Wanted: A Joint Public-Option Single-Payer United Front

single-payer-rally-11If you support a healthcare bill with a public option in it, chances are many single-payer advocates don’t trust you. If you supported that same bill in exactly the same way and also advocated leaving in it the language that allows states to create single-payer, those same missing passionate advocates might not line up perfectly with you, but many of them would be willing to work together — or at least have a beer on a picnic table and talk about it.

You wouldn’t have to believe that there was any chance of keeping that language in the bill. But it’s worth noting that the full bill including the states language passed the Education and Labor Committee, where the only Democrats to vote against it did so for unrelated reasons. You wouldn’t even have to believe that the state single-payer language (which was added by amendment in the Education and Labor Committee) could possibly work with the rest of the bill.

I’ve heard that claim but not seen evidence for it, and in fact the amendment allows states to completely opt out of the rest of the bill. You’d just have to lobby Pelosi, Hoyer, Waxman, Miller, and Rangel to leave it in there. Three of them are from the state most likely to enact single-payer first, California. And the Californian in charge of the issue, George Miller, did vote against it in his committee, but it passed nonetheless; and Miller is himself a cosponsor of HR 676, the bill to create national single-payer. In return for lobbying these leaders, you might find you had major new support for what you’re doing on the public option.

I address this advice both to activist groups and to the Congressional Progressive Caucus, which has not yet supported the state single-payer language as strongly as it has the public option. Supporting both involves no contradiction whatsoever, and could unite your constituents. Remember, this is not creating single-payer in any state. This is simply leaving states the constitutional right to provide their constituents with healthcare.

It Takes Two to Tip the Balance

If you support a single-payer solution, chances are many public option advocates don’t trust you. If you supported single-payer OR, as a second choice, any credible step in the direction of single-payer, many advocates of the public option might be more willing to work with you on ensuring the right of states to create your ideal solution. You wouldn’t have to promise to support whatever bill comes out of the House, much less the Senate. You wouldn’t have to proclaim single-payer hopeless and advocate a public option instead.

But you could lobby for single-payer as your first choice, with an emphasis on the more obtainable goal of allowing states to do it. And you could include as your second choice any public option large enough to actually offer a more attractive alternative to the private health insurance companies. In other words, if Congress can be persuaded to offer a plan that actually does anything like what the Republicans are claiming (namely offers the realistic possibility of moving us at least a little bit in the direction of single-payer), and/or if the bill put forward generally does more good than harm, you will support it.

While proclaiming healthcare to be a human right, you can also work with Congress to get a few more humans their rightful healthcare. You wouldn’t necessarily have to believe that any of the bills we’ve seen thus far meet the standard. You wouldn’t have to believe that a bill that did meet your standard is likely to emerge at all (in which case a single-payer bill is very unlikely too). You’d just have to acknowledge that a serious partial step would be better than nothing, and communicate better that lobbying for the ideal outcome is often the best way to reach a better compromise than can be reach by lobbying for your bottom line. Let your fellow activists know you’re on the same side and helping to reach a better compromise by creating a position to compromise from.

Now, I know that I’ve been saying all of this, in more or less the same words, for months. I know that getting the state single-payer amendment through is unlikely. I know that getting a useful public option or even a token and pointless public option is unlikely. I know that by this point we’ve all offended each other on top of having disagreed with each other. I know we’re all frustrated, out-spent, disorganized, and pulled by our own parochial interests. I know the media sucks. I know that sooner or later we’re all going to die.

But, come on! They’re going to drag this thing out for weeks or months. It is far from too late for us to do better. Can those who want to collectively lift the wealthiest nation on earth above third-world healthcare standards, save lives, and prevent sickness cooperate to the extent of jointly demanding “at least a decent public option if not single-payer and at least state freedom if not federal single-payer”? I think we can do this. I think it would change things. Please say yes.

David Swanson is the founder of and the author of the upcoming book “Daybreak: Undoing the Imperial Presidency and Forming a More Perfect Union” by Seven Stories Press.  You can pre-order it for a discount price here.

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4 Responses for “Wanted: A Joint Public-Option Single-Payer United Front”

  1. Ian Welsh wrote an excellent piece advocating a United Front here:

    * * * Crickets from the public option advocates * * *

    My answer was, essentially: Show me how public option transitions to single payer (since that’s the argument that’s generally made in favor of incrementalism)

    * * * Crickets from the public option advocates * * *

    I’ve asked the people maintaining the whip whether they would add a “single payer in the states” line

    * * * Crickets from the public option advocates * * *

    And now that Speaker Pelosi will let single payer get an up or down floor vote, that’s a perfect opportunity for public option advocates to revisit this issue.

    * * * Crickets from the public option advocates * * *

    So… I guess that makes the recess pretty important, then, doesn’t it?

  2. EM says:

    David, I hope you will post this article (or a diary combining these thoughts with your Media survey) on DailyKos. In just the last 3-4 days, Single payer is beginning to surface there in discussions, and you could contribute mightily to the dialogue.

    I included a link to your article in a comment attached to this dairy ( ) .

    Keep up the good work!

  3. jacksmith says:


    We have the 37th worst quality of healthcare in the developed world. Conservative estimates are that over 120,000 of you dies each year in America from treatable illness that people in other developed countries don’t die from. Rich, middle class, and poor a like. Insured and uninsured. Men, women, children, and babies. This is what being 37th in quality of healthcare means.

    I know that many of you are angry and frustrated that REPUBLICANS! In congress are dragging their feet and trying to block TRUE healthcare reform. What republicans want is just a taxpayer bailout of the DISGRACEFUL GREED DRIVEN PRIVATE FOR PROFIT health insurance industry, and the DISGRACEFUL GREED DRIVEN PRIVATE FOR PROFIT healthcare industry. A trillion dollar taxpayer funded private health insurance bailout is all you really get without a robust government-run public option available on day one. Co-OP’s ARE NOT A SUBSTITUTE FOR A GOVERNMENT-RUN PUBLIC OPTION. They are a fraud being pushed by the GREED DRIVEN PRIVATE FOR PROFIT health insurance industry that is KILLING YOU!


    These industries have been slaughtering you and your loved ones like cattle for decades for profit. Including members of congress and their families. These REPUBLICANS are FOOLS!

    Republicans and their traitorous allies have been trying to make it look like it’s President Obama’s fault for the delays, and foot dragging. But I think you all know better than that. President Obama inherited one of the worst government catastrophes in American history from these REPUBLICANS! And President Obama has done a brilliant job of turning things around, and working his heart out for all of us.

    But Republicans think you are just a bunch of stupid, idiot, cash cows with short memories. Just like they did under the Bush administration when they helped Bush and Cheney rape America and the rest of the World.

    But you don’t have to put up with that. And this is what you can do. The Republicans below will be up for reelection on November 2, 2010. Just a little over 13 months from now. And many of you will be able to vote early. So pick some names and tell their voters that their representatives (by name) are obstructing TRUE healthcare reform. And are sellouts to the insurance and medical lobbyist.

    Ask them to contact their representatives and tell them that they are going to work to throw them out of office on November 2, 2010, if not before by impeachment, or recall elections. Doing this will give you something more to do to make things better in America. And it will make you feel better too.

    There are many resources on the internet that can help you find people to call and contact. For example, many social networking sites can be searched by state, city, or University. Be inventive and creative. I can think of many ways to do this. But be nice. These are your neighbors. And most will want to help.

    I know there are a few democrats that have been trying to obstruct TRUE healthcare reform too. But the main problem is the Bush Republicans. Removing them is the best thing tactically to do. On the other hand. If you can easily replace a democrat obstructionist with a supportive democrat, DO IT!

    You have been AMAZING!!! my people. Don’t loose heart. You knew it wasn’t going to be easy saving the World. :-)

    God Bless You

    jacksmith — Working Class


    Republican Senators up for re-election in 2010.

    * Richard Shelby of Alabama
    * Lisa Murkowski of Alaska
    * John McCain of Arizona
    * Mel Martinez of Florida
    * Johnny Isakson of Georgia
    * Mike Crapo of Idaho
    * Chuck Grassley of Iowa
    * Sam Brownback of Kansas
    * Jim Bunning of Kentucky
    * David Vitter of Louisiana
    * Kit Bond of Missouri
    * Judd Gregg of New Hampshire
    * Richard Burr of North Carolina
    * George Voinovich of Ohio
    * Tom Coburn of Oklahoma
    * Jim DeMint of South Carolina
    * John Thune of South Dakota
    * Kay Bailey Hutchison of Texas
    * Bob Bennett of Utah

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