The Move Away from Single-Payer

by: David Sirota

Mon May 11, 2009 at 16:00


In light of the White House's big hand-holding session today with the pharmaceutical and health insurance industries today, let me take this moment to note that a cynic - or, perhaps, a realist - might look at President Obama's statements on health care and see a politician moving farther and farther away from his progressive roots and closer and closer to the Washington/money Establishment.  
David Sirota :: The Move Away from Single-Payer
In 2003, Obama said he supports a single-payer health care system, and that the only reason we "may not get there immiediately" is "because first we have to take back the White House, we have to take back the Senate, and we have to take back the House" - which, of course, we have:

"I happen to be a proponent of a single payer universal health care program...I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14 percent of its Gross National Product on health care cannot provide basic health insurance to everybody. And that's what Jim is talking about when he says everybody in, nobody out. A single payer health care plan, a universal health care plan. And that's what I'd like to see. But as all of you know, we may not get there immediately. Because first we have to take back the White House, we have to take back the Senate, and we have to take back the House." - Barack Obama, 2003

In 2006, I spent a day with Obama in the U.S. Senate, and he said he supports a "debate" on single-payer, but that he also had started having doubts, now that he was in the Senate:

I asked him to give me some specific examples of what he meant. Is a proposal to convert America's healthcare system to one in which the government is the single payer for all services revolutionary or reformist? "Anything that Canada does can't be entirely revolutionary-it's Canada," Obama joked. "When I drive through Toronto, it doesn't look like a bunch of Maoists." Even so, Obama said that although he "would not shy away from a debate about single-payer," right now he is "not convinced that it is the best way to achieve universal healthcare."

By last week, it became clear that Obama and his allies in Congress will use their legislative leverage to prevent even a debate about single payer. Here's the Associated Press:

Baucus and many others, including President Barack Obama, say single-payer is not practical or politically feasible.

"Everything is on the table with the single exception of single-payer," Baucus said.

My guess is that Obama still believes in what he originally says, because he knows the evidence about the supremacy of a single-payer system is irrefutable. But I'm also guessing that he's afraid of being attacked by moneyed interests that enjoy the status quo, and he's surrounded himself by Clintonites who, after the health care debacle of the early 1990s, aren't interested in antagonizing the insurance industry.

However, let me just echo Ta-Neishi Coates who recently wrote that "while a good politician accomplishes what is possible, a great one expands the realm of possibility - he doesn't simply accept the lines of argument as they're drawn and hew to the side with the most soldiers, he tries to redraw those lines to benefit his ideals."

The whole idea that single payer is the best option but politically "impossible" is simply unacceptable. Last I checked, electing an African American president was politically "impossible"...until Barack Obama went ahead and got himself elected president. The entire notion of "politically possible" and "politically impossible" is a canard that justifies the status quo. So while it's certainly terrific that Obama is fighting for some sort of universal health care system, and one with a public option (which could ultimately become a single-payer system), let's just remember: Nothing has been politically "possible" until it actually happened - and so if that's the major argument against single payer, it's not just a poor argument, it's a fraud.


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points taken, but i have to say that, if we get a real public option, (0.00 / 0)
we are well on the road to single payer.  so, i'm not sure if obama has moved as far from his ideals as you suggest.  

Please stop being so DUMB and Naive..or is it just Dumb? (0.00 / 0)
Nobody cares about PUBLIC OPINION....don't you understand that YET!

C'mon...

Politicians care about organized groups with money who act as voting blocks.

The public is simply an object to be manipulated throught "framing"...and simply saying two things that are actually juxtaposed...like...

Having Insurance companies VOLUNTEER???????????? are you kidding?????? NO!!!!

to reduce their charges...

How do you interpret that?

It means that Health Insurance companies will CHARGE MORE THAN EVER once the idea of single payer or universal coverage is dead based on this SILLY SUCKER promise.

I am overcome with exasperation on how people like you guys just don't seem to understand that OBAMA is not Liberal or progressive...he's conservative....that's putting it mildly..

Jezus Christ...it's not enough that the credit card companies, the government , the defense industry and the utility companies and everyone else is stealing your money with "look over there" Swine Flu!.....you guys still are "waiting to see" if Obama is going to come through...

Well he's not.

C'mon. Please


[ Parent ]
The sky, it's falling! (0.00 / 0)
No, really, guys!  It really is this time!  Seriously!

[ Parent ]
Blind to the Obvious. Focused on Illusion (0.00 / 0)
Don't they have a doomsday clock...these reasoned experts that many people put their trust in?

Don't these "experts" with all their rationality and reasoning say that we are very close to a nuclear exchange either by accident or intentionally?

Why did they invent nuclear weapons? Answer: To use them. There is INTENTION behind their development. And it's a self destructive intention.

More than ever we are close to some sort of end of times...but don't listen to me...it's what the "experts" say....

It's common sense that I think your lacking. Many of the so called progressives can't see what's plainly before their eyes, instead they intellectualize some kind of explanation for what is unpleasant and staring you right in the face and you call it by another name, pretending it's not there. You pretend Obama isn't there, he's somewhere else.

That's why Obama ...who is clearly not going to do anything about health care or war or anything for the average citizen...is kind of invisible to you. You can't see the obvious.


[ Parent ]
oooo k. apparently i struck a nerve -- why, i do not know. (0.00 / 0)


[ Parent ]
"Option" <> "Opinion" (4.00 / 2)
That was an awfully long diatribe based on misreading a single word in a very short post.

Please type less and think more.


[ Parent ]
Depends on what "real" means here... (4.00 / 9)
And what strings come with it.  For example, if the insurance industry demands an individual mandate in return for supporting this public option, it would likely be a real step away from single-payer...and we'd see insurers reap a bonanza of new customers, revenue, and influence in the delivery of medicine.

That's why the Baucus protests are so important.  If witnesses before the Senate Finance Committee are not allowed to mention or debate single-payer healthcare,  then we'll have no way to consider the impact of the various public option proposals, and to guess which will lead to or block single-payer reforms.

Of course, nurses and doctors will be protesting Baucus again, outside the Senate Finance Committee meetings on Tuesday at 10, with the "Florence Nightingale Day Protests"

The National Nurses Organizing Committee (AFL-CIO) is the largest RN union in U.S. history, representing thousands of activist nurses in all 50 states, and leading the fight for guaranteed healthcare, patient safety, and nurse rights.


[ Parent ]
agreed -- keep up the pressure! (4.00 / 1)


[ Parent ]
I think the absolutely key issue (4.00 / 5)
in any public option is whether it introduces a slippery slope whereby, over time, more and more of the public will plunk down for the public option over private options. That, of course, will happen only if the public option is so defined that it can exploit the natural advantages such options should enjoy: lower overhead; no obligation to impose a profit; the ability to negotiate down the price with health care providers, device manufacturers, and pharmaceutical companies. Insofar as a public plan is stripped of these advantages, the likelihood that the public plan might bring about single payer goes down dramatically, perhaps to a vanishing point.

[ Parent ]
I Am A Huge Fan (0.00 / 0)
    I have been doing everything with Progressive Democrats for America.  I think Democrats for America had a better last week on how to get there.  Now, I am wondering.  I wonder what Dean's reaction is?

    Is it possible that the Progressive Caucus will not vote on this plan?
    Similiarly, can these 16 Democratic Senators block the legislation without a public option.  It seems that Ron Wyden, just caved a little.  He says that there must be not just a pledge, but "strong legislation."  The private insurance co's will use their massive lobbying fleet to break the laws.


[ Parent ]
Agreed (4.00 / 2)
There is a reason the fight over the public option is so big.  It doesn't seem like a big deal, but it is.

[ Parent ]
I can't disagree (4.00 / 3)
By the way, I see Kirsten Gillibrand is supporting a public plan by posting a diary entry on Daily Kos.  Personally I take it as evidence the netroots are viewed as important in primaries, and welcome the post.



New Jersey politics at Blue Jersey.


Agreed (0.00 / 0)
Hopefully she is not a lone voice in the senate.

[ Parent ]
we know she's not a lone voice (4.00 / 1)
She is one of 16 senators who signed a letter recently advocating a public health insurance option open to all Americans.

The group also included Senator Sherrod Brown of Ohio and

Senate Majority Whip Dick Durbin (D-Ill.) and Democratic Sens. Bob Casey Jr. (Pa.), Kirsten GillIbrand (N.Y.), Tom Harkin (Iowa), Daniel Inouye (Hawaii), Ted Kaufman (Del.), Carl Levin (Mich.), Jeff Merkley (Ore.), Jack Reed (R.I.), Jay Rockefeller (W.Va.), Charles Schumer (N.Y.), Debbie Stabenow (Mich.), Sheldon Whitehouse (R.I.) and Jim Webb (Va.), as well as independent Sen. Bernie Sanders (Vt.), who caucuses with the Democrats.



Join the Iowa progressive community at Bleeding Heartland.

[ Parent ]
The way to go is to make single payer impossible to deny. (4.00 / 3)
I suggest organizing around The Right to Health. But whatever wording is used, we need a continuous drum beat and march and demand for real healthcare fort Americans.

Ii is beyond imaging that America lets families be destroyed economically  by a heart attack. Everyone reading knows someone whose family's fortunes where destroyed by a health emergency. Someone who was going to retire and leave soemthing to their grandchildren, but lost their home and savings and is working at Walmart as a 'greeter' at 70. A family literally begging for food after a bypass. Selling everything to pay for bone marrow treatments.

The time has come to say NO MORE. The only reason to continue this charade of pain is to keep pouring the cash ripped from grandma's hands into Larry C. Glasscock's overpaid pockets. Its appalling.

Here's a rallying call "Single Payer Damn it!"

Change
"We must break up the banks and never again let them get so big that they distort our politics and take down the economy.


And Medicare for All is cheaper (4.00 / 1)
No need for healthcare insurer profits and payments to shareholders
No need for healthcare insurer excessive CEO salaries and bonuses
No need for healthcare insurer advertising
No need for 50-page legal documents outlining all the reasons you should be denied healthcare
No need for zillions of administrators trying to read those legal documents to see if you qualify
No need for zillions of administrators in doctor's offices shuffling paper around to dozens of health insurers trying to get reimbursed
No need for all the anguish and heartache associated with denying people proper healthcare -- we might actually be able to act like we live in a civilized society

[ Parent ]
yeah (4.00 / 1)
no disagreements with your post here. Obama seems to be taking the safe road through his first term. As you mentioned, he's not willing to piss off the moneyed interests nor do I see him doing so anytime in the next 4 years. It's a shame because he could be a "change" politician. His ability to control the dialogue is way above average for a politician.

Unfortunately, Democratic leaders are doing much to disappoint. Its hard for me to see how leaders within our party are any different from a rag covering up a gash that needs stitches. Sure, it's great that the GOP isn't controlling the policy on their terms, but where exactly are the real solutions that will pay dividends down the long-term?

I want to see those solutions. I really, really do.


Preach it brother Sirota (4.00 / 1)
On the 20th anniversary of the fall of the Berlin wall we should expand our idea of what is possible.

Progressive roots? (4.00 / 3)
What progressive roots? Obama's not a progressive and never has been.

I tried to tell you that during the primary, but you were so busy finding reasons Clinton supporters were racists that you didn't listen.

Carolyn Kay
MakeThemAccountable.com

Carolyn Kay
MakeThemAccountable.com


really? working to end apartheid is not the action of a progressive? (4.00 / 3)
how about working as a community organizer to improve low-income people's living conditions?  

if obama wasn't a progressive before running for office (leaving aside the question of whether he still is progressive), then i don't know who is a progressive.  


[ Parent ]
When and where did Obama work to end apartheid? (0.00 / 0)
Whose life did he improve as a community organizer? And whose life did he improve when he helped Tony Rezko get funding to build substandard housing for those same poor people?

You don't know who is a progressive. The real one, once Edwards dropped out of the race, was Hillary Clinton.

Carolyn Kay
MakeThemAccountable.com


[ Parent ]
Remember when he supported universal healthcare? (0.00 / 0)
That was pretty progressive.

[ Parent ]
I don't know when he supported universal ... (0.00 / 0)
... health care. He never did as my senator. He never did as a candidate for president.

Carolyn Kay
MakeThemAccountable.com

Carolyn Kay
MakeThemAccountable.com


[ Parent ]
YOU ARE SPOT ON CARO . THANK YOU. (0.00 / 0)
not listening was there mode of operation. They preferred to name call and bully.

Now we are in deep doo doo.  


[ Parent ]
Let's start with optional single-payer for everyone unemployed or over 50. (0.00 / 0)
The health insurance industry is just another criminal enterprise, gambling den.  They take as much money from as many people as possible, have someone run the numbers on the odds of each of those people getting some sickness, and hope they'll make more money than they have to pay out.  They always accomplish their goals of taking in more money in premiums than they ever pay out for medical care.  They do this by paying the insurance company insiders hundreds of millions of dollars while denying benefits to their desperate insureds.  

Here's how it works:  when the economy is good, the insurance companies take the premiums and "invest" them in a good place, such as real estate in recent years.  Or in the stock market sometimes.  Or even in CDs and Bonds at other times.  Which means the insurance companies can make a fortune just in the return on their investment.  They take that money and pay it out to the CEOs and corporate insiders.  They don't consider it to be "our" money, the insured's money, even though it is a return on the investment of our premiums.  They don't hold onto that money so they'll have money to pay for our healthcare if needed.  Nope, they loot the business and take all the money for themselves, assuming the market will stay good, the investments will do well, there will be more money tomorrow.

Then one day the market crashes, real estate takes a dump, interest is at 1%, and the insurance companies can no longer get a big return on the premiums.  If they had simply and prudently set aside the returns from earlier years, we'd all be okay.  But they don't.  They stole all that money.  The insiders took it, put it on private planes and flew it out of the country.  So now what?  They do not have enough money to pay out if the insureds get sick.  So they have to find a way to deny the claims.

A few people get sick, then a few more, and all of a sudden the insurance industry's reserves are going down.  What to do?

They have an emergency meeting with the claims adjusters and tell them that if they don't turn down 98% of the claims coming in, they won't have a job.  Tell the insured that there are some questions, make up phony stories to try to say the insured lied about something so we can cancel the policy; delay delay delay, tell them the claim is "pending."  Sometimes if you just delay long enough, the insured dies so you don't have to pay for the treatment after all.  

Or, worse comes to worse, like AIG, they just go to Congress and hand them millions in bribes and say Pssst:  we need some more of that taxpayer money, like $110 million for tomorrow, but we'll have to get back to you on the rest.  And Congress will give the insurance companies my money, steal it from paychecks.

Insurance companies are scum.  You know how you don't hear so much about the Mafia anymore, going after some small Mom and Pop business for a shake-down?  That's because everyone from the Mafia went into the health insurance business, where you can really steal money, but never get in trouble.  

We need to get the insurance companies out of the healthcare business.  Let people have the option.  I would choose to go with a national healthcare program like Medicare.  As a working person, I would be glad to pay in to Medicare, and would be grateful to be in a system that hopefully will not try to dump me when I get old, or if I get sick.  

Maybe we need to start writing letters in our local papers.  I'll draft a proposed form of letter and post it here later.  Then maybe we can post it on other sites like HP, Kos, any and all, ask everyone to send a similar letter to their paper for publication this or next week, keep this front and center.  We want government-provided healthcare and no insurance companies.  Anybody who wants to stay with insurance companies should be allowed to do so, but many of us cannot afford to continue to subsidize the mafia-run health insurance industry.    

As far as the doctors whining about their income, every doctor I know is making $500,000 or more per year, and they are spoiled, lazy, self-centered, narcissistic delusional people who need to be brought down to real life, and slashing their salaries would be a great way to accomplish that.  Anybody doesn't want to practice law if they "only" make $150,000/year, fine, go do something else.  

And now if someone could just come up with a way to get my vet to reduce her fees below $500/hour, maybe I could afford to buy groceries once in awhile.  

This piggish greed by professionals and their related industries (i.e. hospitals, health insurance, drug pushers), without in any way caring about the hardship or devastation they are causing to the people of our country, makes me sick.  I have no sympathy for any of these people.  I'd like to see them shut down and replaced with professionals willing to charge a reasonable fee for their services.

http://NABNYC.blogspot.com  


Let's not attack professionals (0.00 / 0)
The premise of your post is utterly ridiculous.  Doctors and lawyers make a lot of money, but it also requires a massive commitment in education.  While doctors and lawyers are spending $200,000 to go to law school and med school, other professions are making money during those years.  If you add up the interest on those loans plus the lost earning during education you're talking about a gap that can add up to half a million dollars.  

Also, do you know how many hours the average doctor or lawyer works?  Probably in the 50-70 hour range.  Hardly anyone in those field only works 40 hours a week.  In fact doctors in residence work 100 hour weeks often for only 40,000 or 50,000 dollars.  

Do these jobs pay off in the end with really high salaries?  Of course, they do.  Otherwise who would want to be a doctor or a lawyer?  Who would spend $200,000 on another 3 or 4 years of education (and this isn't a regular college education either -- we're talking about studying 80 hours a week).  

Now, of course, there are plenty of lawyers that don't care if they make $150,000.  But if I wasn't reasonably sure that I could find a job paying six figures then there is now way I would put in the time and money to go to law school.  For one thing there is no way I would be able to pay off my debt!


[ Parent ]
I am a lawyer, and I represent a lot of doctors. And the professional's fees are outrageous. (0.00 / 0)
This whole story about "well, they have to pay off medical school" is such a crock.  I went to law school, took out loans, paid them off over time.  But let's use your numbers and see how it plays out.

$200,000 in student loans.  Let's say the average person in the U.S. earns $55,000/year, so the doctor also loses 4 years of income at $220,000.  Total:  $420,000.

Doctor gets out, starts practicing, earns (let's put him/her at the low end) $125,000 to start.  That's $70,000 in year one more than the person would have made with an "average" American salary.  If they never got a raise, they could pay off the total educational investment in six years.  I wish I could have paid off my law school in six years.

But what happens next?  For the rest of their working lives they make two, three, often four times as much as your average person does?  Let's get real in talking about the merit, value, and worth of human beings.

One of the problems in the professions is that they tend to be mostly white male, exclude women and minorities, and all the members insist that they are entitled to own a mansion, many cars, many wives, country club, European vacations, second homes.  But why?  Whatever happened to the regular-income doctors who provide a service to the people in their community but do not rob them blind?  That's what's missing from the medical profession.

So I say bust them all down.  And lawyers are even worse.  I have been an attorney for over 25 years and I can say without hesitation that most attorneys are stupid, lazy, grossly overbill, b.s. their clients, and do a mediocre if not inadequate job in most cases.  Sorry, but it's just true.  I just finished a case in which the judgment was $2,000, but the attorney on the other side ran up a $90,000 bill for fees and costs.  This is more the norm:  misuse of the law, gross overcharging, and a complete refusal to act in the best interest of the clients.

So if you want to go to law school, do.  And be a good lawyer when you get out.  But don't be fooled by the claims that professionals are better than everyone else, and deserve to make these obscene salaries.  They aren't, they don't, and they need to be busted down.  Which, as an aside, is happening all around me as law firms are declaring bankruptcy, and medical practices are shutting down.  Their overhead, consisting mostly of the grossly obscene salaries of the partners, make it impossible for them to survive in hard times.  They devour their own firm then stiff their creditors.

As for your goal of finding a job that pays six figures -- in the long run, you'd be better off finding a job that you like and that pays a decent wage.  Don't get too tied into the numbers, because baby attorneys are brought in, chewed up, spit out.  So think long-term about finding an area of law that you like, and worry less about the money.


[ Parent ]
change direction (4.00 / 1)
Health care employs about 16 million people, it's like a big ocean liner and takes a long time to change direction.

Not only are there huge institutional forces at work which aim to preserve the status quo, but those who are getting the worst deal (the poor, unemployed, chronically ill, etc) are the ones with the least amount of political clout.

It is still true that most people get health care through their employer in some fashion, and generally they are "satisfied" even though they grumble more than they used to. So there really isn't the kind of mass movement necessary to see change in response to widespread protests.

This is more like the civil rights movement: the number affected by social injustice was relatively small compared to the total population and they had to fight their battles using their own resources. I think the riots in cities made politicians more receptive to the idea of change than just the moral force of their arguments.

If we started to see, say, invasions of hospitals and "liberating" needed drugs, then perhaps we might see a similar political calculation.

For those who want to see a universal, government-administered, health program (similar to that in Canada or the UK) are going to have to deal with the details of implementation, not just state goals. What do you do with all the existing plans? Do you eliminate them? Over what period of time? Who takes over the administration? Are efficacy rules for treatment to be put into place before the transition, or simultaneously, or afterwards?

Are doctors to be government employees as with the NHS of the UK, or remain in private practice as in Canada? Where will the funding come from to cover those presently un- or under-insured? Are we going to raise taxes to fund this or use deficit financing?

What happens to the patent protections now in place for drugs and medical devices? What about the status of international treaties which protect such intellectual property? If the drug firms are reduced to cost-plus manufactures then how is future research and development to be funded?

You get the idea, goals are easy, implementation is hard.

Policies not Politics


I think you'll find (0.00 / 0)
That HR676 addresses everything you've brought up here and more.

Just not wasting 350 billion a year on insurance company overhead, and spending what we already spend will cover everyone under Medicare for All.


[ Parent ]
You seem to have (4.00 / 2)
forgotten that Obama's plan during the campaign was nothing close to single payer.  Hell, it didn't have a mandate in it. It wasn't even UHC.

In fact, you can argue he has moved LEFT of where he was in the primaries.


Voluntary Savings my A** (4.00 / 1)
Voluntary savings of 2 trillion my fat a**!!!  I recall a few years back when  "voluntary" wage and price controls were put in place to aid the economy.  Most of corporate and business American did volunteer to freeze wages; volunteer price controls, not so much. How convenient.  

Further, on the universal health care reform issue and the single payer option we progressives, liberals and Democrats need to shame Congress into meaningful health care reform by pushing the details of the coverage that congress-persons and their families enjoy on our dime. How much are their co-pays? What do they pay for prescription drugs? What is their deductible?

Why can't we have access to the same coverage. If tax-payer paid, "SOCIALIZED" medical coverage is good for them how  can they say it isn't good for us?

This idea needs to be plastered on every newspaper, covered on every blog, pushed on all the network news and liberal talk radio outlets that would cover such (I am not counting on coverage by FAUX News).  We need to be like the Rethugs on this and have a wide spread, simple, uniform message that we hammer out day and night every day.


Amazing (0.00 / 0)
Let me ask a question. Regardless of how you interpret today's news, what specific actions can you pre-identify, that will indicate to you the degree that Obama will bring progressive change? On any range of issues, not just health care.

You don't have to list that here; I just ask you to ask yourself what those three or four or five items are, and then to hold yourself to that criterion as time goes by.


It seems to me that the only reason single payer is not "politically feasible" (4.00 / 1)
is simply because those in power don't want it.  And by "those in power" I'm referring almost exclusively to Democrats, since Republicans have little power anymore.  Four years ago you could argue that single-payer was a pipe dream because Republicans controlled everything.  Now you can't make that argument anymore, and all the onus is on these moderate/conservative Democrats like Max Baucus who are blocking progress with just about as much efficacy as the Republicans ever did.

"Everything is on the table with the single exception of single-payer," Baucus said recently. "This country is not going to adopt single-payer, at least not at this time."

He forgot to say, "because I said so."


Are Schumer's proposed rules for the public plan fair? (0.00 / 0)
From the article linked above:

Schumer said he believes Congress can write rules for a new public plan that would not give it an unfair advantage over private health plans. For example, the public plan would not get taxpayer subsidies beyond paying for startup costs, it would have to follow the same coverage rules, and doctors and hospitals would be free to opt out.

Now, I believe that the best way to implement a public plan option would be to just extend Medicare to all people.  And by Medicare I MEAN Medicare, not some program "like Medicare" or "similar to Medicare".  Just plain, good ol' Medicare.  Now, going by that standard...

the public plan would not get taxpayer subsidies beyond paying for startup costs

This would obviously be unfair since Medicare gets its revenues from taxpayer dollars.

it would have to follow the same coverage rules

This seems fair to me assuming that said rules are no less generous than what Medicare currently offers.

and doctors and hospitals would be free to opt out.

The fairness of this provision would depend on whether doctors and hospitals are allowed to opt out of Medicare as it is.  Does anyone know the answer to that question?


As with most major issues that Obama's taken on (0.00 / 0)
that have proven to be less than pleasing to progressives (bailout, states secrets, torture prosecutions, single payer), one has to wonder whether he's been moving to the center and compromising on his previous stances because:

1 - Now that he's in power, he realizes, or at least believes, that these watered-down approaches are the best that are achievable right now, within existing political, economic and legal realities, and that to try to achieve more would not only not succeed, but possibly result in an even worse outcome. I.e. better semi-success than no success, and there will hopefully be an opportunity to revisit each issue someday and achieve a better outcome.

2 - Similar to #1, except that the constraint isn't reality, but rather his unwillingness to take risks, even if they might pay off, because he just doesn't want the agita. I.e. now that he's in power, he's ok with compromise, even if it's not always necessary. He likes his new toys and friends and doesn't want to lose either. It's not so much that he's "sold out", as that now that he's about as inside the system as it gets, he just doesn't feel like fighting it anymore.

3 - Like #2, except that it's less due to a reluctance to fight the system than to a fear of it, which, the closer he's gotten to the center of it, the more he realizes is something to be feared. I.e. he doesn't want to be Clintoned (or, for the tinfoil hat crowd, JFKed).

4 - He's sold out, bought and owned by special interests.

5 - 11D chess: this is all part of some elaborate, 4 or 8 year-long plan to radically reform things, but which he realizes, or believes, can't be done overnight, but in steps and stages, and right now he's just setting the stage for much more radical reform down the line.

Who the hell knows. Myself, I don't think that it's #4. It just goes against his entire life's work. Someone as smart, talented and lucky as him, whose path to power was non-traditional and consisted of some pretty progressive work early in his adult life, is unlikely to have sold out this completely. But I see the other options as equally likely. Yes, even 11D chess, at least as HE sees it. And if I had to guess, I'd say that it's some combination of #1 and #5, with a bit of #2 & #3 thrown in (people are motivated by multiple motivations, of course, all the more so intelligent people dealing with complex and trying realities). I.e. he's serious about more serious reform, but sees it as a slow, systematic and methodical path, not something down in one or two masterstrokes, and is, at least in his mind, doing just that here.

But even if so, the danger is always of leaving something on the table, that won't be there the next time around, and for a long time to come. There's something to be said for slow and steady, but no slower and steadier than necessary. And, operationally, he runs the risk of being too (small c) conservative with all these things. And as far as we know, part of this might even be due to his being risk-averse, wanting to avoid fights and alienating people, and maybe even some measure of fear.

In any case, though, I think that we're still very much in the early, setup stages of a long and difficult process, and the toughest parts by far are yet to come. Hopefully, the coming battles will toughen Obama up, and not soften him. That's what happened in the primaries and general. He tends to naturally shy away from adversity, but when it finds him--and it tends to, as it does any outsider, which he was and in some ways still is--he tends to rise to it. There's a "sleeping giant" quality to him that I hope we'll see in all of these fights.

We'll see.

The liberal soul shall be made fat. He who waters shall be watered also himself. (Proverbs 11:25)


Probably #1 comes the closest (0.00 / 0)
Like you, I don't think it's #4.  Those who point to #5 - and there are many of them on the left - are simply being worshipful of their Obamessiah, and I find the google-eyed unconditional adulation of Obama (and the stubborn insistence of his supposed brilliance that comes with it) among many on the left disturbingly similar to the same kind of adulation for George W. Bush during his first term.  "Don't criticize the President because it's unpatriotic!" has become "Don't criticize the President because he's a genius and you're just some dumb blogger in your mom's basement!"

I don't think it's #2 and #3 either.  Unlike the Clintons, Obama seems to be willing to take on political risks.  I think #1 comes the closest in the sense that Obama wants to get things done.  Like that oft-quoted quote from David Sirota's interview says, Obama knows what he wants and is willing to do whatever it takes to get there. (I personally disagree, as I think how we can get something is as important as what we get, but that's for another discussion.) So Obama seems content to get his half a loaf this time and get the other half sometime down the road.  We saw this very vividly with his handling of the stimulus bill.

Now, I personally think that the ask-for-200%-so-you-get-100% approach makes a lot more sense, in that you can make compromises but still be able to get what you want.  I wish he had asked for more on the stimulus bill.  Either he didn't understand the right approach, or even worse, he actually didn't want that much spending.  Either way, it's bad.


[ Parent ]
Bottom line. . . (4.00 / 1)
Obama is a politician. And like every other politician, he'll say what he needs to when he needs to, whether he ever believes it to be true and honest or not.

The whole hope things was cute, though.


Obama never supported single-payer. (0.00 / 0)
Never take the phony little stain at his word.  As an Illinois state senator, according to an article in "The Boston Globe," he actively moved to gut health care reform.  He did this because health insurance companies, which were already throwing their bribe money at him, balked.

When Barack Obama and fellow state lawmakers in Illinois tried to expand healthcare coverage in 2003 with the "Health Care Justice Act," they drew fierce opposition from the insurance industry, which saw it as a back-handed attempt to impose a government-run system.

Over the next 15 months, insurers and their lobbyists found a sympathetic ear in Obama, who amended the bill more to their liking partly because of concerns they raised with him and his aides, according to lobbyists, Senate staff, and Obama's remarks on the Senate floor.

The Health Care Justice Act, which Obama sponsored in the state Senate, grew out of work done by the Campaign for Better Health Care, an Illinois coalition of healthcare advocates, labor unions, and nonprofit organizations. The ostensible goal was simple: make affordable healthcare available to all Illinoisans. But the politics were anything but simple.

On one side were healthcare advocates, eager to capitalize on the Democrats having won control of the General Assembly and the governor's office. On the other were most insurers, who worked vigorously to sink the bill. Obama was in the middle, trying to reconcile a range of agendas to get a viable plan signed into law.

The bill originally called for a "Bipartisan Health Care Reform Commission" to implement a program reaching all 12.4 million Illinois residents. The legislation would have made it official state policy to ensure that all residents could access "quality healthcare at costs that are reasonable." Insurers feared that language would result in a government takeover of healthcare, even though the bill did not explicitly say that.

By the time the legislation passed the Senate, in May 2004, Obama had written three successful amendments, at least one of which made key changes favorable to insurers.

Most significant, universal healthcare became merely a policy goal instead of state policy - the proposed commission, renamed the Adequate Health Care Task Force, was charged only with studying how to expand healthcare access. In the same amendment, Obama also sought to give insurers a voice in how the task force developed its plan.

Lobbyists praised Obama for taking the insurance industry's concerns into consideration.

Obama was against single-payer from the beginning.  His record as a politician demonstrates that he will gladly lie to the left both to shore up support and squash potential opposition to his clearly right-wing, corporate-friendly policies.



Single Payer - The 100th Monkey (0.00 / 0)
Until we get critical mass of people willing to stand up and demand the right thing then we're going to lose this argument.  I know it won't happen but one way to do it would be for all those with healh insurance to drop it and show up en masse at emergency rooms all over the country.  Actually this economic DEPRESSION is what may actually do more for single payer than anything else..  If you don't have a job or work for WalFart then you may find yourself without insurance any way.


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