In an earlier post on fixing Obama’s message machine, I argued that his primary problem was one of content. The vague public option and insurance exchange idea associated with the plan isn’t something that people easily understand. And progressive cadres that do understand it don’t love it because many of them see “Medicare for All” as far superior. My advice to the Administration was to change direction, go back to the beginning and advocate “Medicare for All.” A couple of days after I made my case, Jonathan Walker, in a post entitled “Why Obama Now Needs the Public Plan, contends that to get reform, Obama needs to rally the base of the Party, and that, in turn: “The only thing which can rally the base is the public option.”

Jon then goes on to suggest that health care activists:

”. . . tend to be the people who were screwed over by insurance companies or had loved ones that were. They aren’t going to waste their weekends knocking on doors campaigning to give insurance companies huge checks from the government. They don’t want to see the industry be forced to accept some sensible new regulations. They want to be free of them. They want to see these evil companies dismantled. . .

”Some in the media wonder why Obama’s progressive volunteers are not turning out in force for health care reform. The answer is simple. He has made it clear he is not committed to their main goal: freedom from the evil insurance companies. . .

. . . If Obama wants to get the grassroots fighting with him for health care reform he needs to make a firm promise that he is not going to sell them out. Every time he makes a wishy washy statement about the public option, says everything must be on the table, and claims private cooperatives might be just as good, it is a blow to the grassroots’ morale. It is Obama telling them he does not need them, does not want them, and will not stand with them. . .

”If Obama wants to rally an army of activists to his cause all he needs to do is publicly say, “I will veto any bill without a real public option.”

I think Jon’s got something with this argument. Today, there were news reports that activist opponents of health care reform are disrupting town hall meetings held by Congresspersons to discuss health care reforms. They’re carrying out demonstrations featuring chants of “just say no,” to drown out discussion. Activist supporters of health care reform are nowhere to be seen, in spite of the importance of many of those activists in getting the President nominated and elected. Clearly, pro reform health care activists are discouraged by the course of events in health care reform over the past few months. Are they discouraged because, as Jon suggests, the reform efforts aren’t seeking to dismantle the “evil” insurance companies, and because Obama is not committed to freedom from these companies? Perhaps, but one would be hard pressed to distinguish motivation they have to get back at the companies, from motivation they may have to pass a “Medicare for All” plan such as John Conyers’ HR 676 bill, (with its 85 co-sponsors in the House).

Jon thinks that the President can rescue health care reform by making clear that he “will veto any bill without a real public option.” But as I argued in my earlier post on this subject, no one, and especially not President Obama has yet distinguished “a real public option,” from a not so “real” one. So, if the President makes such a declaration, I doubt that it will have the effect that Jon is after. But let’s say that the President went further and explained what he meant by “a real public option,” and that explanation persuaded the activists that such a public option would bring the insurance companies into line, and perhaps eventually would lead to a national health care system where they had a definitely secondary role. Even then, I’m not sure that would be effective in mobilizing the activists. Why not? Because it would get them involved in a complex and exhaustive educational effort trying to explain to “regular” people why they ought to be excited at the “real public option,” in the face of insurance company attempts to scare people about that option, and to persuade them that it’s socialized medicine that would take away their choice of Doctors and medical providers. That kind of fight will be unnecessarily difficult and will impose a communications and morale burden on reform activists that would be unnecessary were it not for the complex nature of the messaging they are trying to present and to use in defending the public option.

I agree with Jon Walker, that passing health care reform requires mobilization of the activists who were so important to Obama in the past. But, I think that to mobilize them and to maintain that mobilization in the difficult fight to come, the President needs to backtrack from his earlier positions and guarantee that he will veto any health care reform bill without “Medicare for All.” Since “Medicare for All” will socialize insurance for basic health care, and provide freedom from the insurance companies; that is what will mobilize the activists. That is also what will mobilize the 85 co-sponsors of HR 676 in the House, who thus far have been awfully quiet and unwilling to commit to vote no on any bill lacking a robust public option. And that is what will mobilize masses of Americans in back of health care reform, because everyone understands what Medicare is, and 86% of their parents and grandparents say they’re satisfied with it.



Joseph M. Firestone, Ph.D. is Managing Director, CEO of the Knowledge Management Consortium International (KMCI), and Director and co-Instructor of KMCI’s CKIM Certificate program, as well as Director of KMCI’s synchronous, real-time Distance Learning Program. He is also CKO of Executive Information Systems, Inc. a Knowledge and Information Management Consultancy.

Joe is author or co-author of more than 150 articles, white papers, and reports, as well as the following book-length publications: Knowledge Management and Risk Management; A Business Fable, UK: Ark Group, 2008, Risk Intelligence Metrics: An Adaptive Metrics Center Industry Report, Wilmington, DE: KMCI Online Press, 2006, “Has Knowledge management been Done,” Special Issue of The Learning Organization: An International Journal, 12, no. 2, April, 2005, Enterprise Information Portals and Knowledge Management, Burlington, MA: KMCI Press/Butterworth-Heinemann, 2003; Key Issues in The New Knowledge Management, Burlington, MA: KMCI Press/Butterworth-Heinemann, 2003, and Excerpt # 1 from The Open Enterprise, Wilmington, DE: KMCI Online Press, 2003.

Joe is also developer of the web sites,,, and the blog “All Life is Problem Solving” at, and He has taught Political Science at the Graduate and Undergraduate Levels, and has a BA from Cornell University in Government, and MA and Ph.D. degrees in Comparative Politics and International Relations from Michigan State University.