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A MEMO TO THE PRESIDENT RE: HEALTH CARE.
Mr. President:
Momentum for universal health care is slowing dramatically on Capitol Hill. Moderates are worried; Republicans are digging in; and the medical-industrial complex is firing up its lobbying and propaganda machine.
But, as you know, the worst news came days ago when the Congressional Budget Office weighed in with awful projections about how much the leading health-care plans would cost and how many Americans would still be left out in the cold. Yet these projections didn't include the savings that a public option would generate by negotiating lower drug prices, doctor fees, and hospital costs, and forcing private insurers to be more competitive. Projecting the future costs of universal health care without including the public option is like predicting the number of people who will get sunburns this summer if nobody is allowed to buy sun lotion. Of course the costs of universal health care will be huge if the most important way of controlling them is left out of the calculation.
If you want to save universal health care, you must do several things, and soon:
1. Go to the nation. You must build public support by forcefully making the case for universal health care everywhere around the country. The latest Wall Street Journal/NBC poll shows that three out of four Americans want universal health care. But the vast majority don't know what's happening on the Hill, don't know how much money the medical-industrial lobbies are spending to defeat it, and have no idea how much demagoguery they're about to be exposed to. You must tell them. And don't be reluctant to take on those vested interests directly. Name names. They've decided to fight you. You must fight them.
2. Be LBJ. So far, Lyndon Johnson has been the only president to defeat American Medical Association and the rest of the medical-industrial complex. He got Medicare and Medicaid enacted despite their cries of "socialized medicine" because he knocked heads on the Hill. He told Congress exactly what he wanted, cajoled and threatened those who resisted, and counted noses every hour until he had the votes he needed. When you're not on the road, you need to be twisting congressional arms and drawing a line in the sand. Be tough.
3. Forget the Republicans. Forget bipartisanship. Universal health care can pass with 51 votes. You can get 51 votes if you give up on trying to persuade a handful of Republicans to cross over. Eight year ago George W. Bush passed his huge tax cut, mostly for the wealthy, by wrapping it in an all-or-nothing reconciliation measure and daring Democrats to vote against it. You should do the same with health care.
More advice after the jump.
--Robert Reich
4. Insist on a real public option. It's the linchpin of universal health care. Don't accept Kent Conrad's ersatz public option masquerading as a "health-care cooperative." Cooperatives won't have the authority, scale, or leverage to negotiate low prices and keep private insurers honest.
5. Demand that taxes be raised on the wealthy to ensure that all Americans get affordable health care. At the rate health-care costs are rising, not even a real public option will hold down costs enough to make health care affordable to most American families in years to come. So you'll need to tax the wealthy. Don't back down on your original proposal to limit their deductions. And support a cap on how much employee-provided health care can be provided tax free. (Yes, you opposed this during your campaign. But you have no choice but to reverse yourself on this.) These are the only two big pots of money.
6. Put everything else on hold. As important as they are, your other agenda items -- financial reform, home mortgage mitigation, cap-and-trade legislation -- pale in significance relative to universal health care. By pushing everything at once, you take the public's mind off the biggest goal, diffuse your energies, blur your public message, and fuel the demagogues who say you're trying to take over the private sector.
You have to win this.
Your obedient servant, RBR
COMMENTS (5)
Hey Professor Reich, I worked on your campaign for governor and headed ward 9? in Cambridge for your stunning victory there. Too bad we couldn't have gotten you in.
I just wanted to post that I agree completely with this letter and I hope Obama pulls up his socks and gets it. Last night I watched the Amy Goodman hour salute to I.F. Stone, my grandfather, on the anniversary of his death. She led off with the fact that Izzy appeared on the original, radio, "Meet the Press" for the last time when he challenged Norman Fishbein (head of the AMA) to back up his attacks on "socialized medicine" by going to far as to call Truman a "communist" and a "fellow traveller" for advocating national health care.
Its a pretty stunning indictment of the "Debate" in this country that in the...what? sixty years since we have moved so far right that Obama's best case plan is more conservative than Truman's would have been.
aimai
Posted by: aimai | June 22, 2009 10:35 AM
Nobody can be LBJ anymore - no President has the kind of purse-string power over legislators like they did back then. He can't "twist arms."
Very disappointed that Reich can't understand this, and it damages this critique.
Posted by: Frank C. | June 22, 2009 11:57 AM
Professor Reich, I agree with you on substantive policy and your tactical recommendations for President Obama. Unfortunately, I see little chance that any of your tactical advice will be followed, since Obama seems ready to go to the mat only for the really important matters--you know, perpetuation of the Bush national security state, reneging on his promises of transparency, preventing dislosure of Bush tortue policy, and shielding Bush officials from any consequences of their ilegal acts.
Frank C.--I both agree and disagree with your comments re LBJ and Obama. For a multitude of reasons, I agree that Obama or any Democratic president, has considerably less power to knock heads on Capitol Hill than the master of the Treatment. (Though for the last couple of decades at least, Republican leaders, be they Gingrich, DeLay, Bush, or Limbaugh, seem to have little trouble browbeating their caucus into virtual unanimity and to bring along "centrist" Democrats as well.) Nonetheless, I have no doubt that Obma still retains more influence over the Democrats in Congress then he will be willing to use to enanct a public option.
Posted by: Marlowe | June 22, 2009 2:00 PM
7. You won last year's Presidential election. It's time to act like it.
8. Your greatest obstacle is your own party. Put a foot up its collective ass by asking American voters to bombard Democratic members of Congress with phone calls, letters, e-mail, etc. demanding that they got on board right now or else.
Bob, your heart is in the right place, but I'm afraid we're dealing with a President who has a pathological aversion to confrontation. I love the guy, but he's his own worst enemy when it comes to getting his agenda passed.
Posted by: Marti Perez | June 22, 2009 2:07 PM
The Pesident and his advisors and congressional Democrats have need understand that any bill that does not include a public option plan is likely to do more harm than good. Churchill once noted that ''You can always count on Americans to do the right thing - after they've tried everything else”. We have tried everything else on health care. Now it's time to do the right thing. About 20 other first-world countries with heath care plans with universal coverage and/or single payer systems have better overall health care statistics and costs of 8-12% of GNP compared to our 16-17% of GNP. Pick one of the others you like the best(Germany, Japan,.Canada, France, Norway, Sweeden, Denmark, Netherlands, England, Switzerland, Austria, Australia, New Zealand, whatever) and increase the costs by 20% to cover what you don't like about that particular system and you've got a much better system than ours at 20-40% less cost. If you don't like any of them, quite frankly you're a deluded ideologue that no amount of real-world data will change.
Posted by: george bittner | June 22, 2009 4:12 PM