As a candidate, Barack Obama assured us that if he were elected president, when the time came to reform America’s health care system, “insurance companies, drug companies -- they'll get a seat at the table, they just won't be able to buy every chair.”  Unfortunately, he didn’t mention that when he became president the people with a real solution to the problem – a single-payer insurance system – wouldn’t get any of the chairs at all.

Now it’s not just me saying that “single payer” is a legitimate solution to the problems of incomplete and inadequate coverage and bureaucratic waste – Obama has been pretty clear about it himself.  On New Year’s Eve, 2007, he told an Ames, Iowa crowd that “If I were designing a system from scratch I would probably set up a single-payer system ... But we're not designing a system from scratch ... For now, I just want to make sure every American is covered.”  Fair enough as a seemingly pragmatic rationale, except that on July 22, 2009 he told a press conference that “the truth is that unless you have a what’s called a single-payer system in which everybody is automatically covered, then you’re probably not going to reach every single individual. ”

Well, that completes the circle, doesn’t it?  So, by this point it should be obvious why those pesky single payer advocates have been keeping at, even when no one will let them sit at the table – someone’s got to make some sense out of this situation.  In his effort to avoid the Clinton Administration fiasco of a coming in with a plan so massive that it could be attacked on a thousand points, Obama himself has largely washed his hands of the details, leaving it to various congressional committees to decide whom and what to let in or leave out.  And as Senator Max Baucus (D-MT), chairman of one of those committees – Senate Finance, acknowledged during a May 21 appearance at the Health Care Reform Newsmaker Series (sponsored by Kaiser Family Foundation, Families USA and the National Federation of Independent Business), so far as the single payer option goes, “just to be honest, it’s not on the table. It’s the only thing that’s not, because it cannot pass.”

And just so you knew he wasn’t fooling, sixteen days earlier eight single payer advocates were arrested at one of his committee meetings for trying to speak about the problem that the one proposal that the President acknowledges would “reach every single individual” was “not on the table” at the Senator’s committee.  But guess what – on June 24, the New York Times reported that Baucus “conceded that it was a mistake to rule out a fully government-run health system, or a ‘single-payer plan,’ not because he supports it but because doing so alienated a large, vocal constituency and left Mr. Obama’s proposal of a public health plan to compete with private insurers as the most liberal position.”

(The Times here makes the all too frequent error of calling the single payer proposal “a fully government-run health system.”  There are “fully government-run” health systems, to be sure – in Great Britain, for instance.  But a single payer system, such as exists in Canada, is a not one of them.  It is more a variant of Medicare with its role limited to approving and processing payments for treatment provided by doctors who may work independently or for any kind of institution.  Privately provided health care would remain largely intact; privately provided health insurance would not.)

Did this mean that single payer was now on the table after all?  Well, no – and maybe that’s  not too surprising given that the Center for Responsive Politics says “The health sector has given Baucus at least $2.8 million during his career” and Consumer Watchdog reports him trailing only former presidential candidate John McCain (R-AZ) in congressional campaign contributions received from both the health insurance and pharmaceutical industries over the past six years.  And maybe it’s not so surprising that the President has taken the position he has either – The Atlantic reports that “in 2008, Barack Obama collected 72 percent of the [health care] industry's donations” to the presidential candidates.  (It further reports that “So far in this [congressional election] cycle, Democrats are receiving about 66 percent of ... the $3.5 million donated by health care companies.”)

Still, it’s one thing for Baucus, or even Obama to marginalize single payer, but it seems genuinely strange when people who actually do understand and support it and are not getting campaign contributions write it off as well.  And yet this has been happening with distressing frequency.  When one longtime fixture on the left op-editorialized asking where was Obama’s famous volunteer army on the question of health care reform, the answer seemed only too obvious.  The only health care reform movement there is out there is for single payer and that movement has been slapped in the face from day one.  Another longtime leftist addresses the persistent single payer advocates and suggests that they start asking themselves what compromise they can live with for the simple reason that single payer is “‘off the table’ in terms of political reality.”  And why is that?  “Mostly because of the opposition of the insurance corporations and drug companies.”  Right.  And by that logic, I guess we’d just concede them a veto based on the superior financial resources that they’ve “earned” from their rate payers and customers and concern ourselves with the more limited scope of things the general public is allowed to be concerned with.  Doesn’t seem to be much point getting up in the morning – politically speaking – with that outlook.

Of course, none of what we’re dealing with here is new or unusual, nor is it confined to the left.  For one thing, an administration of the right is just as likely to disappoint its base by dealing toward the center when fishing for votes, with the same rationale that its base has nowhere else to go.  Nor is it unusual for campaigners of any stripe to hold illusions about their presidential candidate.  Perhaps campaigns would be impossible without a certain starry eyed belief among many of the rank and file that their candidate actually privately agrees with them much more than he lets on, but that he has to say what he says for, you know, political reasons.  And when you add in the fact that the President is under attack for attempting to do anything at all, since what the health insurance industry really wants the government to do about the health care situation is leave them alone – and maybe loosen up the regulations a bit while they’re at it – you can understand a reluctance to publicly criticize “our guy” when he’s taking so much heat from the other side.

But in this case the reluctance to criticize seems to extend significantly beyond what it was when Bill Clinton or Jimmy Carter was in the White House.  He’s an African-American; he understands.  He was a community organizer; he knows what’s going on.  We find self identified radicals bubbling on the Internet about Obama’s ability to talk baseball on the All Star Game broadcast – No wonder we love this guy!  They even “Obama-ize” their pictures – We are all Obama!  Friends caution me about not appearing to criticize the man himself when criticizing his policies. And the consequences of the infatuation are not limited by issue or geography.  As a pair of D.C. based antiwar organizers recently wrote back to their allies in the provinces: “What we've just learned in the past three months is that with Barack Obama in the White House, our Congressional work has become more difficult on issues of war and peace.”

One aspect of all this that seems particularly strange for a president and a core of supporters who claim to be all about community organizing is that they sometimes seem woefully deficient in analyzing what they have for a base.  His supporters should rally around what?  The “public option”?  Met anyone lately who can tell you exactly what that is?  Probably not.  It is possible to craft a piece of legislation and pass it relatively quickly and that legislation might even be quite good.  But you cannot build a movement about a proposal in a field so complicated as health insurance overnight, particularly when it doesn’t come with particulars.  The government will sell a certain amount of health insurance on its own – that’s about all anyone’s going to be able to tell you about a public option at this point. 

Most people still don’t know what you’re talking about when you say “single payer” either, but there are far more who do than there were fifteen years ago for the simple reason that a substantial number of committed people have been persistently working at it all that time.  They didn’t put in that effort because they ever thought that the insurance industry would allow it to be “on the table” if it could prevent it from being there, but rather because the logic of the situation of huge and growing numbers of people lacking health insurance combined with the colossal amount of money wasted by the private health insurance industry demanded it.  Any organizers who think they can motivate single payer supporters by telling them to toss away what they know to be true because the other side has more clout on Capitol Hill might want to think about re-upping in organizing school.

Fortunately, not everyone has drunk the Kool Aid and some of the single payer advocates have soldiered on, paying no heed to the cautions of the more “realistic.”  In Congress itself, Rep. Dennis Kucinich (D-OH) succeeded in getting the House Committee on Education and Labor to pass an amendment to the House health-care reform bill specifically granting states the power to create their own single-payer health care systems.  Now that’s a public option we can believe in.  And by his efforts to substitute a national single payer bill for the committee’s bill, Rep. Anthony Weiner (D-NY) has elicited a promise from the House Leadership that a single payer bill will come to the floor for a vote by the entire House.

So, what now?  It’s one thing to argue that it was substantively as well as tactically stupid to eliminate single payer from the mix at the outset, but it’s quite another to believe that it could win this year even under the best of circumstances, which these have certainly not been.  Valuable time that might have been used to clarify the debate has been squandered with this “not on the table” foolishness.  And perhaps the most damaging aspect of the single payer freeze out is that the Congressional Budget Office has never provided a financial analysis of what it would do.  And when you’re pushing a bill on the basis of its ability to cut costs, that’s a mighty big handicap.

At the least, the commitment to a full House vote will allow us to see who’s really willing to buck the insurance industry and who’s blowing smoke.  No more “I’d be for it, but it can’t win.”  Just cast your vote.  But what’s a single payer advocate to do in the event that the votes aren’t there?  Is the public option a fair compromise?  Until and unless someone can explain just how it is going to function and guarantee that it’s not some tiny pilot program, probably not.

The state single payer option may be something else, though.  American single payer advocates did not opt to go with it because it represented the only potential solution to the problem.  Ron Dellums, for instance,  took an entirely different approach when he was in Congress.  He introduced legislation to create a government run health service along the lines of some European systems.  But most American health care reform advocates judged that the specter of “government-run” health care would just be too high a hurdle to surmount and opted instead for a plan that would affect the billing system but not the delivery system.  And there was something else – the Canadian system is province based, not run out of Ottawa.  It started in Saskatchewan and spread to the rest of the country after its success there could not be denied.  The state option, then, would be following the Canadian model in that regard as well.

The California Legislature has twice passed a state-based single payer system, only to have it vetoed by Republican governor Arnold Schwarzenegger.   A Democratic governor and a guarantee of all of the waivers from federal regulation needed to allow the state law to operate would make for an entirely new ball game.  Not that the state would be home free after that, mind you.  First off, there is that immense California budget problem.   And then there’s the question of how many of the legislators who’ve been willing to vote for the bill when they knew it was sure to be vetoed will continue to vote that way when they know it counts.  After all, during his (unsuccessful) campaign the last Democratic gubernatorial candidate wouldn’t even commit to signing the bill.  Nevertheless, there is more than a glimmer of hope there and the Kucinich Amendment just could ultimately turn out to be the piece that matters.  With California having more people than all of Canada’s provinces combined, a single payer system there would be the world’s largest.  And with apologies to Frank Sinatra and New York City, if single payer can make it there ... well you know how it goes.