Obamacare’s Empty Victory

It feels truly Orwellian that progressives are applauding the forced purchase of private health insurance � one of the most hated industries in the United States � while the right is opposing a model that originated from their political leaders. The Affordable Care Act (ACA) is a step farther on the path to total privatization of our health care system, not towards the health care system that most Americans support: single payer Medicare for all.

In the months leading up to the March 31 deadline to obtain health insurance, ACA supporters united around their mission to enroll people. Volunteers knocked on doors and tabled in their communities. Celebrities and athletes tweeted and labor unions ran robocalls. The media buzzed with speculation about whether the ACA would succeed or fail. March 31 felt like election night. And after it was over, ACA supporters clapped each other on the back and celebrated.

Obamacare survived. But now that the law is implemented and the dust is settling, it�s time to question what this actually means for health care and what we should do now.

Before President Obama was elected in 2008, Drs. David Himmelstein and Steffie Woolhandler, two of the co-founders of Physicians for a National Health Program, raised a crucial question in their report, �Our Health Care System at the Crossroads: Single Payer or Market Reform?� They outlined the health care crisis and how past reforms were taking us toward increasingly �threadbare insurance coverage.� Knowing that health care reform would be front and center for the next few years, they argued that as a nation, we had a choice to make. We could stay on the same path toward a market-based health care system or take an evidence-based approach and create national single payer health insurance.

With the ACA, we have now passed that crossroads and are headed down the road to a completely market-based system of privatized health care. This is not something to celebrate. Dr. Adam Gaffney recently wrote an excellent history in Jacobin on the turn we have taken away from the concepts of universal health care and economic justice to a neoliberal model. We are inundated with market rhetoric telling us how wonderful it is to have the choice of shiny silver insurance in the brand new marketplace. Insurance plans are called products and we are consumers of them.

The problem with these public relations messages is that having health insurance doesn�t guarantee access to health care and health care doesn�t belong in the marketplace. As patients, we do not have a choice of whether or not to purchase health care when we need it. Delaying or avoiding necessary care can and does have serious consequences. And we can�t predict how much health care we will need or when we�ll need it. In a market-based system, profits are the bottom line and people receive only the amount of health care they can afford, not what they need.

The ACA is transferring hundreds of billions of public dollars to the private insurance industry to subsidize plans that leave people underinsured, unable to afford care and at risk of financial ruin if they have a serious accident or illness. And even at its best, tens of millions of people will remain without insurance.

Most of the 7.5 million people who purchased health insurance on the exchanges were already insured. More than 80 percent bought the lower-tier silver, bronze or catastrophic plans with the hope that they would not get sick. These plans have the lowest premiums but require that patients pay thousands of dollars out of pocket before insurance kicks in, and then pay 30 to 40 percent of the cost of covered care. The result is that underinsured people will continue to self-ration, delay or avoid care due to cost, as 80 million of us did in 2012.

The ACA includes regulations, but as usual the insurance industry has ways to work around them. Many insurers had caps on out-of-pocket costs waived. Insurers also found a way to �cherry pick� the healthiest customers by leaving cancer centers and major medical centers out of their networks. In fact, most of the new plans have narrow and ultra-narrow networks that shift more of the cost of care onto patients because care outside of insurance networks isn�t covered. And while insurance companies cannot drop individuals when they get sick, they can stop selling their plans in areas that don�t make a profit. Some are already doing this, which means the competition that was supposed to emerge did not. Instead, in 515 of the poorest counties in 15 states, only one insurance company is available on the health exchange. And greater consolidation of the health care system is underway through mergers and acquisitions.

Our public insurances, Medicaid and Medicare, are being increasingly taken over by private insurances in the form of Managed Care Organizations and Medicare Advantage. They compete for the healthiest patients and siphon more of the health dollars for profit, salaries and administration than public insurances. Top advisors to the White House expect our public plans to be rolled into the health exchanges in the near future with subsidies, a plan similar to Congressman Paul Ryan�s voucher proposal.

Nations that treat health care as a public good and not a commodity have universal coverage that costs less and produces better health outcomes. And in polls, some two thirds of Americans support single payer. Now our tasks is to shift the national debate away from how many people have insurance to what type of health care system we support. Efforts to do this are taking place at both state and national levels.

State efforts to educate and organize for universal health systems are using a human rights framework. This started with the Health Care is a Human Right campaign in Vermont that is working to create universal coverage, and similar organizing is happening in Maine, Pennsylvania and Maryland. An essential component of this organizing model is to develop leadership within communities that are uninsured or underinsured. States such as Washington, Oregon, Colorado and New Mexico also use human rights messaging in their campaigns.

State health reform faces significant barriers because federal legislation is needed to allow the creation of a state single payer system. However, state campaigns are essential because they push state health policy to be the strongest it can be and build an informed and organized grassroots movement that can also push for solutions at the national level.

Legislation for single payer health systems exists in Congress. In the House, Congressman John Conyers (D-MI) has introduced HR 676, �The Expanded and Improved Medicare for All Act,� in every session since 2003. So far it has 56 co-sponsors. In late 2013, Senator Bernie Sanders (I-VT) introduced SB 1782, �The American Health Security Act,� in the Senate. National organizations are working together to encourage more members to sponsor them and a national lobby day is happening in Washington, D.C., on May 22.

On a personal level, I have chosen to be a conscientious objector to the ACA. I cannot in good conscience give my support to the very industry I am trying to eliminate. Being a conscientious objector is a decision that people have to make for themselves. So far nearly 500 people have joined me by signing a petition at PopularResistance.org.

Some people speculate that the ACA will bring us to single payer some day because it will fail. This will only happen if we fight for it. Every day that we delay, people suffer and die in this country unnecessarily. Neil H. Buchanan says it best, �The ACA is as good as it gets, when it comes to basing a health care system on private insurance, and it is simply not good enough. Even as the ACA takes effect, therefore, we need to start planning to make it disappear.�

Margaret Flowers is a pediatrician and co-chair of the Maryland chapter of Physicians for a National Health Plan. She serves on the board of Healthcare-Now and of the Maryland Health Care is a Human Right campaign. She is also an editor at popularresistance.org.

Tim Carpenter’s Politics of Radical Inclusion: In the Streets and in the Polling Booths

Tim Carpenter never lost faith in the very real prospect of a very radical change for the better. And he never lost his organizer�s certainty that the tipping point that would make the change was just a few more phone calls, a few more rallies, a few more campaigns away.

So he kept on organizing.

To the last.

Carpenter, the lifelong social and economic justice campaigner who nurtured Progressive Democrats of America from its founding a decade ago into a national movement, died Monday at age 55 after a long battle with cancer.

Not many hours before I learned that he had passed, Tim was on the phone with me, running through the latest numbers from a national petition drive he and PDA had organized to urge Vermont Senator Bernie Sanders to seek the presidency. They were over 10,500. A few hours after the call, he emailed me, with more numbers. They were over 11,000. That was typical Tim. His enthusiasm for politics was immeasurable, and infectious.

But Tim�s was never a typical politics. He knew the drill: he had been at the side of presidential candidates, developed winning electoral strategies and helped to organize movements around every essential issue of the Carter, Reagan, Bush, Clinton, Bush (again) and Obama eras. But Tim was always about something more; he was never satisfied with an election victory, or a legislative success; he wanted to transform politics because he wanted to transform America into a land that realized what he believed was an irrevocable promise of liberty and justice for all.

To achieve that end, Tim knew it was necessary to transform a too-often centrist, too-frequently compromised Democratic party into a dramatically more militant and more meaningful organization than it has been for a very long time. Mixing memories of the New Deal with elements of the 1960s civil rights and anti-war movements, linking the vision of the Rainbow Coalition with the new energy of fast-food and retail workers demanding a $15 minimum wage, Tim sought to define and achieve what one of his heroes, author and Democratic Socialists of America chair Michael Harrington, described as �the left wing of the possible.�

Tim refused to compromise with politics as usual. Yet, he refused just as ardently to be pushed to the margins. He waded into the middle of every new fight, grabbed a stack of precinct lists, distributed them to the activists he�d brought along in that beat-up car with Bob Dylan blasting on the stereo, and headed for the doors shouting, �Teamwork!�

�The Progressive movement is driven by people, but it is only successful because of people like Tim Carpenter,� said Congressional Progressive Caucus co-chair Keith Ellison, D-Minnesota, a PDA board member who got it right when he said, �Tim showed the kind of determination and courage that was contagious. His passionate idealism was matched only by his inexhaustible commitment to making those dreams a reality.�

Combining his encyclopedic knowledge of movement history and electoral strategy with the knowing optimism of one who had actually bent the long arc of history toward justice, Tim embraced an �inside-outside strategy� that was designed to go around the party elites and link insurgent campaigns to grassroots movements.

�In the polling booth and in the streets� was his vision, and if that meant breaking with the party establishment and aligning with the demonstrators outside the party convention, or outside the White House of a Democratic president, so be it. The principles were the point, and while Tim could join a coalition with folks who might not share every one of his positions, he believed his mission was to pull that coalition to the left.

Tim was a Democrat�to the frustration of his Green, Socialist and social Libertarian friends�but he was never a member of the Democratic Party establishment. He was the thorn in its side, declaring, �I�m not satisfied with the party as it is. I want the party as it should be.�

Tim cut his teeth on campaigns that recognized the connection between transforming politics and transforming the country: as a kid working �behind the Orange Curtain� (in then hyper-conservative Orange County) for George McGovern in 1972 and for the remarkable radical intervention that was Tom Hayden�s 1976 US Senate bid. Tim was a trusted aide to the Rev. Jesse Jackson�s 1988 �Rainbow Coalition� run for the presidency, an inner-circle strategist for Jerry Brown�s 1992 presidential run (addressing that year’s Democratic National Convention and urging delegates to “Save Our Party” from ideological compromises and corporate influence), a key figure in Dennis Kucinich�s anti-war presidential campaign of 2004.

Tim worked on plenty of campaigns that lost�as well as winning campaigns such as those of Congresswoman Donna Edwards, D-Maryland, Massachusetts Governor Deval Patrick and, to his immense delight, Senator Elizabeth Warren, D-Massachusetts�but he didn�t count wins and losses. He was interested in movement building. Drawing together veterans of the 2004 Kucinich and Howard Dean campaigns, Progressive Democrats of America grew, with Tim as its national director, into a network of activists and elected officials on the left of the party.

At the core of the mission was Tim’s vision of a movement-guided politics.

It was the same vision that shaped Tim’s grassroots activism, as a Catholic Worker advocate for the homeless who slept on the streets of Santa Ana to challenge police harassment; as an organizer of the anti-nuclear Alliance for Survival who counted musician-activists Jackson Browne and Bonnie Raitt as friends and comrades; as an organizer and champion of groups that opposed not just wars but the overreach of a military-industrial complex�from United for Peace and Justice to Democrats for Peace Conversion. To begin to list Tim�s causes, his victories and his ongoing struggles would take days�or weeks if Tim was still telling the stories. But suffice it to say that, for more than four decades, he was there�behind the scenes, sleeping on the floor, risking arrest, flying in with the rock stars, counseling the presidential candidates, remembering the name of every son and daughter of every activist, making the money pitch, organizing, always organizing.

The Nation named Tim as its “Progressive Activist of the Year” some years back. And it was far from the only honor accorded him. When Congressman John Conyers, the Michigan Democrat who is the senior progressive in Congress and arguably in America politics, learned that Tim was sick, he told the US House, �Tim has been indefatigable in pressing forward progressive ideals to help strengthen our American democracy. He has been in the forefront of progressive causes, from promoting nuclear disarmament to fighting to abolish the death penalty to establishing health care as a human right, as well as securing voting rights and jobs for all.”

Around the same time, Tim�s daughter ran up to him with an envelope from the White House that had arrived in the mailbox of the family�s Florence, Massachusetts, home. When they opened it, there was a note from President Obama, wishing Tim well while celebrating his resilience.

That was how most of us took the news that Tim was ailing. Knowing he had beaten cancer before, we wanted to believe that Tim was unstoppable. When he warned �it�s pretty serious this time,� we paid attention to his actions, not his words. Because even as he made the rounds of doctors and hospitals, treatments and hospice preparations, he was still on the phone, still texting, still emailing, still organizing.

Tim was determined that Progressive Democrats of America, a group founded when Democrats were not doing enough to oppose the war in Iraq or to advance a �Medicare for All� reform of a broken health-care system�PDA’s slogan: �Healthcare Not Warfare��would keep embracing new issues: amending the US Constitution to end the buying of elections by billionaires and corporations, getting Washington to take seriously the threat of climate change, blocking “Fast Track” and the Trans-Pacific Partnership trade deal.

Tim believed every battle could be won, by building bigger coalitions, by getting more people engaged.

Tim had a remarkable gift for what actress and PDA advisory board chair Mimi Kennedy referred to as �radical inclusivity.� He was always welcoming young activists into the fold, flying off to meet with folks who might form a new PDA chapter, asking people to tell him what new issues they were working on�and then asking how he could help. He had a faith that the change was going to come: a faith born in having won and having lost but never having surrendered the organizer�s dream of a movement that would be unstoppable.

We were in California last year and Tim asked a crowd to:

Help us grow this movement. Help us to put 435 activists in every congressional office, and another 100 activists in every Senate office to say: not only is it time to end this war, not only is it time to bring about healthcare as a human right, but it�s time for our community to stop turning our back on those who so desperately need us. To stop talking just about the middle class� It�s time to talk about the 50 million Americans who are poor.

A politics that speaks not only for the middle class but for the poor�proudly, energetically, radically�jumps boundaries that many top Democrats still avoid. But that was what Tim Carpenter wanted.

“It’s our responsibility to build that movement, your responsibility, my responsibility,” Tim said, even as he warned, �I may not be with all of you when you are out there in those streets, in those struggles, but I will be with you in spirit.�

If we did not fully understand then, we do now.

Tim Carpenter was right. The building of the politics he wanted�more powerful than any party or politician�is now our responsibility. But Tim is with us in spirit, still telling us that the key is not money or television ads, not caution or compromise. It’s a passion for justice. It’s a belief that peace is possible. And, like Tim said, it’s “Teamwork!”