What we need to do now is to get morally outraged at the whole legislative process up till now, and work to defeat everything “on the table” in Congress, and go back to square 1. And square 1 is enhanced Medicare for All. And the first thing we ought to do in the context of pushing that, is to seek a vote on S703, Bernie Sanders’ Medicare for All bill, and, along the way, force a showdown on the filibuster and use the “nuclear option” to get the 60 vote nonsense off the table for good, so we can pass health care reform with a simple majority, and without the need for any deficit-neutral nonsense.

Again, I’m all for outrage, and even fury; but it needs to be directed toward the right things, and they are all the earlier outrages committed in this health care reform legislative process starting with taking Medicare for All, single-payer off the table.

”Everybody In, Nobody Out!

Democrats are reportedly considering permitting individual states to opt out of a public option if they want. This could be the big break supporters of the Kucinich amendment to HR 3200 need.

The result of the meeting was to structure the complex issue of health care reform into two sides, and to make HR 3200 the only reasonable side. Was this the actual purpose of the Town Hall meeting, both from the viewpoint of Congressman Moran, and from the viewpoint of the insurance industry, which perhaps will gain a great deal and won’t lose too much if HR 3200 is passed, and will gain a great deal, and lose even less, if a revised version of HR 3200 without a PO is passed? If so, it was a great success. On the other hand, if its purpose was to inform constituents about health care reform issues, and really explain why Jim Moran is in back of HR 3200, rather than a more comprehensive PO, or a Medicare for All solution, then I’m afraid that it did very little on that front, and that perhaps Jim Moran ought to schedule a second town hall, so that reform supporters can ask why he supports HR 3200, rather than alternative versions of health care reform. All I know is that I’d sure like him to answer that simple question in a meeting devoted only to it, and I’ll bet a lot of other supporters of health care reform in the 8th district would like that too.

Tomorrow evening is Congressman Jim Moran’s (D-VA) Town Hall at South Lakes High School in Reston, VA. This is the only Town Hall Jim has scheduled during the current recess. Governor (and Dr.) Howard Dean will be joining Jim to answer questions, and it promises to be a very interesting meeting. During the past few weeks, Jim has moved from being relatively silent on his support for a PO, to more explicit support for one. He has appeared on MSNBC supporting the PO and saying how important its presence is in any reform, and he has sent letters to his constituents, including myself, thanking them for visiting him and explaining HR 3200, the House version of Health Care Reform emerging from various committees, and its public option among other features of the bill. What he has not done however, is to explain why he no longer supports HR 676, a Medicare for All bill, even though he co-sponsored it in the past, except to say that it is “off the table,” and also why he will commit neither to voting “no” on any bill that does not provide for the “Medicare for All” solution he supported in the past, nor, at least, to voting “no”on any bill that does not provide for a strong public option plan that can provide meaningful competition for private insurance companies. Without such a commitment, which by the way, would not be satisfied by a commitment to HR 3200, which according to CBO, will not provide such competition, Jim Moran’s support for the PO is mere lip service, since he leaves himself entirely free to sign on to any “reform” measure that the Administration, in its infinite wisdom, asks him to support.

In the past few weeks we’ve begun to see e-mails, face book groups, and other communications calling for a March on Washington to support health care reform. Yesterday, sTiVo at Firedog Lake called for one, and one facebook group is trying to get one going for September 13th. I also think that a March for health care reform would be a good idea. The reason for it is that the dynamic of internal Washington legislative processes has grabbed health care reform by the scruff of the neck and dragged its dynamic sharply to the right. The undemocratic power structure comprised of industry lobbyists and embedded congressional caudillos from small and unrepresentative rural states, the “rotten boroughs” of American politics, is blocking reform with a significant public component designed to evolve toward Medicare for All, and is threatening to substitute for such an outcome a series of changes that will end some of the worst insurance abuses, but retain the structure of abuse and accelerating cost inflation, while extracting the price of a giveaway of an expanded market for the insurance companies backed by mandates and subsidies at the cost of at least $1 Trillion.

For the past few days, I’ve been trying, by e-mail, to get the participants in the Northern Virginia Move-on Council to take my advice about the best way to get a good, strong, public option. Namely, to abandon the public option advocacy in favor of all-out support for “Medicare for All,” and specifically for HR 676, John Conyers’ bill. My efforts at this have been quite unsuccessful.

Today, I went to a face-to-face meeting called by the Council to plan activities for the rest of this month to provide explicit support for a “strong public option.” At the meeting I questioned the continuing strategy of Move-on calling for support for a strong public option. In one way or another, I made most of the points I made here.

Yesterday afternoon, my wife and I kept an appointment we’d made through Organizing for America to see an aide to Jim Moran’s (D-VA) in order to discuss health care reform. When we walked into the Congressman’s office, one of his aides, a gentlemen by the name of Andy, was talking with another constituent, who, as it turned out, worked for Kaiser Permanente’s education and training branch. My wife and I agreed to join the discussion, and, for some time we listened to the Kaiser employee’s strong and enthusiastic pitch for the Congressman to support a meaningful public option.

Of course, all of us have heard about one of the President’s favorite maxims, “the perfect is the enemy of the good,” with its implication that practicality most often calls for us to forego our attempts to reach a hard to achieve or impossible ideal, in favor of acting to achieve a good result that, while not ideal; certainly represents an improvement in our current situation. It’s very hard to disagree with a proposition like that; but while there’s nothing wrong with the idea behind it; the devil is in the details of how you apply it.

The politics of health insurance reform is a great example of reflexivity. Reflexivity is the idea that acceptance and assertion of our beliefs about reality, has an effect on how we act, which, in turn, has an effect on reality, and to some extent creates it; and, equally, reality influences what we think about it and how we act, thus closing a reflexive circle. George Soros who has written a lot about reflexivity focuses on the idea of interference and specifically on the interaction of the cognitive and manipulative functions underlying human decision making and action.

In current health insurance reform politics, it was decided early on that America wasn’t ready for a Medicare for All, single payer program, and therefore that it was not feasible to try to pass such a program. This decision seems to have been made collectively by key members of the Obama Administration, including the President, as well as key members of Congress including the heads of important committees such as Teddy Kennedy, Charlie Rangel, George Miller and others, The Speaker of the House, and the Majority Leader of the Senate. Outside of the Government, progressive interest groups such as Move-on and Health Care for America Now (HCAN), also made that judgment early on, and have supported the Administration in taking “single payer off the table.” In addition, key influential individuals like John Podesta and George Soros have supported this view, with Soros becoming one of the major financial benefactors of HCAN.

The preference for the public option as a political strategy has, at least partly, been based on the conventional wisdom that single payer has been defeated by its opponents again and again in American history. However, the truth is that we haven’t seen an effort to pass single payer backed by a President of the United States since Harry Truman. That old defeat of a relatively unpopular president, provides absolutely no basis for opining about what would have happened in 2009, if single payer had been pushed by a progressive president this time around. So, based on an assumption, and perhaps some questionable polling, public option proponents decided it was politically more astute to propose a compromise with the industry right out of the gate, even though there is absolutely no history at all about how public option plans work on a large scale, while there are many nations, where single payer is working well, compared to what we have now. In other words, single payer is something that has worked many times before; but public option is, as yet, only a theory.