With hopes sagging in the face of the Obama era’s disappointments, the American Left has split into two positions over the health care reform bill. On the one hand, radical health care activists have opposed any bill short of a single-payer system, or at least a public option. On the other hand, commentators such as Paul Krugman have embraced the bill as a sad but necessary compromise with right-wing and centrist legislators. They have criticized radical health care activists who reject the bill wholesale as ultra-leftists, intransigent protesters who refuse to accept the terms under which real political change happens.
Commentators like Krugman have a point. There is little gained by sermonizing when radical reformers lack votes in Congress. It may even reflect poorly on the Left overall, associating it with the self-righteous and puritanical zeal that alienates the mainstream. A single-payer movement? Even at the University of Chicago, interest in health care continues to dwindle despite the urgency of the crisis for residents of Chicago’s South Side. Those stalwart few seem to take the moral high ground as a substitute for politics. The only people in a position to make serious reforms a reality—reforms that require state power—are the progressive Democrats, who can use their authority to craft legislation and, inevitably, broker a compromise with opponents to seal the deal. The final bill won’t be everything, but it will fill much needed gaps in the current system to provide for the working poor.
But not so fast, say the “radicals.” What is the content of these reforms? In reality, the health care bill will simply fill gaps in a system that leaves the basic problem, the domination of capitalist interests in the insurance sector, intact. There will be some much needed changes and human lives will be saved, but the bloated health care industry will continue to reap huge profits at the expense of the insured. This ameliorative change won’t develop more effective treatments for the common diseases that the poor face. It won’t improve the status of “illegal aliens,” or even establish universal preventive medicine. “Don’t trust the Democrats—Not a one. Especially the progressive Democrats,” declared Helen Redmond, a Chicago-based single-payer advocate. Maybe we shouldn’t have expected the Obama administration to back liberal reforms in the first place, but there is no excuse for the Democrats’ pusillanimous retreat from universal health care.
Both sides are, in certain respects, correct—at least about each other. But they overlook what both sides have in common: political helplessness.
The assumption on both sides, the radicals and the liberals, is that the Democratic Party is and will always be the sole instrument of liberal reform. Political commentators like Krugman say so directly: they urge liberals to settle for less, because the Democrats are the only game in town. Ironically, however, liberals undermine their own efforts by firmly tying the interests of liberal reform to the Democratic Party. Although there exist allegedly progressive Democrats, recent history—think Dennis Kucinich and Howard Dean—has demonstrated the extent to which the Party will censure any internal attempt to push its politics to the Left.
The salutary appeals by Krugman and others to remember the need to participate in partisan politics and to fight over state power, hark back to the mid-1960s. At that time, the liberals hoped the Democratic Party, long controlled by the right-wing Dixiecrats, was temporarily susceptible to internal transformation by mass movements. But the analogy is specious: Krugman is no Rustin, who attempted to lead a mass movement in 1964 to turn from protest to social politics.
In contrast, our current moment is marked by a stunning lack of any popular movement that has the interest, let alone the capacity, to wage long-term political struggles. Hence radical single-payer activists tacitly accept the same situation of political helplessness as the dissatisfied liberals. They try to build a “single-payer movement,” but implicitly adopt a stance outside of party politics and thus see themselves as pressuring politicians from “below,.” without any hope for real political power.
The single-payer movement, despite the fierceness and dedication of its activists’ advocacy, is largely ineffective. The activist position, substituting moral purity for politics, winds up in radical defeatism—a position that is no more responsible than even the most opportunistic Democrat. Both positions accept their own marginality in American politics, but have failed to offer convincing political strategies to solve the problem.
There is a way out, but the single-issue campaign ain’t it. In fact, any suggestion that a single-payer health care system is meaningful without a Leftist position, a political movement for the emancipatory transformation of society, is misleading. Without a movement for reform and revolution, we may as well give up hope for gradual improvement. One way to organize politically for health care reform would argue for the principle of freedom from sickness. As opposed to the Right’s commitment to freedom for choice, or some other abstract intangible, the Left—both liberal and radical—should openly commit itself to freedom from disease, as part of a general struggle against all unnecessary debilitation and incapacity. Indeed, freedom from disease is a precondition for any real freedom of choice. This programmatic demand would probably mean socialized health care. However, the important point is that liberals recognize that they do not need to cede mass politics to the conservatives, and radicals realize the necessity of organizing politically around long-term, coherent, emancipatory goals.
The unwillingness on the Left to conceive of this broader movement is manifested in the depoliticization of the debate attempted by those on both the liberal and radical Left: Rather than a fight for political principle, the Left has squandered its political ideals into “common sense.” Suffice it to say, liberals who have attempted to voice a common sense position have only been one-upped by the Right, whose scurrilous and cynical behavior has thrown even the most intelligent Left commentators in the lurch. If there is anything to learn from last year’s health care debacle, it is that liberal reform itself requires independent political expression outside the constraints imposed by the Democratic Party. It is on this point that the orientation of liberals and radicals should converge.
— Greg Gabrellas is pursuing a Master of Arts degree in the Social Sciences.