Back and forth on the art of the possible in health care legislation

Grassroots activism, most compellingly by doctors, nurses, and patients, nudged single payer into the public eye in 2009 and, at times, into Congress, although there was never a debate or vote on the single payer bill, HR 676, or the Weiner and Sanders amendments that would have substituted single payer programs for the House and Senate bills. In 2010, the underwhelming end result of a year of citizen activism and government dealmaking has progressives dismayed about the pending legislation, and their criticisms are, in turn, getting some attention from mainstream media.

Much of the mainstream commentary urges the left to stop whining. Some compare health care reform to social security, which itself started small, with delays in implementation and major exemptions. Of course, there was never a private "social security industry" out to protect its interests against the expansion of a popular and vital public program. On yesterday's edition of Democracy Now!, writer and surgeon Dr. Atul Gawande defended Massachusetts' program of individual mandates with subsidies, and said that the current reform bill could, in time, lead to a single payer system. But will a future committed movement to "reform health care reform" be able to make headway against the same corporate interests who limited the scope of legislation in this go round?

Hendrik Hertzberg blames breakdowns in the legislative process, particularly in the Senate, and says progressive anger at Democrats is misdirected. In reply, Firedoglake's Marcy Wheeler points out that progressives' criticisms have been well-directed at deserved Democratic party targets, and for specific reasons.

The lack of a real conference committee is another criticism well-directed, since important changes to the bill, including empowering states to institute their own single payer systems if they choose, were hopefully going to be addressed there. And, as C-SPAN argues, negotiations, whatever form they take, need to proceed on camera. Otherwise, who runs the show? A select number of legislators (working for a not-so-select coterie of lobbyists and industries), who, as John Nichols writes, "are already thinking--make that, already worrying--about the fall and who have set themselves up as conduits for campaign cash."

Finally, there is growing concern on the right and the left as to whether an individual mandate sets a dangerous precedent--kicking privatization up a notch by requiring citizens to buy into the services of private corporations.

Critics of health care reform are not just sniping at a party or a person who didn't live up to the campaign hype. The state of the final health care bill and the path it took points up some serious systemic flaws in our governance and in the way we allow corporate interests to influence legislation and legislators. Despite hyperbole in the comments sections of some blogs, these criticisms point to the need for ongoing work not only on health care, but also governance, campaign finance, and corporate personhood. The challenge for activists in 2010 and beyond is to organize in a way that recognizes we are dealing with politics and the "art of the [incremental] possible", but continues to advance on all these issues as part of a badly-needed system-wide fix.