The Key to Health Care Reform

Personal Health
The following piece is part of an ongoing series of OffTheBus reports by citizen policy experts critiquing different aspects of Campaign 08.

Much of last Wednesday's Democratic presidential debate at Dartmouth College focused on health care reform, which Americans consider the top domestic policy issue, according to polls. Moderator Tim Russert asked each of the eight candidates about their proposals to guarantee every American affordable health care, and each responded with their well-practiced sound-bites.

But only John Edwards identified the most important ingredient for pushing a universal health care plan through Congress -- mobilizing public opinion, and changing the nation's political balance-of-power, through grassroots organizing.

Edwards acknowleged that winning health care reform won't happen simply by inside-the-Beltway maneuvering. On that playing field, the drug companies, the insurance industry, and the hospital and HMO chains have the money and the upper hand.

The other candidates, Edwards said, believe that the way to get a health care bill is to broker a deal between "Washington insiders" -- insurance companies, drug companies and other lobby groups. "Its like the rest of America doesn't exist," Edwards noted.

"We need a President who is willing to go to America and make the case for universal health care."

Edwards pledged to be a leader, not just a deal-maker. Twice during Wednesday's debate, Edwards mentioned his hard work over the past few years helping labor unions and community organizing groups. Both prior to launching his campaign for president, and as an integral part of his crusade for the White House, Edwards has crisscrossed the country speaking at union rallies, joining picket lines and campaigns to raise the minimum wage, and visiting job-training centers, affordable housing developments sponsored by nonprofit community groups, and public schools where parents are trained to be effective advocates for children. At the debate, he talked about his work in New Orleans with the community group ACORN to organize residents trying to restore their homes and return to their neighborhoods in the wake of Katrina. And he talked about the importance of union organizing as a way to give workers a voice on the job and in the political arena.

This is hardly the typical path to the White House. Winning health care reform is part of Edwards' moral crusade against poverty and widening inequality in the world's wealthiest nation. While each of the Democratic candidates has put forward a health reform plan, Edwards seems most eager to forge alliances with unions, community groups, religious congregations, public interest and public health organizations, women's groups, and others to wage a campaign that is both bottom-up and top-down, one that combines an "inside" strategy and an "outside" strategy.

Edwards doesn't view these groups as "special interests," but as the key elements of an emerging movement to renew American democracy by empowering ordinary people.

When he visited the United States in the 1830s to write the now-classic Democracy in America, Frenchman Alexis deToqueville viewed the many voluntary self-help organizations among ordinary citizens as the genius of our pluralistic democracy.

Edwards is the first presidential candidate since Robert Kennedy who understands that grassroots organizing -- from the Boston Tea Party to the civil rights movement -- is a central part of American tradition.

Edwards wants help build on the upsurge of civic activism that has taken place across the country over the past decade, often below the media radar screen. He seems inspired by the people he's met in his work with grassroots groups. He wants to apply those lessons as President. He wants to be America's organizer-in-chief.

Indeed, It will require an enormous well-orchestrated, coordinated, and strategic grassroots organizing campaign to win health care reform. A broad coalition -- including unions, community groups, public health organizations (like the American Cancer Society and the American Lung Assn), nurses and other health professionals, environmentalists, netroots activists like MoveOn, and enlightened business leaders -- will need to find common ground on both a single policy plan and, equally important, a grassroots organizing effort that can persuade moderate Democrats in Congress to back health reform as well as target Republicans in "swing" districts and states who could lose their re-election efforts in 2010 if they don't jump on the health reform bandwagon.

In 1993 and 1994 -- the last time the country engaged in a major health reform debate -- the medical-industrial complex put the kabosh on reform. Back then, Hillary Clinton quarterbacked her husband's effort to find a broad consensus for change. But even with a Democratic majority in Congress, the Clintons failed because the health industry lobbyists were able to persuade enough moderate Democrats as well as Republicans to oppose any reform plan that threatened their bottom lines.

By trying to accommodate all the health industry lobby groups, the Clintons' plan was so complex and convoluted that it was difficult to explain and easy to caricature. The health industry successfully muddied the waters with clever TV and radio ads (remember "Harry and Louise"?). The industry lobby groups mischaracterized the Clinton plan as "socialized" medicine and claimed that "big government" would come between patients and their doctors. They effectively used the network of right-wing radio talk shows and the Religious Right to mobilize people to contact their Congresspersons to oppose the Clinton bill. Without a well-organized countervailing movement at the grassroots level, the industry lobby groups were able to win over enough Democrats to thwart a consensus on reform. They outmaneuvered the Clintons, who thought they could achieve health care reform by deal-making in Washington and splitting-the-difference among the various lobby groups. The Clintons didn't tap the potential power of ordinary Americans, who can speak loudly if they are organized and mobilized through their unions, community groups, religious congregations, and issue groups. But their voices were drowned out.

Now, 13 years later, the health care situation is worse. More than 46 million Americans lack health insurance -- up from 39 million in 1993. As Michael Moore's documentary film "Sicko" reveals, millions of families who have insurance are worried that they might lose it (if they lose their job or if their employer demands that they assume a great share of the cost) or that it won't cover them for serious illnesses. Businesses are complaining that they can't afford the skyrocketing cost of health care. General Motors claims that health care costs add $1400 to a car made in the US compared with the same car made in Canada, whose single-payer system reduces administrative costs, limits price-gouging by drug companies, doesn't impose health care costs on employers, and covers everyone.

According to public opinion polls, Americans are even more ready now than they were 13 years ago for a bold universal health care reform plan. But turning public opinion into public policy won't be easy.

Edwards scored the biggest audience response at the Dartmouth debate when he promised to cut off health insurance coverage for members of Congress if they don't pass universal health care reform by July 2009. But his real insight last night was when he talked about the importance of mobilizing Americans to fight for health care reform. Although Hillary wrote her senior thesis at Wellesley about organizing guru Saul Alinsky, and Obama spent several years as a community organizer in Chicago, it seems that only Edwards has absorbed the cardinal rule of organizing: it requires organized people to beat organized money.

To read more OffTheBus coverage and get involved here.

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