Heckling Clinton/ Single-Payer Health-care Reform

                                                Heckling Clinton



            Hope or despair?  There is a lot arguing for the latter.  The history of the world for example.  The history of the last century, in particular.  That’s a serious body count, and the moments of triumph, when they are studied closely, almost always have a long-term deleterious edge to them.  And the May, 2006 picture is a sad portrait as well.  The forces of reaction have a death grip on the tiller and, if they have a clue where the rocks and shoals are, they are not letting on to the fact.  There was a moment of personal crystallization, and it came in 1994.  Clinton was president, and he and Hillary had recently had their hindends handed to them on the question of health care.


            There are all of the ways that the world has produced to alleviate suffering on the part of its inhabitants and then there is universal, single-payer health care as provided in Canada.  In 1994 pollsters were having trouble finding respondents who were not satisfied with the health care system in Canada.  Today, it is still a lopsided win, but the forces of reaction have been at work in Canada, and they have been doing their best to starve the system into unworkability.  There has been very little success, but there is clearly the occasional grumble that would dissipate instantly if all segments were properly funded.  In 1994 the forces of reaction had not begun to fight in Canada; probably because they knew they didn’t have to, yet.


            Everybody who lives in Canada carries a card, and presents it for care, and there are no bills.  Doctors negotiate fees with the government, and nobody tells them or their patients what is, or is not, appropriate care.  It is socialized health insurance, as opposed to the opposition spinner’s socialized medicine.  It costs about what Medicare costs to run, 2-3% of a dollar, as opposed to United States private health insurance that spends anywhere from 14-25% on things like obscene executive salaries and advertising.  If you really set your mind to it, you can think of arguments against it, but they are all specious and born of a desire not to put an enormously powerful segment of US capitalism out of business.  In 1994 it was 39 million Americans who were uninsured.  Today it is 46 million.  If they are getting care at all, it is in the ER, where it costs the most, and where preventive medicine is not dispensed. 


            The situation was every bit as dire in 1994; the numbers were a just a little smaller.  I don’t think there was even one health insurance executive who had ½ to 1 BILLION dollars in the bank back then.  It was one of Clinton’s best instincts, to fix the health care system and provide it universally to all Americans.  One of the most interesting questions is whether or not he knew what was in store for what he would propose.


            In pursuit of his stated objective, he convened a health care colloquium.  There was a debate between a single-payer advocate and a private health insurance advocate with the underlying assumption of universal coverage.  On good authority I am informed that Clinton said to the single-payer partisan at the end of the proceedings, “You won, but it is simply not politically feasible.”  If he meant that the single-payer proposal could not make it through Congress, he surely should have pursued that option.  At least, he would have been beaten in a noble endeavor.


            The health insurance industry spent 300 million dollars to defeat one of the most complex and impenetrable reform proposals that any wonk has ever had to try to explain.  In addition to the Madison Avenue-slick “Harry and Louise” ads, the industry also provided honoraria to the likes of NPR reporter Cokie Roberts, as a hedge against a fair airing of the issues.  Of all of Clinton’s political mistakes, it may not have been the sexiest, but certainly the most profound was not choosing single-payer.  In defeat, assuming he did everything in his power to win the fight, he could have put his charisma on display and highlighted everything else that is wrong with this democracy, everything that prevents reform in spite of the people’s desire.  And that could have been the start of something beautiful.


            The Clinton proposal died the death it deserved, but the proponents of single-payer did not quit.  They crafted a single-payer bill for the State of California, Proposition 186, and put it on the ballot in November, 1994.  Seeking to do what little I could in this fight, I gave speeches at house parties.  I talked about my wife, a family doctor, having discussions about the nature of a patient’s insurance at 3 in the morning when the conversation should have been directed at the alleviation of suffering.  No one was optimistic about the chances of success.  It is, after all, the most populous state in the union.  It is, after all, the relinquishment of the control of, and profit from, that large state’s portion of 1/6th of the US economy.  Had it passed nationwide, it would have been the largest transfer of capital in the history of civilization.  The forces arrayed against the proposal were, after all, precisely what one would have expected, staggering.


            But what if we had some serious heft in our corner?  A spokesman of some eminence, a presence on the national stage, a power in his own right, and charismatic to boot, schooled on the issue and probably smarter than any theoretical oppositional spokesperson?  What about the sitting president of the United States of America who had recently had his clock cleaned by our opponents but in a fight over an impoverished idea that would have been a disaster of administration even if it had managed to cover the entire population.  Had he not made it clear that universal coverage was his primary concern?  Had he not proclaimed single-payer the winner in the conceptual debate?  If he believed in the cause, why would he not seek to fight for it wherever he could?  How about in the largest state in the union where he was overwhelmingly popular?


            Bill Clinton came to town to campaign for Kathleen Brown who was running for governor.  Now, today, I am equipped with the dark, dark view that it was the plan of the media to simply ignore Proposition 186, and thereby cede the field to the health insurance industry’s money, against which there was not the vaguest chance of success.  Back then, I was just thinking.  I was just taking Clinton at his word.  I was just taking journalists at their job description.  Revolutionary health care proposal?  Overwhelmingly popular in the nation most like our own?   Biggest state in the Union?  I don’t know; sounds like a story to me.  Clinton is coming to California; Proposition 186 is on the ballot at the same time his candidate is.  I wonder what he thinks about it?  So I pondered.  So, I thought, would a reporter have pondered.


            There was close to nothing in the paper.  There were plenty of interviews with the President, but Proposition 186 was never mentioned.  Then I see an ad for a fund-raiser in San Francisco, and the seeds of subversion are planted.  Maybe I’ll just ask the guy myself.  I call the DNC or whatever the state equivalent is.  I get a go-getter with a lovely voice on the phone.  “Is there a ticket available?” I inquire.  “Sure,” says she, “what sort of business are you in?”  Interesting question, I thought.  I couldn’t figure it out exactly.  Seating, possibly?  Maybe they want the big shots with big subsequent giving potential up front?  “Public defender,” say I, as self-deprecatingly as it is possible for me to say it.  “Oh,” says she, with an encouraging lilt to her voice; “I’ll see what I can do.”  Public defenders are not universally viewed with suspicion and distrust.  Enlightened liberals and assorted others understand the Constitution and are perfectly happy to have the rights set out there protected even if it means bad things occasionally happen.  They even have a brand of admiration for those who have chosen to stand next to the most despised in our midst.  She must have been one of those.


            There were at least two metal detectors after the $500 check was written, and I was escorted down to the “Front Row,” as the baseball announcer mugs in the TV ad.  I wasn’t directly in front of the podium, more off to the side so that I could see how tall the wooden box is that Barbara Boxer stands on when she addresses the crowd.  But I was definitely in the first row of tables and looking right at the dias.  And I sat next to Congressman Pete Stark, a northern California more-or-less progressive.  My pulse hadn’t begun to race; that would happen later, but I was a bit uneasy.  Said to be naturally shy and kind of antisocial, I had some trouble starting a conversation with the Congressman.  There may have been a forgotten soul on my left, but they have become forgotten, if they were ever memorable, which they may have been, but my mind was occupied with how, how exactly, this was going to happen.


            I did manage to learn that, according to Representative Stark, Clinton’s prerequisites with regard to health care reform would be satisfied by single-payer, but it was clear to me that Representative Stark had no inside information, and could not refer to any occasion when the subject of Proposition 186 and Clinton had been part of a single paragraph.  Before I entered the hotel, I asked a wandering reporter, who had been chasing Clinton around the state, if he or anyone in his hearing had raised the question of Clinton’s view of 186, and he assured me that the subject hadn’t come up.  It was clearly that person’s view that bringing the subject up was someone else’s job.


            I sat uncomfortably through Brown and Boxer and maybe someone else before President of the United States, William Jefferson Clinton, stood to speak to grand applause by all and abject apoplexy by me.  I had no idea how I would say whatever I would say.  Speaking in public is my daily bread; yelling at and interrupting Presidents?  Not so much.  I think I can remember the sweats, hot and cold.  I definitely remember my heart pounding, and the butterflies were on their way to South America in a hurry.  There would be a moment of courage here, or there would be a disheartening deflation whose proportions I really could not assess, and that is what kept the idea alive.  But when, and what?  When and what, when and what?


            As if on my internal cue, the large and robust and pasty-faced-at-the-moment President Clinton began a catalogue of his achievements.  I couldn’t list them now more than by just guessing, but I knew then, with his recent over-facing at the hands of the big boys, that health care was not going to be a highlight.  And so it wasn’t.  And I write now, with really a quite stunning pride twenty years later, that I did the highlighting myself.  “What about health care?” I shouted. And with those deep blues, customarily used to stare into the souls of attractive women, he is on me like a hawk and looks straight into my eyes, not thirty feet away.  I might give another ten or fifteen feet, but not much more.  “Do you know the first thing about manners?” he inquires with disdain written everywhere it would fit.


            No one else would find that an interesting question, but, had the opportunity presented itself, I could have gone on for some time.  My parents were both still alive then, and if I know anything, it is manners.  Lordy, do I know manners.  That however, on my best day, would not have been the focal point of my rebuttal.  Rather I would have referred to the failure of the media to even find the room where the discussion was taking place much less to demand answers of those in power about essential issues of democracy.  Apparently they leave it to the interested citizen to inquire personally.  And it is more likely to happen if all one gets in response to inquiries of governmental officials is off-the-mark form letters, signifying nothing.


            Anyway, I was riding the seat of my pants, and there was no discussion of the quality of my upbringing.  “What about 186?  We need your help.”  Ole Clinton was equal to that, of course, and so much more.  On paper he was probably the best qualified president in a hundred and fifty years.  His retort was a crowd-pleaser and a question-evader.  “I tried to pass health care in the best way I knew how.”  The thousands stood and cheered.  I sat quietly, shaking, and remained that way until it was all over.  As the crowd moved toward the door, I heard a reference to my antics by a couple in their thirties. The man made the point that it hadn’t been disrespectful; that the guy was actually asking for help.


            I stood on the curb and watched as the limousine drove away, and you could see him in the back seat reading a briefing paper with his reading glasses down on his nose, the affairs of state presumably on his mind.  And so it ended, almost.  Of course there was no eager reporter trying to figure out what or why whatever it was had taken place.   The next day’s paper did make mention of a presidential heckler over the question of 186,  but the presidential quandary of how to continue the battle to reform health care in this country was of no apparent interest.  It will always be amazing to me that that next day, while searching for some baseball game on television, I happened to turn to some public affairs channel at the instant I was in mid-heckle.  I really don’t know what a public affairs channel does, though I could guess.  I certainly don’t know how many there are, or where to find one on the dial, or how to check their listing.  But that wasn’t the most interesting thing theoretically connected to one citizen’s meager effort to advance the cause of health care reform.


            As I do now, I considered it then, a good moment for me. With that pride not far from the surface, I regaled my colleagues, and agreed with my boss’s observation that it must have taken some courage.  But before that discussion, I was presented with the information that the office that I supervised had been broken into over the weekend.  Channel locks had been used to force the door.  Nothing was taken that anyone could tell.  The police were called.  Reports were written.  No suspects were noted or later apprehended.  It was the virtually unanimous consensus that this had been the work of the Secret Service, protecting the President from the decidedly unlikely violent impulses of a provoked health care reform advocate.  God bless them; I have always thought it added a nice coda to the story.


            So the first question was hope, or despair?  Here is what I know: 


1.      The citizenry wants single-payer.

2.      Corporate capitalism doesn’t want them to have it, in spite of the fact that about $1300 of the price of a new car in this country can be laid at the doorstep of health insurance.  In other words, the problem here isn’t so much economic sense.  Virtually all industries would benefit from generally lower health care costs and a healthier labor force uniformly able to take advantage of preventive care.  The problem is social and ideological.  The CEO’s, health insurance and all others, play golf at the same clubs.  They also breathe in sync with the underlying principles of the Republican Party, none of which include a concern for the nation’s un- or underinsured. 

3.      The Opposition, therefore, has the will and the ability to wage an enormous battle whose cost would be staggering.

4.      It may well be that a necessary prerequisite to the fight is the passage of significant campaign finance reform.  At the moment it is probably a minority of elected leaders that isn’t owned by the insurance industry.

5.      The enormity of the fight craves comparison to women’s suffrage and civil rights.  Therefore the masses must be moved.  The only way to encourage such large scale activism on the part of normal people is to make it fashionable.  That means that Hollywood and the sports equivalent will have to be involved, along the lines of Farm Aid.  It also means that there can’t be an overburdening war being waged at the same time.  Normal people can’t bear more than one focal point.

6.      There will have to be a Democratic president who is willing, no matter how many of the other preconditions are, or are not, met, to do everything, including give a weekly speech in prime time, which isn’t a bad idea in any case.

7.      Even a state-by-state strategy will require an unparalleled popular mobilization.  When was the last time the nation was mobilized for a state’s battle?


Despair. Not inactivity or acquiescence, but a stiff dose of despair..

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