It's conventional wisdom that if Hillary Clinton's presidential campaign falters with Democratic activists in places like Iowa and New Hampshire, it will be over the issue of the Iraq war. And her vacillations on the war.
Yet the dividing-line issue in the upcoming primaries may turn out to be not Iraq, but healthcare. And just like on Iraq, the Democratic base is in no mood for timidity and half-way measures and vague rhetoric. Most rank-and-file Democrats support government-provided national health insurance: enhanced Medicare for All.
And that's no secret to the candidates. This is how the Washington Post described Hillary Clinton's recent, maiden voyage into Iowa as a candidate:
In keeping with her expressed desire to hold a "conversation with Iowans," Clinton asked at one point for a show of hands from the audience, asking them to declare whether they preferred an employer-based system of insurance, a system that mandates all individuals to purchase insurance, with help from the government if necessary, or one modeled on the Medicare system. Overwhelmingly the audience favored moving toward a Medicare-like system for all Americans.
A show of hands in almost any roomful of Democratic activists will produce the same result: they want a single-payer "Medicare-like system for all Americans." According to the Post, Clinton told the Iowa group: "I'm not ready to be specific until I hear from people."
Pressure from the base on Clinton and other Democratic contenders to get specific will intensify in the early states -- mobilized by groups such as Progressive Democrats of America, Healthcare Now, National Nurses Organizing Committee and Physicians for a National Healthcare Program. So far, none of the sitting Senators seeking the nomination are supporting Medicare for All, though former Sen. John Edwards may be coming close. Rep. Dennis Kucinich for years has been a leading supporter in the House.
That single-payer is the rational, cost-effective way to reform healthcare is an easy case to make -- and was eloquently argued last month by respected Democratic party activist and lawyer Guy T. Saperstein. Despite spending twice as much money on healthcare as other industrialized nations, our system fails to cover 47 million people and generally performs poorly. Experts point to the main cause of the failure -- a private insurance bureaucracy that soaks up nearly one-third of all healthcare dollars in waste, profits, paperwork, commissions and advertising.
Insurance companies don't treat or heal patients; they just suck the healthcare system dry of hundreds of billions of dollars.
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Adding pressure on Democratic presidential candidates was last month's reintroduction of "The U.S. National Health Insurance Act," HR 676, authored by Rep. John Conyers and soon expected to have 80 Congressional cosponsors. This "Expanded & Improved Medicare for All Bill" would fully cover every American, thanks to cost-savings. In its first year, single-payer would save over $150 billion on paperwork alone, and $50 billion though rational bulk order purchasing of medications. Care will be privately-delivered by healers and hospitals, but publicly-financed -- with no bills, co-pays, deductibles, denials or medically-induced bankruptcies.
Every Democratic aspirant will be asked where they stand on HR 676, which is endorsed by 225 labor organizations. Over the years, a common-sense single-payer approach has been endorsed by Consumers Union, some corporate CEOs and 20,000 physicians. Only one force in society stands in the way: the insurance industry. And that sector donates heavily to many "top tier" Democrats.
As healthcare emerges as a dividing-line issue among Democratic candidates, expect mainstream media to tell us the story of Hillary Clinton's healthcare initiative as "First Lady" in 1993. And expect every fact in the re-telling to be wrong. Why? Because they got almost every fact wrong at the time. Clinton did not support single-payer; she resolutely stood against popular legislation led by Sen. Paul Wellstone, Conyers and Rep. Jim McDermott, then one of two "doctors in the House."
Indeed, Clinton's proposal was aimed at "reforming" healthcare while keeping a handful of huge insurance companies in the center of the system. No surprise since those firms helped draw up her complicated and bureaucratic "managed competition" scheme, through the industry-dominated Jackson Hole Study Group. A Mother Jones writer in 1993 described the assignment given Hillary by the White House: Build us a better, leaner, cheaper mousetrap (healthcare system) -- but make sure you include a player piano (private insurance giants) in the middle of your contraption
In late 1993, Hillary's plan came under attack by devious TV ads sponsored by an outfit called the Health Insurance Association of America, acting on behalf of smaller and medium-sized insurance companies. These smaller firms were furious that the Clinton plan would wipe them out and concentrate the industry in a handful of insurers like Aetna and Cigna. (Not unlike what happened to broadcasting under Clintonite media "reform.")
Last November's election has already changed the terms of the national debate on Iraq. If progressives mobilize, we can also use this moment (and the upcoming presidential primaries) to transform the healthcare debate.
And one day soon we may get what other advanced countries already have: a healthcare system that works, with nonprofit insurance for all.