Memo to the President: What You Must Do To Save Universal Health Care
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
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 healthcare 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
If you want to save universal health care, you must do several things,
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.
4. Insist on a real public option. It's the lynchpin of universal health
care. Don't accept Kent Conrad's ersatz public option masquerading as a
"healthcare 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 healthcare 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
You have to win this.
Your obedient servant, RBR