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Sicko Citizenship … And What We’re Missing

sicko.jpgSo, you saw Sicko last week. (Yes, you did — or you devoutly intend to see it. Oh yes.) And maybe you’re like the two New Jersey transit workers I overheard last weekend, discussing the movie animatedly — “And then Hillary took the money! — Can you believe that??” Or, maybe the movie really got your dander up, and you’re like these folks at a Dallas cinema last weekend:

When the credits rolled the audience filed out and into the bathrooms. At the urinals, my redneck friend couldn’t stop talking about the film, and I kept listening. He struck up a conversation with a random black man in his 40s standing next to him, and soon everyone was peeing and talking about just how fucked everything is.

I kept my distance, as we all finished and exited at the same time. Outside the restroom doors, the theater was in chaos. The entire Sicko audience had somehow formed an impromptu town hall meeting in front of the ladies room. I’ve never seen anything like it. This is Texas goddammit, not France or some liberal college campus. But here these people were, complete strangers from every walk of life talking excitedly about the movie. It was as if they simply couldn’t go home without doing something drastic about what they’d just seen. My redneck compadre and his new friend found their wives at the center of the group, while I lingered in the background waiting for my spouse to emerge.

The talk gradually centered around a core of 10 or 12 strangers in a cluster while the rest of us stood around them listening intently to this thing that seemed to be happening out of nowhere. The black gentleman engaged by my redneck in the restroom shouted for everyone’s attention. The conversation stopped instantly as all eyes in this group of 30 or 40 people were now on him. “If we just see this and do nothing about it,” he said, “then what’s the point? Something has to change.” There was silence, then the redneck’s wife started calling for email addresses. Suddenly everyone was scribbling down everyone else’s email, promising to get together and do something — though no one seemed to know quite what.

“… No one seemed to know quite what.” To whom do you write that check? What pro-health-care organization has the connections, the firepower, the bad-ass lobbyists buttonholing Congresscritters left and right on behalf of health-care-for-everyone?

Yeah, I don’t know either. And that’s a problem. Our health care activist infrastructure is fractured and weak. If we’re going to get anything done in the next two-to-four years, we better get it together.

Let’s start with our “incrementalist” friends — the folks who concentrate on covering all kids and strengthening Medicare. Families USA is the pre-eminent “health care consumer” lobbying group out there. Look at their front page: Lots on Medicaid and Medicare, but do you see one single solitary word about universal health care? How sad — a group with potentially great influence, relegated to fending off the GOP rear attacks on what we’ve already got. Is that how it has to be? I don’t believe it.

PS: What the hell is a “Families USA”, anyway? Is it animal, vegetable, or mineral? Is it a fundamentalist theme park?

Then there’s a group called the National Coalition on Health Care. They go with the Obama-esque “roundtable” model: Bring all your “stakeholders” together, and try to bang out a solution that makes as many people happy as possible. They’ve got ex-governors, CEOs and labor leaders on their board. They could be influential, but I don’t see them as a populist counter-balance to the insurance industry — that’s just not their thing. Right now they look an awful lot like a health care Concord Coalition: A bunch of smart, well-meaning, very earnest bipartisan-ish folks who will get rolled by Big Insurance and Big PhRMA when the deal goes down. (They do have useful stats and other information on their site, which I’ve used frequently.)

And over to the left, we’ve got Physicians for a National Health Program, a fine group of folks, with real research and clinical backgrounds. They wrote the single-payer health care bill that would sweep away the insurance companies and have the federal government pay for (but not deliver) all health care — HR 676. They run the website, meant to direct the firehose of Sicko-inspired citizen activism toward getting more support for their bill. All well and good. Their bill has 78 co-sponsors (and rising) in the House, but bupkis in the Senate — not a single sponsor. Why does this well-credentialed group get so little traction with our decision-makers? The threat of insurance company resistance, no doubt — but that’s only part of the story.

Unfortunately, PNHP doesn’t play well with others: “As a matter of policy, PNHP expressly opposes what are sold as “gradual” steps towards single-payer.” Indeed, warns,

Beware of Phony Universal Coverage: Many political candidates say they support “universal health care,” but usually this just means making more Americans insurance company customers. Real universal coverage means evicting insurance companies and establishing a national health program instead.

Translation: You’re either for us or against us. They may be right on the policy, but statements like that leave them on a political island. One can express skepticism for incremental plans while engaging, rather than vilifying, those working in good faith on other proposals — these folks, for instance, or John Edwards, or Barack Obama. I hope PNHP will reconsider that language — and more importantly, its underlying political strategy. But I’m not holding my breath.

Currently, PNHP is a proposal in search of a movement. With their purist attitude, I sincerely doubt PNHP has the organizing chops to come anywhere close to majorities in the House and Senate — even with Michael Moore and a wave of spontaneous citizenship in their favor. That’s not to say that supporting their effort is useless — anything but. We need ballast on the left side of this argument, especially now, 18 months from a new (Democratic!) administration. But folks who get involved in their effort need to know how to work in coalition and dialogue with others of good faith, who may not be willing to buy into the whole program. Neglecting or even shunning the building of coalitions leaves the entire movement weaker. PNHP (et al.) would be more influential, more powerful, and accomplish more good if they were at least at the table with other health care activist groups.

Now, as for those groups that do know something about how to do politics: I think it’s great that MoveOn is getting involved in Sicko Citizenship. Their brand of people-powered activism is exactly what the doctor ordered, so to speak. And remember that “health care for all” was the #1 priority of MoveOn members last year. They’re involved in getting folks to see the movie, and telling the presidential candidates to reject health insurer cash, which is great. But goodness, we’ve got 535 members of Congress to work on as well. It’s worthwhile, but still like trying to take down a mountain with a toothpick. So I assume that MoveOn has a comprehensive strategy in mind with regard to health care: What else have they got coming between now and 2009?

So what’s the right way to express Sicko Citizenship? Let’s keep in mind this quote by Dr. Quentin Young, actually one of the prime movers behind PNHP:

“I’m a recovering incrementalist,” says Quentin Young, M.D., national coordinator of Physicians for a National Health Program, a group advocating a single-payer system. He says incremental efforts are difficult for the public to understand, complicated for both providers and consumers to participate in, and subject to political shifts and the vicissitudes of the economy like those now threatening Medicaid programs in many states. “Incrementalism fosters disenchantment with reforms, or worse, the rejection of government solutions,” Young says.

I hear that. And as the flipside of this thought: Real transformation, real health care justice, real humanity, will capture the public’s imagination. We’ve got to advocate for something we understand, something we can relate to, something we’d actually want. As citizens, it’s not our job to make excuses for our dysfunctional politics, or our dysfunctional health care. It’s not our job to parrot policy buzzwords: “Quality, affordable, accessible blah blah blah”. At this point, we should unapologetically advocate for a principle, not a policy: People should not be denied the medical care they need. Ever. Pretty simple, huh? How can anyone of good conscience deny that?

We must decide our true north, and make our policymakers follow it. Yeah, we’ve got to know enough about policy to know when someone’s trying to put one over on us, and we need to be wary of gauzy rhetoric backed up by slender substance. But if we lead with a statement of our core principles now, we’ll have a standard by which to evaluate the process as it continues — and indeed, participate and shape it according to our values.

What are the next steps for the health care movement? Let ‘er rip in the comments.

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Charley Blandy

Charley Blandy