than to assure that advocacy groups will always have causes to fight, since they will never make meaningful progress with a government so thoroughly corrupted by corporate influence. All advocates for justice must help make clear that large international banks ultimately dictate its economic and military policies. Only when major organizations learn to coordinate the message with this overarching theme can a truly unified progressive movement emerge.



After the end of the Vietnam War, most of those who had committed themselves to working for social change declared victory and went on with their lives.  Many of them went on to become part of the Establishment they had loathed for putting them or those they loved at risk of having to fight and die in a war for corporate Empire. Once unified by the overall theme of social justice and overturning a social order that systematically oppressed the poor, women and minorities, the progressive movement soon lost its collective identity. The Kennedys, King and Malcolm X were all dead, martyrs to a cause that too few remembered when the immediacy of the threat seemed to fade. Despite gains in civil rights for African-Americans and women, the essential corruption was largely unchanged. Nixon was forced to resign in disgrace and some of the CIA and FBI abuses of power against protestors were revealed. Many of us were under the impression the system was working.

Just as we have learned from the successes and failures of Occupy, so we must look to the 60s for lessons that will help us win the revolution that was left unfinished in the aftermath of the Vietnam War. One key lesson from that struggle was the realization that the power of the People could only be realized when those struggling for justice for various groups of individuals joined forces to fight for liberty and justice for all. Another was that the movement was most successful when it appealed to the universal desire to see America be the beacon of hope for this ideal, contrasting it to the reality of the actions of its government.  Inspiring hope created growing support, while merely inflaming anger at the established order led to resistance by the large segment of Americans who are fearful of change.  As we educate the public about the need for change, we must make them understand that they can make those changes by taking control of their government using a practical strategy, not a nebulous fantasy of creating a new society or form of government by rational persuasion alone.

Without going into detail here, the basic idea behind such a strategy is that the only way to create real change is through the power of the vote. We must find a way for Americans to use it to seize control and establish a government of, by and for the People rather than the economic elite. Many people have reacted to corruption in politics by giving up on electoral politics. Rejecting the only means we have of exercising political power reduces the idea of revolution to a dangerous fantasy, since the only alternative in the end would be violent resistance. Fortunately, it is possible to use the electoral process to pass a constitutional amendment that will effectively reform campaign finance. All it will take is to make support for such an amendment a litmus test for candidates for Congress in 2014 and beyond until we elect a legislature that will pass the amendment.  Since the reasoning behind this claim is not self-evident, a more complete analysis of this idea will be elaborated on in the final essay in this series.

We cannot wait for a movement to arise spontaneously as the result of ever-worsening economic conditions and infringements on civil liberties. If we do, by the time Americans realize a democratic revolution is necessary. It will be too late to challenge a corrupt government that has granted itself enormous power to repress dissent. The least informed will then to resort to violence. This can only result in the deployment of a police state apparatus that is already in place. We need a strategy based on ideas that are widely accepted if we want to achieve a real majority. Occupy should have proved conclusively that with the mainstream media almost completely controlled by corporate interests, it will take more than slogans to create a shift in the collective consciousness of Americans that challenges nearly universally accepted ideas. If we want to lead them to the truth, we have to start from where they are.

To challenge the lies about “free” markets, the notion that democracy equates to the right to vote and the fallacy that there are two parties with competing interests, we have to tie the lessons to ideas that are even more fundamental.  The goal is to make people realize that these ideas are used to keep us from seeing the systemic manipulation of the 99% by the 1%. Because they are so deeply ingrained, it is very difficult to challenge them directly. That means that we have to create cognitive dissonance by highlighting how accepting them conflicts with even more deeply held beliefs.  No ideas are more basic to the American psychology than freedom and representative democracy.  Starting from there, it is possible to create a groundswell of support for a plan that could unite the vast majority of Americans from across the political spectrum in a common goal. How to do that will be the subject of the next two essays in this series.
Next:  Changing the World: The Psychology of Belief