Memo to President Obama

Six things you must do to save universal healthcare

Published June 21, 2009 2:20AM (EDT)

Dear Mr. President:

Momentum for universal healthcare 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 machine.

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 cost savings that a public option's bargaining power could generate to lower drug prices, doctor fees, and hospital costs, and force private insurers to be more competitive. Projecting the future costs of universal healthcare 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 healthcare will be huge if you leave out the most important way of controlling them.

If you want to save universal healthcare, you must do several things, and soon:

1. Go to the nation. You're not only a powerful orator; you're also capable of motivating, energizing, and mobilizing the American public. You must go on the road -- building public support by forcefully making the case for universal health care everywhere around the country. The latest Wall Street Journal poll shows that three out of four Americans want universal healthcare. 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 the American Medical Association and the rest of the medical-industrial complex. He got Medicare and Medicaid 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 have to be twisting congressional arms and drawing a line in the sand. Be tough.

3. Forget the Republicans. Forget bipartisanship. Universal healthcare 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 years 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 healthcare.

4. Insist on a real public option. It's the lynchpin of universal healthcare. It's one thing to give up on single payer, and say that a public option is the best feasible alternative. But further compromise would essentially gut any healthcare plan. 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 healthcare. Not even a real public option will hold down costs enough to make healthcare 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 healthcare 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 healthcare. By pushing everything at once, you take the public's mind off the biggest goal, diffuses your energies, blur your public message, and fuel the demagogues who say you're trying to take over the private sector. You have to win this.


By Robert Reich

Robert B. Reich is Chancellor's Professor of Public Policy at the University of California at Berkeley and Senior Fellow at the Blum Center for Developing Economies. He served as Secretary of Labor in the Clinton administration, for which Time Magazine named him one of the ten most effective cabinet secretaries of the twentieth century. He has written 15 books, including the best sellers "Aftershock", "The Work of Nations," and"Beyond Outrage," and, his most recent, "The Common Good." He is also a founding editor of the American Prospect magazine, chairman of Common Cause, a member of the American Academy of Arts and Sciences, and co-creator of the award-winning documentary, "Inequality For All." He's also co-creator of the Netflix original documentary "Saving Capitalism."

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