Lessons from the Health Care Fight

What can left organizers learn from the fight over healthcare?

We have incredible contributions from:

• Jonathan Kissam, Vermont Workers Center
• Michael Leon Guerrero, Grassroots Global Justice Alliance
• Terry Marshall, Healthcare Education Project (SEIU)
• Jennifer Flynn, Health GAP
• Trishul Siddharthan, Medical Student and Community Activist with Power U and Miami Workers Center
• Randy Jackson, consultant with movement-based organizations.

What should we talk about next month? Got something you think people need to hear? Email us.

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Taking On the Right Over Healthcare Reform in Vermont

Jonathan Kissam is a rank-and-file member of UE Local 203 in Burlington, Vermont, and a member of the Vermont Workers’ Center/Jobs with Justice. More information about the Healthcare Is a Human Right campaign can be found here.

Well-organized right-wing crowds disrupted most of the healthcare town halls that took place across the country in recent months. But the August 15^th healthcare town hall in Rutland, Vermont was different. The red placards and t-shirts of the “Healthcare Is a Human Right” campaign of the Vermont Workers’ Center/Jobs with Justice (VWC/JwJ) dominated the audience and the media coverage of this town hall. Anti-reform speakers got their share of time at the microphone, but they were unable to be disruptive because of the large VWC mobilization. Independent Senator Bernie Sanders–a long-time supporter of a single-payer healthcare–remained in control of the room and was able to challenge the lies that came from some of the right-wing speakers.  Media reports attributed the lack of disruption to Vermont’s tradition of civil debate, but the real reason was good old-fashioned grassroots organizing: dozens of volunteers making hundreds of calls to a base built over more than a year of our Healthcare Is a Human Right campaign.  The VWC/JwJ believes that there are important lessons to be learned from our success in turning back the right wing:

• Putting policy reforms in the context of a values-based campaign: We built our campaign based on the idea that health care is a human right. Basing our campaign on a commitment to this basic value allowed us to build a larger and more engaged base than a narrow policy-based campaign could have. While many of the people we turned out to the town hall meetings may not have understood the ins-and-outs of health care policy, they were committed to the notion that healthcare is a human right.

• Understanding that this is a struggle over power, not a debate over policy: Throughout our campaign, we have been clear that only serious struggle from the grassroots can win real healthcare reform.  While our campaign is focused on state heath care legislation, we mobilized our base for these town halls because we saw the federal debate as a critical battle in which our opposition has access to friendly media and unlimited resources from the insurance companies.

• Placing the voices of people most affected front and center: At hearings that we held around the state, a wide spectrum of Vermonters shared their stories about the broken healthcare system, from union members with “good” health insurance who had been denied care to uninsured loggers who live with daily fear of accidents to women who stayed with abusive husbands out of fear of losing health insurance to the nurses who see needless suffering everyday. In the town hall meetings, this kind of powerful personal testimony stood in sharp contrast to the shrill rhetoric of the right wing.

• Leadership development: Too often, campaigns are so focused on winning policy goals that we neglect to develop the skills and leadership potential of the people who we are organizing.  During the course of this campaign, the VWC held organizer trainings around the state. As a result, campaign leaders were prepared to speak up at the town hall meetings and to represent the powerful voices of the people who have suffered under the current system.

• Taking on right-wing beliefs about government: VWC/JwJ chose healthcare as our major campaign not only because it is an issue that affects all sectors of the working class, but also because it offered an opportunity to engage people in a discussion about social values and a vision for a different society.  We don’t believe that progressive forces can win policy debates if we accept the values framework of neoliberal capitalism, that markets are inherently more efficient than government and that individuals are on their own to provide for their own welfare.  By challenging these values with a vision of a caring society, in which communities take collective responsibility for the general welfare, we hope to contribute to building a movement than can win universal healthcare and a just society.

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Shifting the Terrain

Michael Leon Guerrero is coordinator of the Grassroots Global Justice Alliance (GGJ) and a member of the National Planning Committee for the US Social Forum.

The Battle of Ideas: The Right engaged in the battle of ideas in the health care fight. They utilized basic military strategic principles: set the stage for where your battles take place, and you will win. They are trying to shift the battlefield about the role of government by framing government as an enemy that will control our lives.  We need to fight on this terrain as well: take on right-wing beliefs about government and put forward our own visions.  If we focus only on narrow policy issues, we are missing the broader struggle. Winning ground at the ideological level can create space for us to win more concessions on policy and implementation.  We should not focus on pressuring the Obama administration. Instead we should work to open political space for the administration to win its more progressive reforms and position ourselves to push for more progressive policy later.  Our messages should target our real adversaries, including (1) the people who benefit from regressive policies, like health insurance companies and bankers, (2) figureheads in the Right, like Dick Armey and Rush Limbaugh, who are promoting the regressive agenda and (3) conservative policy-makers.

Provocative Tactics: The Right has succeeded by using a provocative agitational and direct action strategy, including carrying automatic weapons to Obama town hall meetings and drawing on Saul Alinsky’s tactics. Even though the people who disrupted the healthcare town halls acted crazy, polls showed that their strategy worked. The Obama administration went on the defensive and is prepared to cave in on key aspects of healthcare reform.  Recently, a confidential memo from the American Petroleum Institute (API) surfaced which called for a similar strategy in the upcoming climate policy debates.  The memo called on “member companies to ‘move aggressively’ to stage public meetings, similar to the recent protests against [Obama’s] healthcare plans.”  Although this plan backfired and caused a split within the API, it suggests that we have not seen the last of the disruptive tactics of the Right.  We need to plan ahead and develop our own agitational strategies to sharpen the debate about the role of government and the economy.  Our strategies should focus on direct action – including rallies, town hall meetings, days of action and civil disobedience – and be coupled with an aggressive communications plan to promote our values to a wide audience.

Take Advantage of the Moment: There are key political moments – like the 2006 immigrants rights mobilizations and the aftermath of Hurricane Katrina – when we need to carve out time and take on issues that are not currently part of our work-plans.  This is one of those moments.  If the most progressive aspects of the healthcare reform are gutted and we lose more ground on energy policy, then the window of opportunity for progressive policy may close soon.  We need to act decisively and aggressively this year. What happens in the next six months will set the political tone for the next decade of our work.

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Don’t Wait on the Sidelines!

Terry Marshall has been involved in youth and social justice struggles for the past 13 years.  In 2005 he founded the Hip-Hop Media Lab, an intermediary that uses culture and new media to organize social networks. Today Terry is the Lead Youth Organizer for the Healthcare Education Project (1199SEIU), a Blogger for octavianprinciple.wordpress.com and enjoys being a heretic of the Left.

The left has largely been absent from the fight over healthcare. There have been many important political developments that evolved out of this fight, and we need to understand and analyze them if we are going to develop an effective left strategy for our current moment.  One of the most important developments has been the resurgence of the grassroots Right and the return of red-baiting.

Obama’s election victory has revitalized the mostly Christian and white grassroots base of the Right in this country. Where did this resurgence come from? These people have seen the privileges they gained from being white within the American Empire wither away. They see the election of the first Black president as the final closing of the door on the America they imagine and love. Talking heads, such as Glen Beck and Rush Limbaugh, speak to the fears of white middle class and working class people. They have played on those fears to go on the attack and push back the possibility for progressive gains that came with Obama’s election.

The fight around healthcare is the first major policy battle where these groups came into play. These forces became the shock-troops of the resistance to healthcare reform. The funding for that resistance came from the big health insurance companies, but the interests of the grassroots base and big corporations do not actually always align.  We need to be clear where their interests actually diverge. Even with all of their red baiting, their confused rants and their racist attacks, we have to remember that these social forces are actually “up for grabs” by the Left. We need to learn how to win some of these forces over to a Left progressive agenda. We need to develop mechanisms that can speak to their issues and clear up the confusion promoted by the Right.  It won’t be easy, but it is absolutely necessary.

There are other valuable lessons that the Left can draw from this fight.

First, we need to move beyond critique. The Obama administration did blind side the single payer movement with his “public option.” But we were reeling from that for far too long.  Most of the left stayed stuck in critiquing Obama and didn’t move to develop a plan on what to do about it. The Left needs to move through our critiques and concentrate on laying out a plan for how to actually move our agendas through the Obama administration.

Second, we need to move faster. The Left jumped in the game far too late. Many of our organizations move at a glacial pace, even in the face of major crises and significant political shifts. We get caught up in our “three-year strategic plans” and such. We need a more flexible strategic orientation that can allow us to make fast decisions without losing our long-term focus.

This leads into the final lesson: we need new organizational forms. A large section of the left today is trapped in non-profit structures, and we suffer from the limits of that organizational form.  Many people have talked about the need to develop cadre structures, but we also need other intermediary forms. Some people have formed volunteer collectives outside of non-profits.  Some progressive staff and members who work at nonprofits have formed volunteer groups to do actions that they could not do within the limitations of non-profit structures. Some examples have been the Community Avengers in Miami and Young Voices Nation in NYC.

The Left needs to learn these lesson fast enough to be able to weigh in on the other upcoming battles: the fights over climate change and energy policy, education and immigration reform.  Training season is coming to an end. It’s time to get off the sidelines and into the game!

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How a Good Idea Without a Base Becomes Nearly Impossible

Jennifer Flynn was the co-founder and director of NYC AIDS Housing Network and is a current board member.  She is the Managing Director for Health GAP (Global Access Project) and writes about organizing, social justice, AIDS and healthcare issues for numerous outlets.

My job at Health GAP, an international AIDS advocacy and organizing group, meant that I spent a lot of time on the campaign trail during the 2008 Presidential campaign.  I heard the stump speech from every candidate at countless town halls and forums.  In every one, an audience member asked about healthcare.  And every candidate felt the pressure to release a policy document outlining how they would creatively restructure the way we deliver healthcare in the United States.  No one could deny that healthcare is an issue that is deeply and widely felt among people living in the United States.  No one could deny that there are creative ways to solve this issue.  Anyone who has been to a training on grassroots organizing could tell you: the fight over healthcare meets all the criteria for a great campaign.

So then why is healthcare reform facing challenges that seem insurmountable?  What seemed like our big chance for real reform and “change we can all believe in” is becoming an increasingly distant opportunity.  We have been missing a crucial part of the equation: there hasn’t been a serious investment in real organizing around healthcare in years.  In fact, over the years, investment in healthcare organizing has been shrinking dramatically.

I hope that we will see a different outcome in the next big policy battle: immigration reform.  Why would we have a different outcome?  For the past five years, private foundations have consistently invested in progressive grassroots organizing among immigration issues.  This investment was necessary to combat the war on immigrants that escalated after September 11^th.  Because of this investment, I think that progressives will be more vocal and effective and that the broad debate around immigration reform will look different then the debate around healthcare.  At least, I hope so.

One of the reasons that private progressive foundations have cut funding for healthcare reform is because health inequities expose the complicated root causes of inequality in our country.  It is easy to see the reality that healthcare delivery is abysmal in poor communities, both urban and rural. The fight for better healthcare shines a bright light on our nation’s systemic racism and sexism.  By its very nature, working on the issue of healthcare means that we must address the body.  Organizing around other issues, like housing, is simply less complicated. We don’t have to look at ourselves. We can point to the landlord, at the structural damage and ignore our racism and sexism. It is less controversial and safer, and funders like that.

William Smith, the Executive Director of SEICUS (Sexuality Information and Education Council of the United States) deftly identified that—in this debate over health care—elected leaders missed an opportunity to move thinking about “constitutional rights” to an acceptance of a broader “human rights” framework.  Because they missed that opportunity, they gave up debating what the “best idea” is. Instead, we are now fighting over the worse of different evils. I would argue, that like during the Civil Rights Movement, the people who hold power are simply unwilling to create a crack that might let the light in and expose the deep inequality facing our people. What’s worse is that there are few progressive organizations that are positioned to shift this paradigm. Powerful progressives gave up on the right to protect women’s bodies and on frank talk about sexuality because working on those issues would force us to expand our views about controversial issues around sexuality and gender. We chose to find common ground and settle rather then change hearts and minds.  We gave up the fight. Now, when we need strong ranks, they are not organized.

The answer is to reinvest in organizing around these issues: support organizing among women, make HIV prevention an issue that is as commonplace as fighting for heat or lead paint removal in housing. Without a mass of people demanding progressive social justice, change may come but it will not be the change that we seek.

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The Summer of Discontent

Trishul Siddharthan is a community activist with Power U and Miami Workers Center and third-year medical student at the University of Miami.

As a medical student, I witness the casualties of the healthcare fight on a daily basis. A sweltering summer of Washington debates and street protests didn’t produce any consensus on fixing the healthcare system. The political left remains fragmented: some people are working towards a government-run system while others want to maintain a market-based approach and add in a “public option.” As organizers, we should expect Washington to fail in passing effective legislation because three questions remain unanswered:

• Who is organizing?
• What is the message?
• What is the base?

We can’t just watch these policy debates unfold. We need to be out there, organizing the base of people who are affected by these issues.

Meanwhile, local health care policies continue to get worse. While public attention was directed at partisan politics in the Capitol, state governments cut the type of programs that the federal health care legislation is supposed to support. For example, in Miami, two of our ten public health clinics will be closing this year. State funding for public education and housing continues to erode, even though education and housing determine health outcomes far more than access to health insurance does.

There are two principles that we need to remember moving forward from the fight over health care:

1. Health equity will not be achieved with specific health policy prescriptions. Health equity can only result from a full-spectrum investment in community infrastructure: education, housing, access to fresh food, clean and safe environments. We cannot limit our fight strictly to issues of health insurance and health-care access.
2. Dogma does not treat patients. Privileged people have dominated the healthcare debate, and that’s true on both sides of the political aisle. They maintain their political doctrines at the expense of the patients who face the daily realities of health inequity. Although we cannot compromise on people’s human right to health access and care, both sides need to make concessions to ensure the passage of health legislation this year. Although the current legislation does not reflect progressive demands, we need to get something passed this year. If we don’t pass a bill soon, the progressive movement will continue to be distracted from far more pressing issues, and the burden will fall firmly on the shoulders of patients like the ones I see every day.

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Expose the System & Build the Fight

Randy Jackson is a 15-year veteran of social justice organizing and activism. Most recently he served as Development Director of the Miami Workers Center, a strategy and organizing center for Miami’s working class African-American, Latina and Caribbean communities fighting for self-determination and power.

Expose the System

Let’s start with the larger forest we often fail to see because we are so pressed up against the tree: the system is broken, and this is not just about healthcare, but the system of advanced global capitalism in which we live. The health care system in the U.S. is emblematic of the failed nature of the broader system.  Capitalism treats human life as a commodity, and it treats the work to care for life as a commodity as well. Medical bills are the #1 reason that people in this country can’t afford to pay their rent or their mortgages and face eviction and foreclosures, and that’s an outrage! We should be a lot angrier than we are! This health care debate is a moment of opportunity to engage in exposing the failures of the status quo on a mass level. But as leftists we must ensure that this exposure is happening among oppressed communities (the unemployed, poor, and working class women and children, immigrants and people of color), the people who make up the lions’ share of the forty million uninsured in this country. For the past ten months the organized voices of the oppressed sectors of society have been absent from the broader healthcare debate; left organizers need to play a role in turning that dynamic around.

Visionary Demands towards a Visionary Alternative

In the context of health care, universal healthcare coverage (perhaps best captured in the single payer model in the context of the current debates) is the most visionary response. Period. We have the wealth in this country to cover this; that’s not the problem. Michael Moore in Sicko laid out multiple possible models based on health care system’s from at least half a dozen western industrial countries (and Cuba!). C’mon now, more anger please!  But if it’s the whole system in disarray, then demands around health care should be only a part of our total visionary alternative.  Families in the U.S. are making heart-wrenching and life-changing decisions where they have to choose between their next meal or paying a utility bill. One out of every six children in this country is not sure where her next meal will come from. medical costs force families out of their homes. All of these are daily events under U.S. capitalism.

One lesson is clear: U.S. capitalism cannot care for the basic necessities of its people. Since a leap forward to a new society isn’t on the immediate horizon, we need to develop landscape-shifting demands that move us closer to that leap. As we fight for a better health care system, lets put forward the demand for a total package of social goods: a social wage, guaranteed housing, health care, childcare, basic food, public transportation. In the current economic climate this is something that more and more of us can relate to. And it’s a glimpse of a visionary society, of the way things ought to be. Fighting for it will bring it closer.

Charting the Path—A Strategy

First, we have to continue the work of organizing the unorganized, and building fighting institutions of the most oppressed.

Second, we need sharp assessments of the broader political moment and the nimbleness to mobilize resources when the political moment requires us.

Third, we need to take it to scale. We lack the mechanisms for flexible coordination at a mass scale that can make an impact. There is an emergent trend towards greater coordination. Activists are becoming parts of collectives. Grassroots groups are aligning themselves into networks. Networks are forming alliances among each other. These are positive developments and they should be supported. Beyond these developments, we need a new kind of party: with membership in the hundreds of thousands that can represent the interests of the people most impacted by the system. One that truly represents the Latina family who had their home foreclosed on by the banks; the single black mother who had to chose between feeding or clothing her newborn; the subway conductor who was laid off and is now struggling to make ends meet.